Rates of mortality for heart surgery at Oxford Radcliffe Hospitals NHS Trust are within the acceptable statistical limits, according to a report by the Healthcare Commission.
But the cardiothoracic surgical unit lacks key components of a high quality service and needs to make improvements if it is to reclaim its reputation as a centre of excellence.
Anna Walker, Chief Executive of the Commission, said: “It is important to remember that cardiothoracic surgeons are under more scrutiny than any other type of surgeon. They are the only surgeons to publish comprehensive information on rates of mortality and this is to be strongly commended.
“We investigated the cardiac unit at Oxford Radcliffe because of doubts that have been raised about its performance over a number of years.This investigation has shown that this unit is currently operating within acceptable limits. Patients should be reassured by that.
“But the investigation also shows that surgeons must analyse the causes of high mortality rates when they do occur, ensure that arrangements for proper care are in place for high-risk cases, and work closely together and with colleagues in other specialties. All of these are very important for patients. The Oxford Radcliffe needs to do this systematically.
“This investigation has provided a clear way forward for the Trust to improve its practices through better use of data, better leadership and better management of patients assessed as being high-risk. We hope that we have given the unit an opportunity to take actions that will end some of the doubts that have surrounded it for too long.
“With the uncertainty now behind it, providing the Trust acts on the recommendations, there is no reason why the cardiothoracic unit at Oxford Radcliffe should not once again lead in the field of heart surgery. I hope it achieves this.”
The report criticises the Trust for failing to its review its performance despite being aware that its rate of mortality for the most common cardiac operation was higher than average. The Commission found that the Trust did not tailor its systems to cater for high-risk patients and said that consultant surgeons did not work together to coordinate care or learn from each other. The Commission also considers that leadership of the consultant surgeons needs strengthening.
The investigation was prompted by concern over higher than expected rates of mortality and a history of problems in the unit since the late 1990s. These included a critical report by the then NHS Executive in 2000 and a rating by the Healthcare Commission of significantly below average for deaths following cardiac bypass operations in 2004/05.
The Healthcare Commission’s recent investigation looked at the quality of service, data on rates of mortality and how the Trust had responded to previous reviews.
The Commission used information held in the national cardiac database (Central Cardiac Audit Database) to analyse rates of mortality for heart surgery at Oxford Radcliffe compared with other UK trusts. Given that cardiac units across the UK varied in the way that they reported to the database, work was undertaken to improve the data before the Commission’s analysis could begin.
The Commission analysed data on patients at the unit who had a coronary artery bypass graft for the first time between April 2002 and March 2005. It used data that adjusted the crude rates of mortality to account for risk, taking into consideration factors such as age and medical history.
The analysis showed that rates of mortality for this period at the trust were some of the highest in the UK. However, when adjusted for risk, the rates were within predicted limits for this kind of surgery, when compared with other hospitals doing similar work.
The analysis found that although the unit did take on a relatively high proportion of high-risk patients, this did not explain the higher rate of mortality as the Trust had previously claimed. In fact, the high rates of mortality were spread across all categories of risk. The investigation also found that the high rates of mortality could not be attributed to any single surgeon or period of time.
The Commission recognised the improvements that the Trust has made since the critical report in 2000 and said it was encouraged by the significant improvement in rates of mortality at the unit since March 2005. It has urged the Trust to examine this positive trend and to use its data to identify ways to continue to improve its services to patients.
The report makes 13 recommendations relating to consent by patients, the management of patients assessed as high-risk, clinical governance and leadership, and the collection and use of data. The Trust will now produce an action plan and the Commission will monitor its implementation.