NHS leaders have condemned a coroner’s intervention in a scandal-hit heart surgery and warned the official defense patient safety could be at risk, leaked documents reveal.
NHS England has defended the decisions it took to limit heart surgery at St George’s University Hospital Foundation Trust after a senior London coroner condemned the measures earlier this year.
It’s the latest in a four-year saga about the quality of heart surgery at the Trust’s specialty department, after concerns were raised in 2018 that warned the department’s “toxic” environment is harmful to patients.
Chief Medical Examiner Fiona Wilcox is overseeing the examinations of 67 heart surgery patients being treated by the hospital. These patients were referred to the coroner after an independent review commissioned by NHS England in 2018 which found poor care may have led to their deaths.
Of the 67 cases referred, 26 investigations so far have not found that poor care led to their deaths.
Following the latest inquest, Coroner Wilcox provided NHS England and St George’s University Hospital with a highly critical report on preventing future deaths, warning that patients had died needlessly due to restrictions imposed by the NHS on the unit.
The coroner argued the decision to cut service was “unfounded” as it was based on the findings 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 reply to the coroner, seen by the independent, NHS medical director Stephen Powis defended the decision to limit service and screening. He also warned: “We regret that in this event the PFD could potentially set back the approach to restoring service capacity and relationships at the Trust and public trust and create further conflict and doubt for families, staff and leadership teams in both the 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 fallen out with surgeons in the unit who have argued loudly The times, trust “encourages a risk-averse culture.”
As a result of initial concerns in 2018, two doctors were suspended from the Trust but reinstated after a court battle and found they had no case to answer in relation to the General Medical Council referral.
That Independently announced in June that the education authority Health Education England had identified ongoing concerns about “inappropriate” behavior within the unit.
In her warning to NHS England and the Trust Coroner, Wilcox said the “unnecessary restrictions” on surgeons’ operating rights in the unit had meant they could treat fewer patients. She said this could mean patients who wait too long for surgery could die while waiting, and emergency patients also died after being diverted to other trusts.
In a response from Jacqueline Totterdell, Chief Executive of St George’s University Hospital, seen by LatestPageNewsThe Trust said that 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 diversion.
Criticizing the independent NHS review, coroner Wilcox said the clinicians involved had not been able to provide adequate feedback, the time reviewers spent looking at the cases was “negligible” and the review chair was working in a hospital with less complex cases.
However, NHS England said the clinicians involved had the opportunity to provide feedback on accuracy during the process, arguing that the time spent reviewing the records was not relevant to the opinions expressed by the panel.
Referring to the independent review’s chairman, Mike Lewis, NHS England said the coroner’s “potentially derogatory” conclusions were “inappropriate”.
It said: “As you will no doubt appreciate, given your own important role in patient safety, it is of the utmost importance not only to ensure that an adequate standard of care is provided in our healthcare system, but also to ensure that the public has confidence that.” Patient safety concerns are being investigated and action taken to ensure the safety of all users of the service.”
The coroner’s report argued that the patients’ families had faced “pain and suffering” as a result of the “unfounded” criticism of the care in the NHS death inquest.
She added, “The call for investigations to allow for an independent assessment of how her loved ones died was immeasurable.”
NHS England said in response it recognizes the plight of families arising during the investigation but it is “difficult to see (in context) such as a desire to be transparent about opinions leading to the care of a patient before his death.” received should be criticized”.
A St George spokesman said: “Cardiac surgery at St George is safe and our response to the Coroner sets out the improvements we have made. We hope that the coroner will consider publishing our response as this will inspire confidence in the high quality of care provided and reassure families and patients that the services are safe.”
An NHS spokesman said: “The independent verification of mortality was important to drive important safety improvements – including the introduction of a new patient risk assessment to ensure all factors are considered before undergoing surgery and the review of all heart surgery deaths at a monthly multi – Disciplinary Committee meeting to ensure lessons are learned from each case.”
The Wilcox coroner’s office was asked for comment as the coroner was on leave for August.