Review condemns poor leadership of Oxford cardiac services
Authors: R. Dobson
Journal: BMJ (2000)

A review into cardiac services in Oxford has said that a lack of leadership, surgeons working autonomously, severe difficulties in recruiting and retaining nursing staff, and a culture of complacency and secrecy have all contributed to a decline in the quality of services.

The report, commissioned by the South East regional office of the NHS Executive, made several wide ranging recommendations, some of which are already being implemented by the Oxford Radcliffe Hospitals NHS Trust.

The report of the review, which was commissioned earlier this year after concerns raised by staff working in the unit, said: “The cardiothoracic surgeons must put aside their personal animosities and genuinely try to work together as a team, otherwise the future for this speciality in Oxford is bleak.”

Two of the 35 recommendations say that the five surgeons should function as a team with a common vision of the way forward, and that there should be an overhaul of the system for managing operating theatre lists.

It criticises consultant cardiac surgeon Stephen Westaby for using scarce resources on his research and not being a team player. “Mr Westaby has built up an international reputation as a surgeon. Lately he has been pursuing the development of an artificial heart, the Jarvik. There are problems however.

“Mr Westaby has tended to isolate himself from others in the unit and built up his own research team. The Jarvik programme, which is funded independently, still puts pressure on resources, particularly a CRU [cardiac recovery unit] bed and of course nurses.

“While we would not wish to criticise unduly what might be a pioneering research programme, we must note that at the time the last Jarvik heart was implanted, 40 per cent of the beds on the cardiac ward were closed due to nursing shortage.”

It adds, “Furthermore, even Mr Westaby would not consider himself to be a team player. He functions as an individual.”

Mr Westaby said: “I welcome the report. It is important that people have a clear picture of what went on here. We have been a pioneering centre for fast track, postoperative recovery aortic surgery and the artificial heart programme. My team has the lowest death rate in the world for dissected aorta, and we have taught stentless valve surgery to the majority of European surgeons. We are prolific contributors to cardiac surgery journals.

“In response to the criticism that the artificial heart programme consumed resources in a cash strapped centre, I would like to point out that the whole programme is paid for by research funds raised by myself.

“An awful lot of good things are happening here, but it has to be recognised that you can't keep a centre with five enthusiastic surgeons constrained so tightly by facilities that we have to fight each other for the privilege of taking patients to the operating theatre. Tomorrow, for example, we have three surgeons operating, and we have been told we can do only four cases between us because of nursing shortages and other problems.

“I think that if you scrutinised any cardiac unit in the country you could find similar problems. We all know that cardiac surgeons are strong, opinionated characters that many administrators find a complete pain. But if you are going to stand at the operating table and operate on anything from premature babies to people in their 90s and do high risk cardiac surgery continuously, you have to be opinionated.” • The Commission for Health Improvement (CHI) has said that an action plan drawn up by Carmarthenshire NHS Trust after the death of a man who had the wrong kidney removed at the Prince Philip Hospital, Llanelli, is taking too long to implement.

Graham Reeves died some time after the operation, and because his death is still being investigated by the police and coroner, reports into the incident itself have not been made public.

The commission was asked to look at those reports and into quality of care at the trust.

The report on Oxford's cardiac services is accesible at www.doh.gov.uk/stheast/oxcardiac.pdf. The Carmarthenshire report can be accessed at www.doh.gov.uk/chi