NHS chiefs have condemned a coroner’s intervention in a scandal-hit heart surgery unit, warning that the official defense could put patient safety at risk, leaked documents show.
NHS England has defended the decisions it took to limit heart surgery at St George’s University Hospital Foundation Trust, after a senior coroner in London condemned the actions earlier this year.
It is the latest in a four-year saga over the quality of cardiac surgery at 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 oversees the inquiries 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 poor treatment may have resulted in their deaths.
Of the 67 referred cases, in 26 investigations the coroner has so far not found that poor care led to their death.
Following the latest inquest, Coroner Wilcox served NHS England and St George’s University Hospital with a highly critical report on the prevention of future deaths, warning patients that they had died needlessly due to restrictions on the unit by the NHS.
The coroner claimed the decision to restrict the service was “unfounded” as it was based on the findings of the “inadequate” independent review.
Restrictions on the number and type of operations the unit could do were enforced by NHS England in August 2018 but were lifted last year.
In an official reply to the coroner, set off The independent, NHS medical director Stephen Powis defended the decision to limit the service and the review. He also warned: “We regret that the PFD in this case could potentially set back the approach to restoring service capacity and relationships at the Trust, as well as public trust, creating further conflict and doubt for families, staff and management teams in both the Trust and NHMS, for a time where the focus (rightly) is on restoring relationships and quality of service, solely in the interest of patient safety.”
Since 2018, St George’s University Hospital and NHS England have also been locked in a row with surgeons in the unit feuding, according to the times, the trust is “fostering a risk-averse culture.”
As a result of the initial concerns in 2018, two doctors were suspended by the trust, but then reinstated after a legal battle and found to have 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 ongoing concerns over “inappropriate” behavior in the unit.
In his warning to NHS England and trust coroners, Wilcox said the “unnecessary restrictions” on the operating rights of surgeons in the unit had meant they could treat fewer patients. She said it could put patients who wait too long for surgery at risk of dying while waiting, and that emergency patients also died after being diverted to other trusts.
In a response from the chief executive of St George’s University Hospital, Jacqueline Totterdell, seen by The independentThe trust said during the period the restrictions were in place eight per cent of patients were diverted and it was not aware of any patient deaths as a result of emergency diversions.
Criticizing the independent NHS review, Wilcox said that clinicians involved were unable to provide adequate feedback, the time spent by reviewers looking at the cases was “insignificant” and the review manager worked at a hospital with less complex cases.
However, NHS England has said that clinicians involved were given a chance to provide feedback on accuracy throughout the process and argued that the time spent reviewing records was not relevant to the opinions expressed by the panel.
In relation to the independent review lead, Mike Lewis, NHS England said the coroner’s “potentially damning” conclusions are “inappropriate.”
It said: “As you will no doubt appreciate, given your own important role in the patient safety sphere, it is of the utmost importance not only to ensure that the correct 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 steps are taken to ensure the safety of all who use the service.”
The coroner’s report claimed the patients’ families had been subjected to “pain and distress” as a result of the “unfounded” criticism of care in the NHS death review.
She added: “demanding that inquests be held to allow independent evaluation of how their loved ones died has been immeasurable.”
NHS England said in response that it recognized the distress for families arising during inquests, but that it was “difficult (in context) to see how a desire to be open about opinions received regarding the care of a patient before their death should be criticised. “
A spokesperson for St George’s said: “Heart surgery at St George’s is safe and our response to the coroner outlines the improvements we have made. We hope the coroner will consider publishing our response as it will build confidence in the high quality of care and reassure families and patients that the services are safe.”
An NHS spokesperson said: “The Independent Mortality Review has been instrumental in driving important safety improvements – including the introduction of a new patient risk assessment to ensure all factors are considered before surgery, and the review of all heart surgery deaths at a monthly multi-disciplinary panel meeting to ensure that lessons are learned from each case.”
Contacted for comment due to the coroner being on leave in August, Coroner Wilcox’s office contacted the chief medical examiner for comment.