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28 October 2014, 18:01
Rivalry between heart surgeons at two paediatric units, including one at Newcastle, whose futures were under threat has been criticised in an independent report.
Plans to cut the number of children's heart units nationally led to problems between staff in Leeds and Newcastle, and caused anxiety among patients' families.
In March last year children's heart surgery at Leeds General Infirmary (LGI) was halted for more than a week amid concerns about the unit's mortality rate, before it was allowed to resume.
Surgeons in Newcastle had been critical of the way some cases were transferred from Yorkshire to the North East.
That was against the background of campaigning to keep the LGI children's unit open after it had been chosen to close as part of a national plan to streamline services. The plan is to be re-evaluated and Leeds and Newcastle remain open.
A review of the Leeds unit published concluded that improvements have been made and it can go from strength to strength.
But the report highlights tensions between staff in Leeds and those in Newcastle as far back as 2011.
It said the family of a child included in Newcastle's dossier of 14 cases of concern were worried that clinicians in Leeds wanted a complex case off their books.
But the family were also worried that staff in Newcastle could take on the tricky case to ``score points'' against Leeds at a time when both units were being scrutinised.
Paediatric heart surgery is a tiny speciality, with about 30 consultant paediatric cardiac surgeons in the NHS, who know of each other and should share expertise, the report said.
``Any disagreements and personality clashes should be in a context of mutual respect, but this is not the case at Leeds and Newcastle, where we found evidence of a strained relationship between clinicians,'' the report said.
The independent reviewers were told in Newcastle that the accuracy of medical notes made in Leeds was to be doubted and one consultant claimed that ``Leeds would provide after-the-event justification for their actions or inactions that would not accurately reflect why they had made decisions at the time'', the report said.
Meanwhile in Leeds, staff were sceptical of the motives for Newcastle's ``whistleblowing'' dossier, claiming some issues were old, and that they should have been raised directly with Leeds first.
The independent report into the LGI unit looked at its mortality rate, the experience of some families and 14 cases highlighted by Newcastle staff.
The review made 17 recommendations about records, communication, whistleblowing and managing change and these should be adopted nationally.
NHS England's deputy medical director Mike Bewick said:
``Patients should be reassured that this service has been rigorously scrutinised and has improved as a result.
``Patients and the public can have confidence that this is a well-run unit and is now in a position to go from strength to strength.
``Not only have we learned about service in Leeds, we have learned lessons of relevance nationally.
``We are currently consulting on new standards for children's heart surgery across the country and the review in Leeds has made a significant contribution.''
The Children's Heart Surgery Fund, a charity that supports the Leeds unit, welcomed the outcome.
Chief executive Sharon Cheng said:
``The report's findings confirm that the Leeds unit is safe and provides excellent standards of clinical care, treatment and outcomes for the children under its care.''
She said plans to streamline cardiac services nationally ``pitted units against each other and created a climate of fear and uncertainty''.
``The whole sad affair of the last 18 months has been a symptom of this.
``Success rates in this speciality, both at the Leeds unit and nationally, stand at 98.2%, an incredible statistic when dealing with such a complex speciality.''
Newcastle upon Tyne Hospitals NHS Foundation Trust said the changes already brought in justified the comments staff made about Leeds.
``We can give a categorical assurance that our aim then, as it is now, reflects an unstinting commitment to improve pathways of care including choice where appropriate.''