A review of patients who died undergoing heart surgery at St George’s University Hospitals NHS Foundation Trust is being carried out.
The mortality review at St George’s – commissioned by NHS Improvement – is being conducted by a panel of independent cardiac surgery, cardiology and anaesthetic consultants.
The panel is reviewing the cases of all patients who died following cardiac surgery at St George’s between April 2013 and September 2018.
The panel has chosen this timeframe because – between April 2013 and March 2017 – the Trust was found to have a statistically higher mortality rate when compared with the 31 other cardiac surgery centres in the UK (NICOR data).
The panel will also review deaths between April 2017 and 1 September 2018, a period during which improvements were being introduced by the Trust to improve services for cardiac surgery patients.
The review only applies to cardiac surgery at St George’s, and doesn’t include other associated specialities (e.g. cardiology).
The panel will examine the safety and quality of care that patients who died during or after cardiac surgery at St George’s received during the review period.
They will do this by reviewing the medical records of deceased cardiac surgery patients, as well as any investigations conducted by the Trust at the time of the patients’ death.
The panel is likely to review between 200-250 deaths as part of this process, which will take place between 6 and 12 months to complete.
Families and relatives of cardiac surgery patients who died at St George’s during the review period will be contacted if the panel identifies any significant concerns about their care.
The cardiac surgery service at St George’s is safe, and the improvements the Trust is putting in place continue to be overseen by the separate, external oversight panel convened by NHS Improvement last year.
St George’s chief executive Jacqueline Totterdell said: “It is absolutely essential that patients and their families have full confidence in the care our cardiac surgery team provide – and this review of past deaths will be a key part of that process.”
The review follows another independent review of the cardiac unit by Mike Bewick, commissioned by the Trust, which found the hospital’s cardiac surgeons ‘were working in camps’ and that there was a ‘persistent toxic atmosphere’ within the unit.
His report revealed a cardiac surgery death rate of 3.7 per cent – the national average is two per cent.
It said the team was consumed by a “dark force” and patients were put at risk.
Data from last month shows mortality rates at the hospital, which carries out about 1,000 cardiac operations a year, have improved, with the cardiac surgery death rate reduced to 2.7 per cent.
His report, published by the hospital in August, made a series of recommendations, which the hospital accepted in full.
It said then its actions would include:
– Moving all cardiac surgeons to a single specialty practice. As a result, both cardiac surgery and thoracic surgery at St George’s is now only undertaken by single specialty surgeons.
– Inviting Guy’s and St Thomas’ to provide us with on the ground, clinical leadership support. They agreed, and a cardiac surgeon from Guy’s and St Thomas’ has spent time in our cardiac surgery unit this week.
– Addressing concerns about cardiac surgery data management and governance, with a new management structure introduced last week.
– Advertising for an additional consultant cardiac surgeon to join the team.
The hospital’s statement last August said: “Professor Bewick’s report also raised a number of serious concerns around team working among the cardiac surgery consultants.
“As a result, we have appointed a senior HR specialist to complete a focused review of behaviours within our cardiac surgery unit which will report within five weeks. Interviews with staff have begun this week.”
The August statement also quoted Totterdell and medical director Professor Andrew Rhodes saying: “We would like to stress again that the cardiac surgery service at St George’s is safe.
“However, we also know the service needs to improve, and quickly – this is why we asked Professor Bewick to carry out his review, and this is the reason we are implementing his recommendations as quickly as we can.
“We would like to thank our patients and members of the public for their support, as well as our staff who are continuing to do their very best for patients every day.”
One surgeon was temporarily excluded from her job there but won a High Court injunction to return to work.
Complex heart operations were moved out of St George’s Hospital in September after a leaked Care Quality Commission inspection (CQC) report revealed a “toxic” row had contributed to an above average death rate.
The CQC said mediation worked only briefly, with “poor behaviour” soon returning.
When CQC inspectors visited over three days in August and September, they found top physicians with “strong” personalities unable to work together effectively. It found “consultant surgeons mistrusted each other, as well as cardiologists, anaesthetists and senior leaders.”
Staff told inspectors the cardiac surgical team “had not worked effectively for several years”.
“Consultants did not work collaboratively, share responsibility or resolve conflict in a constructive and timely manner.
“Staff did not work together to ensure delivery of high-quality, safe and effective services that put patients at the centre.”
CQC’s chief inspector of hospitals, Professor Ted Baker said: “Issues such as weak leadership, internal unrest and multiple electronic patient record systems are just some of the problems affecting St George’s Hospital cardiac surgery unit.”
The hospital’s statement from August is here: https://www.stgeorges.nhs.uk/newsitem/cardiac-surgery-at-st-georges-updated-statement-thursday-9-august-2018/