By Dr Minh Alexander retired Consultant Psychiatrist 7 March 2022
A controversy rumbles on about the cardiac surgery service at St Georges, where some allege that NHS England/ Improvement took a very heavy handed approach to mortality alerts. Mortality alerts do not prove that a service is unsafe, but they signal a need for review.
Several investigations took place of the St George’s cardiac surgery service, which was a specialist centre caring for patients with more complex needs, that sometimes presented greater surgical challenges.
This culminated in the so-called Lewis review by NHSE/I, which ended with 67 cases being referred to the coroner with allegations of poor care. The senior coroner dealing with these cases has so far rejected the vast majority of the Lewis review’s findings and criticised the review’s methodology. Some of the inquests remain to be heard.
Heart surgery restrictions led to deaths at London hospital
These are some of the comments by the senior coroner on the St Georges affair:
However, a whole team of cardiac surgeons was also referred to the General Medical Council following NHS England’s “Lewis” review, but I understand all referrals ended with a “no case to answer” outcome.
NHS England’s Medical Director Stephen Powis, in a response to a Prevention of Future Deaths report issued by the senior coroner, stated that NHS England gave relevant parties a proper right of reply (Salmon process).
“The surgeons and referring cardiologists had full visibility of the SJRs for cases where they were involved and were able to collate significant responses and material that was submitted to the panel. This was initially a 2 week period for response, but extensions were granted where requested. As mentioned above, full consideration of their opinions and additional information provided was given over a number of days across a 3 month period. This resulted in updates made to the SJRs, factual accuracy checks and reconsideration of opinion where appropriate. We do not agree with the suggestion in the PFD that this feedback “was mostly ignored”.
A recent “Lewis” inquest into the death of Mrs Maureen Brett, which I observed, gave rise to conflicting evidence. First hand evidence from clinicians and from Mr Mike Lewis himself (the chair of NHSE’s review) revealed that not all parties were given sight of the draft Lewis report or a right of reply.
Mike Lewis himself told the inquest that he asked for Salmon letters to be sent to relevant individuals, but he was not responsible for overseeing the process. If he received no responses, he assumed that the individuals had no comment to make.
I wrote to both Amanda Pritchard CEO of NHS England and to Stephen Powis about the concerns regarding NHSE’ Salmon process. Neither have replied.
I have also contacted a senior medical manager from NHS England, who was a contact point for St. Georges, to ask for information on who was responsible for NHS England’s Salmon process. He has not responded either.
The Bewick report on cardiac surgery at St Georges
The Lewis review was preceded by the briefer Bewick review on cardiac surgery at St. Georges.
Bewick’s 2018 report on cardiac surgery can be found here.
An FOI request has revealed that the review by Mike Bewick GP and former Deputy Medical Director of NHSE England, was commissioned by the trust with the “support and guidance” of NHS Improvement, a predecessor body of NHS England.
The FOI response from St Georges can be found here.
St. Georges stated in its FOI response:
“The Trust appointed Professor Bewick, a former Deputy Chief Medical Officer at NHS England, to lead the independent external review because he had specific experience of conducting similar reviews into cardiac surgery at NHS trusts in both Leeds and Bristol.”
“The Trust’s commissioning of the independent external review and the appointment of Professor Bewick was with the support and guidance of NHS Improvement.” [my emphasis]
In response to a question about the tendering process for this review, St Georges replied:
“Direct award, as provided for under the Trust’s Standing Financial Instructions.”
The Bewick review of cardiac surgery cost St Georges £47,410.14, as noted in trust board papers:
It is perhaps relevant to mention that St. Georges dragged its feet on the above FOI about NHSE’s involvement in the Bewick review, despite several reminders. The trust only issued a response after the matter was referred to the Information Commissioner.
All eyes are on Mike Bewick again, as he was recently commissioned by the Birmingham and Solihull ICB to carry out an urgent review, one of three, of University Hospitals Birmingham NHSFT (UHB) after revelations by BBC Newsnight of alleged bullying, safety concerns and governance failures by the trust.
The ICB has now revealed that Bewick has been hired to carry out the other two of three reviews of UHB.
Whilst not disclosing the contents of Bewick’s initial report, the ICB CEO told an irate Joint Health Overview and Scrutiny Committee that Bewick has found no red flags on patient safety.
This cannot be reassuring at all for the many staff who have been brave enough to come forward, and I repeat my general advice that it is probably safest to disclose directly to the media at present, either anonymously or with agreement that identity will be protected. But do take personalised advice first.
Was Bewick appointed to review UHB with “support and guidance” to the ICB from NHS England?
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