Bristol heart scandal

The Bristol heart scandal occurred in England during the 1990s. At the Bristol Royal Infirmary, babies died at high rates after cardiac surgery. An inquiry found "staff shortages, a lack of leadership, [a] ... unit ... 'simply not up to the task' ... 'an old boy's culture' among doctors, a lax approach to safety, secrecy about doctors' performance and a lack of monitoring by management".[1] The scandal resulted in cardiac surgeons leading efforts to publish more data on the performance of doctors and hospitals.[1][2]

An investigation chaired by Professor Ian Kennedy QC was set up in 1998. It reported in 2001.[3] It concluded that paediatric cardiac surgery services at Bristol were "simply not up to the task", because of shortages of key surgeons and nurses, and a lack of leadership, accountability, and teamwork. In fact the unit, which had “not been up to the task” in 5 years (1991-1995) had left 34 children under one year of age dead, who would have survived in other NHS units (Ref ). Overall 170 children died in the Bristol unit between 1986 – 1995 who would have survived in other NHS hospitals as estimated by Laurence Vick, the lawyer most closely involved in the Bristol Scandal.[4] Sadly the same expert estimates that 25-30 children suffered permanent brain damage after cardiac surgery by the Bristol surgeons over the same 10 year time span.[5]

The NHS Plan 2000 published a year earlier, included the establishment of the Commission for Health Improvement, which was intended to tackle such problems.[6]

By 2010, the mortality rate within 30 days of a child's heart operation had fallen from 4.3% in 2000 to 2.6%. Plans to reduce the number of centres performing children's heart surgery have been opposed.[7] A report to NHS England in July 2015 proposed a “three tier” model for all hospitals providing congenital heart disease care. It suggested that they would work within “regional, multi-centre networks, bringing together foetal, children’s and adult services” and noted that since 2001 there “have been subsequent reviews each making a series of recommendations, but no coordinated programme of change, and concerns have remained”.[8]