Quizzes & Puzzles0 min ago
Heart Surgery: Three Hospitals Told To Stop Complex Treatment
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What the ruddy hell is going on.
My Dad had triple heart-bypass surgery at the Royal Brompton 25 years ago, and had the most marvelous care you could wish for.
If we can't trust somewhere like that, what can we trust ?
What the ruddy hell is going on.
My Dad had triple heart-bypass surgery at the Royal Brompton 25 years ago, and had the most marvelous care you could wish for.
If we can't trust somewhere like that, what can we trust ?
Answers
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25 years is a very long time, especially in medicine where things are advancing all the time.
The number of very complex operations is probably quite small so it makes sense to concentrate them a a few hospitals so the surgeons and care staff become very skilled in that area.
And, of course, it is more cost effective to run and manage.
The number of very complex operations is probably quite small so it makes sense to concentrate them a a few hospitals so the surgeons and care staff become very skilled in that area.
And, of course, it is more cost effective to run and manage.
Mikey,
25 years is a very long time in the NHS. You only need a couple of good surgeons get headhunted or retire and you have a whole new team. And of course over that length of time working practices have changed considerably.
As part of an action group I went to many of the consultations for the Peadiatric Cardiac Review and every single unit, regardless of ranking, thought they were good enough to keep going.
What amazes me though is the units that have been deemed below standard that have been allowed to remain open (with a bit of extra support).
The Bristol unit has twice been the subject of catastrophic failings and still gets to stay open JUST because of location.
25 years is a very long time in the NHS. You only need a couple of good surgeons get headhunted or retire and you have a whole new team. And of course over that length of time working practices have changed considerably.
As part of an action group I went to many of the consultations for the Peadiatric Cardiac Review and every single unit, regardless of ranking, thought they were good enough to keep going.
What amazes me though is the units that have been deemed below standard that have been allowed to remain open (with a bit of extra support).
The Bristol unit has twice been the subject of catastrophic failings and still gets to stay open JUST because of location.
Sorry Young didn't see your post lol
I agree 100% with what you have said.
Concentrate skills to maintain skills and improve transfer of patients. Also something I and other muted at the consultations have a 'flying squad' of the best teams I. The area that can be transported to the patient hospital if the patient is too ill to be moved.
I agree 100% with what you have said.
Concentrate skills to maintain skills and improve transfer of patients. Also something I and other muted at the consultations have a 'flying squad' of the best teams I. The area that can be transported to the patient hospital if the patient is too ill to be moved.
If the authorities spot that fatalities from heart operations are significantly higher in one hospital compared to another, they have to take action, including stopping the operations. That appears to be what has happened in Bristol and the other areas.
In my area, Manchester, there appear to be two hospitals affected. However, another hospital, Wythenshaw, does these procedures as a specialism with a good success rate. The patient is better served by resources and expertise being spent at Wythenshaw, than the other two.
In my area, Manchester, there appear to be two hospitals affected. However, another hospital, Wythenshaw, does these procedures as a specialism with a good success rate. The patient is better served by resources and expertise being spent at Wythenshaw, than the other two.
mikey.......triple heart bypass surgery is "bread and butter" cardiac surgery and was, even 25 years ago.
This report is about neonatal or paediatric cardiac surgery which in many units sited has unacceptable post operative death rates.
The answer to this is obvious......as in other specialised units.....CENTRALISATION. One or two units performing these complex operations on a regular basis. This means that patients may travel long distances for these types of operations and generally, the British public is "loath" to travel with an attitude of "let the service be locally available rather than the patient traveling to medical services.
This cannot go on.....on cannot have specialised services in every town in the UK, the patient must get used to travelling if they want a high standard of medical care which is affordable.
NHS is and always has been a political pawn....being what the electorate wants against what is good for the electorate.
This report is about neonatal or paediatric cardiac surgery which in many units sited has unacceptable post operative death rates.
The answer to this is obvious......as in other specialised units.....CENTRALISATION. One or two units performing these complex operations on a regular basis. This means that patients may travel long distances for these types of operations and generally, the British public is "loath" to travel with an attitude of "let the service be locally available rather than the patient traveling to medical services.
This cannot go on.....on cannot have specialised services in every town in the UK, the patient must get used to travelling if they want a high standard of medical care which is affordable.
NHS is and always has been a political pawn....being what the electorate wants against what is good for the electorate.
long-distance travel in the UK is expensive and stressful, Sqad, and so not always great for patients. There's a reason sick people are reluctant to do it; it's not just wanting to be operated on next door.
If only there was some sort of transport service that would pick people up and deliver them to hospitals as appropriate
http://
If only there was some sort of transport service that would pick people up and deliver them to hospitals as appropriate
http://
children's heart surgery has been a hot potato for quite a few years. When i worked in patient engagement the consultation was going onabout the proposed changes then (not quite sure from the link if it's the sme issue, as i recall southampton and evelina being for the chop then) didnt' something happen with professr sir bruce keyoe? There are pros and cons however, the lady in the article isn't thinking of the larger picture - would she honestly say she would rather her son received poor care, with a higher chnce of dying than her having to travel?
Southampton is ranked best in the country outside London. Which was one reason it seemed hypocritical to say SGH unit should go in Favour of the failing Bristol unit.
I wholeheartedly agree that fewer, specialist units would serve the public better. The problem is, as already been said people don't want to travel.
I say get me to the best unit that will save my life. A patient with a cardiac incident doesn't often sit there and say to the medics 'no keep me in my non specialised unit' cos it's easier. Location shouldn't matter a hoot to the patient. It is the visitors, whoever they may be, that the travel is difficult for. However once stabilised they can then be transferred to a unit nearer home.
I wholeheartedly agree that fewer, specialist units would serve the public better. The problem is, as already been said people don't want to travel.
I say get me to the best unit that will save my life. A patient with a cardiac incident doesn't often sit there and say to the medics 'no keep me in my non specialised unit' cos it's easier. Location shouldn't matter a hoot to the patient. It is the visitors, whoever they may be, that the travel is difficult for. However once stabilised they can then be transferred to a unit nearer home.
hahaha has anyone read the post above
there certainly is no logic in it ( transport is different in kind to stopping and starting - ho hum )
Good results against numbers ( practice really does make perfect ) have been known for a long time and are true in heart surgery as elsewhere
good results may be ignored or discounted if the after care 'looks' crap, This was at the bottom of the most recent report into Bristol. Actually their death rates WEREN'T bad it was just they didnt seem to care when the kids did die.
at the time Mikey hailed as the good old days - in fact 20% of cardiac surgeons were not working as their results were so bad .... oops. They had been suspended until they were investigated. They reacted by not operating on ill people ( death rate will go down even if you are really crap )
Liverpool Alder Hey was almost closed as they couldnt hire a second paed cardiac surgeon - and one was not enough. (pozzi) . The second one ( Frank ) had gone back to adult surgery after a bout of criticism and he correctly said - "I just dont need this" and did adults with money rather than sick little kiddies with holes in their heart and Parents who were Waiting For Him Outside.
If you read the most recent Bristol report ( above ) - there is a little too much of Ian Kennedy puffing out his chest and insisting that there wwas nothing left from his report of fifteen years ago - but you will also read that the knight in white armour ( Ash Pawade ) who was parachuted in to save everything then was himself edged out/thrown out within ten years. ( not for incompetence but whistleblowing )
so Mikey - the provision of effective cardiac services for children within England is more complicated than you think.
there certainly is no logic in it ( transport is different in kind to stopping and starting - ho hum )
Good results against numbers ( practice really does make perfect ) have been known for a long time and are true in heart surgery as elsewhere
good results may be ignored or discounted if the after care 'looks' crap, This was at the bottom of the most recent report into Bristol. Actually their death rates WEREN'T bad it was just they didnt seem to care when the kids did die.
at the time Mikey hailed as the good old days - in fact 20% of cardiac surgeons were not working as their results were so bad .... oops. They had been suspended until they were investigated. They reacted by not operating on ill people ( death rate will go down even if you are really crap )
Liverpool Alder Hey was almost closed as they couldnt hire a second paed cardiac surgeon - and one was not enough. (pozzi) . The second one ( Frank ) had gone back to adult surgery after a bout of criticism and he correctly said - "I just dont need this" and did adults with money rather than sick little kiddies with holes in their heart and Parents who were Waiting For Him Outside.
If you read the most recent Bristol report ( above ) - there is a little too much of Ian Kennedy puffing out his chest and insisting that there wwas nothing left from his report of fifteen years ago - but you will also read that the knight in white armour ( Ash Pawade ) who was parachuted in to save everything then was himself edged out/thrown out within ten years. ( not for incompetence but whistleblowing )
so Mikey - the provision of effective cardiac services for children within England is more complicated than you think.
Transport in this day and age should not be a barr on where surgery is done.
The majority of congenital heart surgery is elective in as much as it is planned and not done as an emergancy so getting a child to a particular hospital would be no more difficult than any other hospital transport. Like wise getting a specialist team to a unit that a child cannot be moved from should be within the realms of possibility. However it is sometimes the after care that is lacking and not surgery itself. Unnessisary death whether from surgery or poor after care at a unit is equally cause for concern to be classed as underperforming.
Spreading your specialist surgeons too thinly without the experience can be a reason why there are spikes in death rates. Not to be confused with some specialist hospitals 'taking on' the more complex and rarer conditions.
Some light reading if you're interested.
https:/
https:/
With experience of paediatric cardiac services there are units that I would refuse to send my son.
The majority of congenital heart surgery is elective in as much as it is planned and not done as an emergancy so getting a child to a particular hospital would be no more difficult than any other hospital transport. Like wise getting a specialist team to a unit that a child cannot be moved from should be within the realms of possibility. However it is sometimes the after care that is lacking and not surgery itself. Unnessisary death whether from surgery or poor after care at a unit is equally cause for concern to be classed as underperforming.
Spreading your specialist surgeons too thinly without the experience can be a reason why there are spikes in death rates. Not to be confused with some specialist hospitals 'taking on' the more complex and rarer conditions.
Some light reading if you're interested.
https:/
https:/
With experience of paediatric cardiac services there are units that I would refuse to send my son.
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