My advice on Bristol: we have come a long way

Last week, Maria Von Hildebrand chose to comment on children’s heart services in Bristol. The increased involvement of parents and young people in the planning and evaluation of NHS services is to be welcomed. Maria’s tireless campaigning for improvements in children’s heart services has undoubtedly contributed to better standards of care nationally.

Maria is also right to highlight the decade-long failure to implement the recommendations from two national reviews of children’s congenital heart services and the risk that creates for the English NHS as a whole and our patients. Bristol, of course, was selected following the Safe and Sustainable review to be one of seven centres for the future.

• Maria Von Hildebrand: My advice to Bristol heart parents – consider another hospital

But I do not believe Maria’s experience equips her to comment on Bristol as it is today. She accepts that the service’s clinical outcomes are unequivocally good and she also acknowledges that the medical director for NHS England has publicly declared he would be happy to have his own child treated here.

She draws parallels with the past that do not bear scrutiny and she paints a regrettably one-sided picture of the current service.

Robust assurance systems

We operate in a markedly different NHS to that of 20 years ago; the focus on patient safety and care quality has never been higher. Congenital heart services in England are demonstrably among the best in the world and we have highly sophisticated and robust assurance systems for the reporting and monitoring of paediatric cardiac outcomes.

Mortality data relating to surgical outcomes is publicly available through the Congenital Cardiac Audit Database, which shows that Bristol consistently delivers good results. This was true before we invested an additional £3.5m in the service to boost staffing and improve facilities in recent years. The trust sits in the lowest risk band of the Care Quality Commission’s new intelligent monitoring framework, with no risks showing across any of the 80-or-so adult and paediatric mortality measures.

These good outcomes are not achieved by chance; they are the result of many factors, including clinical leadership and multiprofessional teamwork. In fact, the very things that Maria seeks to question. Our team – not “club” – of highly talented surgeons, cardiologists, intensivists and nurses has an excellent professional pedigree, many are renowned experts and I have yet to meet one who does not have the wellbeing of each and every child at the centre of their practice.

‘We awelcome the opportunity to work with Sir Ian Kennedy; no one is better placed to see the difference in this service’

She is right to say that surgical outcomes should not be viewed in isolation. My discussions with NHS England suggest a wider recognition that, in our relentless focus on survival and harm-free care as measures of service quality, we are in danger of overlooking the emotional needs of families using such specialised services. These services are not without significant risk and, when things do not go as planned, these families need even greater support.

We realise that Maria’s comments are influenced by some families who feel they did not get the treatment and care they expected and recognise that we do not get it right every time. Their concerns are real and will be properly investigated in the planned review led by Sir Ian Kennedy.

But to represent those concerns in general terms, to refer to a single specific issue about IT systems (which actually reside at another trust) and to present inquest findings about “lost opportunities” in two cases as suggestive of negligence is disingenuous and does a disservice to our professional, hard working staff and the hundreds of patients and families we care for each year. (For the record, Her Majesty’s Coroner found no negligence in either case and saw no need to exercise statutory powers to require improvements in the service.)

An opportunity to improve

In Bristol, we actively seek feedback about the service; in the latest independent survey more than 98 per cebt of respondents described their experience as “good” or better.

The question for me then is, when results are good and the great majority of families are content, how can we have lost the trust of a small number of families so completely?

‘See for yourself, talk to families who have had a good experience in Bristol’

One thing our past has taught us in Bristol is that we must embrace these concerns as an opportunity to examine our practice and ourselves. We are visiting other centres such as Newcastle to learn how we can improve further.

We also welcome the opportunity to work with Sir Ian Kennedy; probably no one is better placed to see the difference in this service from 1990s. We are committed to assisting the review team with their investigations in the hope that this will restore full trust and confidence in our service. Since the review was announced, I have been delighted by the number of families who have come forward already wanting to share their positive experiences with Sir Ian and his team.

My advice on Bristol: we are a service that’s come a very long way. See for yourself, come and look around the facilities. Meet the expert staff. Talk to families who have had a good experience in Bristol. 

Robert Woolley is chief executive at University Hospitals Bristol Foundation Trust