The quarrel with the NHS escalates as leaders respond to the coroner’s defense of the heart surgery unit

The quarrel with the NHS escalates as leaders respond to the coroner’s defense of the heart surgery unit

Pig heart transplant (ASSOCIATED PRESS)

Pig heart transplant (ASSOCIATED PRESS)

NHS leaders have condemned a coroner’s intervention in a heart surgery unit hit by a scandal, warning that the official defense could jeopardize the patient’s safety, leaked documents reveal.

NHS England defended decisions made to limit heart surgery at St George’s University Hospital Foundation Trust after a London coroner condemned the actions earlier this year.

It’s the latest in a four-year saga about the quality of heart surgery in the trust’s specialist unit after concerns were raised in 2018, warning that the unit’s “toxic” environment was harming patients.

Senior coroner Fiona Wilcox is overseeing the investigation of 67 heart surgery patients treated by the hospital. These patients were referred to the coroner following an independent review commissioned by NHS England in 2018 which found that poor care may have resulted in their death.

Of the 67 cases reported, in 26 investigations the coroner has not so far found that poor treatment has led to their deaths.

Following the most recent investigation, Coroner Wilcox served NHS England and St George’s University Hospital with a highly critical report on the prevention of future deaths, warning patients had died unnecessarily due to NHS restrictions on unity. .

The medical examiner said the decision to limit the service was “unfounded” as it was based on the results of the “inadequate” independent review.

Restrictions on the number and type of surgeries the unit could perform were enforced by NHS England in August 2018, but were lifted last year.

In an official response to the coroner, seen by The independent, NHS Medical Director Stephen Powis defended the decision to limit service and review. He also warned: “We regret that the PFD in this case could potentially delay the approach to restoring service capacity and relationships at the Trust, as well as public trust, creating further conflicts and doubts for families, staff and leadership team in both Trust and NHSE, at a time when the focus is (rightly) on restoring relationships and quality of service, in the sole interest of patient safety ”.

Since 2018, St George’s University Hospital and NHS England have also been stuck in line with the unit surgeons they supported, according to Times, trust is “fostering a risk averse culture”.

Following initial concerns in 2018, two doctors were suspended from the trust but then reinstated following a court battle and felt they had no case to answer in relation to referrals to the General Medical Council.

The Independent revealed in June that training authority Health Education England had identified continuing concerns about “inappropriate” behavior within the unit.

In his warning to NHS England and trusted coroner Wilcox, he said “unnecessary restrictions” on the operating rights of surgeons in the unit were able to treat fewer patients. He said patients who wait too long for surgery risk dying while waiting and that emergency patients also died after being diverted to other funds.

In a response from the chief executive of St George’s University Hospital Jacqueline Totterdell, seen by The independentthe trust said that during the time the restrictions were in effect 8% of patients were hijacked and were not aware of any patient deaths as a result of emergency diversions.

In criticisms to the independent coroner of the NHS review Wilcox said that the doctors involved were unable to provide adequate feedback, the time that reviewers spent reviewing cases was “negligible”, and the chairman of the review worked in a hospital with less complex cases.

However, NHS England said the clinicians involved were given the opportunity for feedback on accuracy during the process and said the time taken to review the records was not relevant to the views expressed by the panel.

In relation to the chairman of the independent review, Mike Lewis, of NHS England, the coroner’s “potentially disparaging” inferences are “inappropriate”.

It said: “As you will no doubt appreciate, given your important role in patient safety, it is of the utmost importance not only to ensure that the appropriate standard of care is provided in our healthcare system, but also that the public has confidence that when patient safety issues are identified, these are investigated and measures are taken to ensure the safety of all those who use the service. “

The medical examiner’s report claimed that the patients’ families had been subjected to “pain and distress” due to “groundless” criticism of assistance in reviewing the NHS deaths.

He added: “Requesting investigations to allow for an independent assessment of how their loved ones ended up dying was immeasurable.”

NHS England responded in response that it acknowledges the distress to families that occurs during investigations, but that it was “difficult (in context) to see how the desire to be transparent about opinions received regarding a patient’s care should be criticized before.” of his death “.

A spokesperson for St George said, “Heart surgery at St George’s is safe and our response to the coroner illustrates the improvements we have made. We hope the coroner will consider publishing our response as it will strengthen confidence in the high quality of care provided and reassure families and patients about the safety of services. “

A spokesperson for the NHS said, “The Independent Mortality Review has been important in advancing vital safety improvements, including the introduction of a new patient risk assessment to ensure that all factors are considered prior to surgery. and review of all cardiac surgery deaths at a monthly multi-disciplinary panel meeting to ensure that lessons are learned from each case. “

The medical examiner Wilcox office was contacted for comment due to the coroner being on leave for August, the chief medical examiner approached for comment.

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