Damned if he does

There has been growing drama at Leeds General Infirmary, part of the Leeds Teaching Hospital NHS Trust.

A decision was made by the government to shut their children’s cardiology unit on the basis of a strategic decision (agreed across the mainstream political spectrum) to concentrate children’s heart surgery in fewer, bigger centres.

However a petition was lodged by more than 600,000 people (including the parents of children who were concerned that they would have to travel longer distances to access this care) which lead to a High Court ruling that the unit should be kept open on the basis that the government did not consult adequately before making their decision to close the unit.

Then something strange happened.

On 28th March 2013 Sir Bruce Keogh, the NHS medical director, arrived at the unit in person and ordered the chief executive of the trust to suspend surgery due to concerns about the mortality rates which were said to be considerably higher than in comparable units. Apparently this information had come from two whistleblowers including a senior cardiologist. Sir Bruce is quoted as saying:-

‘There had been rumblings in the cardiac surgery community for some time that all was not well in Leeds and…I had two phone calls which I found disturbing, both from highly respected, temperate surgeons who commenced the conversations by saying that they had to speak out. (They quoted) some mortality data…which showed that mortality for 2011-12 and 2010-11 was considerably higher than any other unit in the country and there was clear blue water between the Leeds mortality rate and other units, so as medical director I couldn’t do nothing’.

There has since been further controversy about the accuracy and completeness of that data. A cardiologist there has been was quoted as saying that the data referred to was selective and had it not been so, the mortality rates quoted would not have been so controversial.

Even Sir Bruce concedes that the timing of the closure, coming so soon after the High Court ruling is embarrassing since the rationale behind it might easily be misconstrued.

Much will depend on the accuracy of the data relied on but Sir Bruce was in a no-win situation whatever he did. If he failed to heed the warnings of senior clinicians he could easily have been criticised later for knowingly exposing patients to sub-standard and possibly negligent medical treatment (particularly in the aftermath of the Mid-Staffs Hospital scandal).

On the other hand, by suspending and delaying planned heart surgery on children with congenital heart defects there will be those whose urgent treatment will be put back (possibly unnecessarily) which could in theory also result in sub-standard and possibly negligent medical treatment.

The medical director is not in an enviable position. Then again, neither are the unit’s patients….