Ban on heart ops must stay, says review

Surgery at the smallest children's heart unit in England should remain "suspended until or unless the service can safely be expanded", an independent review into the deaths of four babies at the John Radcliffe Hospital in Oxford has concluded. The unit has been shut since February after the four children died within weeks of one another having been operated on by a junior consultant, Caner Salih. He had been appointed to raise patient numbers at the unit, which was under threat of closure, but was asked to stop operating after blowing the whistle on practices within the unit. The review panel, commissioned by the South Central Strategic Health Authority (SHA), has been examining all aspects of patient care at the unit. The department carried out around 100 operations a year and was one of the smallest units in the country. It has examined the systems in place and asked whether "appropriate, proportionate, and timely actions were taken by the right members of staff whenever concerns were raised". The report says there were two distinct groups of patients that had "more deaths than would have been expected from national mortality rates for the procedures carried out", and these could not be explained by chance. First were the 15 cases operated on by the new surgeon, for which the rate of mortality was 4.8 times higher than that expected from national rates. Second were complex procedures undertaken under the supervision of the senior cosultant, Professor Stephen Westaby, between 2000 and 2008, for which the rate of mortality was 5.3 times that expected from national rates. Westaby and Salih were the only two paediatric cardiac surgeons at the time of the suspension. Salih left shortly afterwards, having been appointed as a consultant at Guy's and St Thomas' NHS Trust in London. Bill Kirkup, director of clinical standards at the SHA, said it would be unsafe to allow any further children's heart surgery to take place unless the unit is expanded. Although the report states there were "no errors of judgment that directly led to any of the deaths", there were problems in the "induction" and "mentoring" of Salih. Westaby also comes in for criticism for his "somewhat idiosyncratic approach". He had booked a three-week holiday at the time his new junior surgeon arrived – and expected him not to undertake any surgery. "It should have been clear from the outset that the two surgeons had significant differences of outlook and personality, and neither surgeon expressed any enthusiasm for joint working," said the report. The panel makes it clear that although "the results between 2000 and 2008 were almost within the bounds of expected variation", this was because of the staff's determination to make an "unsatisfactory situation work despite its inherent flaws". It adds: "That they did so is a reflection of their efforts, but we do not believe that it is right to rely on this to deliver a safe service in future: the risks for patients and parents are too high".