St George’s University Hospitals Trust: Cardiac Surgery Mortality Review

Felicity Buchan Excerpts

Monday 18th July 2022 Commons Chamber

[Felicity Buchan (Kensington) (Con)]

I thank Mr Speaker for granting this Adjournment debate. I first want to explain why I have brought it forward. St George’s University Hospitals NHS Foundation Trust is not in my constituency, but Professor Marjan Jahangiri, professor of cardiac surgery at St George’s Hospital, is my constituent, hence my involvement today. I am delighted that my constituent is in the Gallery. I reassure you in advance, Mr Deputy Speaker, that while I may refer to coroners’ inquests, I will refer only to those that have concluded; there are several pending, but I will not refer to them, so my remarks will not be on matters sub judice.

I have secured this debate because I believe my constituent may have suffered a serious miscarriage of justice. There are also major public policy issues, if my conclusion is right that the independent mortality review of cardiac surgery at St George’s is deeply flawed. Let me say by way of background that my constituent is a pre-eminent cardiac surgeon and was the first female professor of cardiac surgery appointed in the UK and Europe.

Let me attempt to summarise a very complex situation. The results of cardiac surgery in the UK are reviewed on a three-yearly cycle. St George’s Hospital went into alert for the periods of 2013 to 2016 and 2014 to 2017, due to excess mortality of 11 to 12 patients. I should state that my constituent’s results have never been subject to an alert or an alarm. There were 202 deaths from approximately 5,200 operations at the unit between 2013 and 2018. NHS Improvement commissioned an independent mortality review of the cardiac surgery unit, which is known as the Lewis review.

The Lewis review panel studied the cases and wrote a one-page report on each patient—a structured judgment review. These were based solely on a review of hospital records. Each case received a score of 1 to 6 for problems in care contributing to death. No medical professional was interviewed, and no risk-adjusted mortality was analysed. This methodology is, I understand, very non-standard and runs counter to the methodology of the National Institute for Cardiovascular Outcomes Research. My constituent highlighted, before publication of the Lewis report, factual errors in the structured judgment reviews, but these letters were ignored.

The review, when it was published, concluded that 67 out of the 202 deaths were avoidable. The figure of 67 is vastly different from the original alert of 11 to 12. As a result of the review, all consultant cardiac surgeons at the unit, including my constituent, were referred to the General Medical Council by NHSI and St George’s. The General Medical Council found “no case to answer”, with no failings in care, and the case was closed.

The 67 cases were referred to Her Majesty’s senior coroner for inner west London, Professor Fiona Wilcox. The coroner has rejected the findings of the Lewis review in all 13 of my constituent’s cases, and no failings in care have been identified. In total, the coroner has rejected the findings in almost 40 cases, and in only one has she concluded that there have been failings in care—a case in which she had already opened an inquest.

I want to give the House a flavour of some of the comments that the coroner has made. I will just choose a few quotations from an inquest on 14 July 2021, which was one of my constituent’s inquests. One quote is:

“I can find no failings of care. I find no criticism of the care delivered by the clinical team. The failings identified in the review have, once again, not been found after consideration of the evidence.”

Another quote from that inquest is:

“I cannot find failings that contributed to the death. On the contrary, I find that the care given by the staff of St George’s was excellent and beyond criticism.”

And another quote from that inquest is:

“There has been enormous damage and suffering as a result of the NHSI Review to the families and St George’s staff, sufferings to relatives who fear that their loved ones died because of lack of care or failures in care, and extraordinary amount of work for this Court.”

On 9 May 2022, the coroner issued a regulation 28 report under the Coroners (Investigations) Regulations 2013, in which she described the failings of the NHSI Lewis review and stated that its implementation has caused deaths and harm. I want to quote just a few quotations from that regulation 28 review. It said that

“when the operative mortality statistics of each of the surgeons is examined across the range of theatres where they work, no surgeon had then or has now an operative mortality rate higher than expected.”

Separately, it said:

“The whole reputation of the cardiac surgery department and the hospital has been damaged with no evidence that this court has so far seen of deficiencies in care.”

Specifically, it was said as a matter of concern that

“the SJR process as deployed in SGH is not fit for purpose, further undermining the public confidence in the NHS, which the public may perceive as the NHS being unable to appropriately audit its own work.”

My constituent finds herself in a position where a review states that her unit caused 67 avoidable deaths, yet she has been exonerated by the coroners’ inquests and the General Medical Council.

This has wide-ranging implications. Not only is my constituent’s medical reputation severely affected, but there are many other consequences. The families of those who died are left confused and troubled as to why their family members died, and it erodes public confidence. As noted in the regulation 28 report, which I mentioned briefly, the restrictions imposed on the unit are limiting its ability to carry out necessary surgeries. The coroner also said that the trust’s cardiac research and training programme had to be disbanded as a result of the review, and surgeons and nurses are losing vital skills. Finally, significant public funds are being spent on the court’s time and legal settlements.

This troubling situation raises significant public policy issues. The situation has been raised in the other place. Lord Kamall said that

“it is also important to recognise the differences between the coroners’ inquests and the work of the independent mortality review, which was not undertaken to determine the cause of death in individual cases or attribute blame”—[Official Report, House of Lords, 18 May 2022; Vol. 822, c. 451.]

and that it was all about processes, procedures and culture. I would argue, however, that that is not the case.

The Lewis review is specifically called a mortality review, and the terms of reference for the review refer nowhere to a review of processes, procedures or culture. Instead they are focused squarely on whether there are

“problems in care that may have or definitely contributed to the death of a patient.”

Furthermore, the terms of reference explicitly confirm that the review was to consider the same issues as the coroner. I therefore ask the following of my hon. Friend the Minister, although I appreciate that he may want to reflect on this: given the rulings of the coroner and the General Medical Council, I ask that the findings of the NHSI/Lewis review be dropped. This was clearly a review into individual deaths rather than a review of culture, and the findings have been discredited by the coroner. I believe it is firmly in the public interest to drop the conclusions of this review. I further ask that that be done quickly, as it is taking a significant toll on all those involved. I would be most grateful if my hon. Friend the Minister gave this issue his full and due consideration.

Access to GP Services and NHS Dentistry

Felicity Buchan Excerpts

Tuesday 21st June 2022 Commons Chamber

[Wes Streeting]

The hon. Gentleman is right to describe the state of dentistry and I will be getting my teeth into that issue very shortly.

[Hon. Members: “Groan!”] It had to happen at some point. I had to get it in at some point. Let me touch on the other issue he mentions, which is about inequality and inequality of access.

The system in primary care is entirely unequal. Some areas have twice as many doctors as other parts of the country, with as many as 2,800 patients fighting over one family doctor. Patient safety is being put at risk. Last week, the BBC revealed the scale of the crisis in GP surgeries with its investigation into Operose Health. Patients who can get an appointment are seen by less qualified staff, standing in for GPs without supervision. Patient referrals and test results were left unread for up to six months: private profit placed above patient safety. When the Health Secretary was asked about that last week, he said:

“we expect local commissioners to take action.”—[Official Report, 14 June 2022; Vol. 716, c. 140.]

Well, it is not good enough to sit back and wait for others to act. Is an investigation happening? Can he tell us? If not, why on earth has he not launched one? [Interruption.] The Under-Secretary of State for Health and Social Care, the hon. Member for Lewes (Maria Caulfield), from a sedentary position, talks about the last Labour Government. When are the Conservatives going to wake up to the fact that they have been in government for 12 years? Twelve years! It is remarkable. Twelve years they have been in government.

[Felicity Buchan (Kensington) (Con)]

rose—

[Wes Streeting]

Perhaps the hon. Lady could tell us why they want to run away from their record of 12 years.

[Felicity Buchan]

I thank the hon. Gentleman for giving way. He makes grand statements in support of the NHS, but I am afraid his actions do not support the NHS. He has backed these train and tube strikes today, which have meant that in my constituency patients cannot get to hospital, and nurses and doctors cannot get to their places of work. Can we have better action, rather than words?

[Wes Streeting]

I am very, very grateful to the hon. Lady for that intervention. Our party has been clear: we did not want to see the strikes go ahead. We believe the strikes could have been averted if the Government had shown responsible action. The absolute brass neck of the Secretary of State! It is one thing pretending they have not been in government for the last 12 years; now they are pretending they are not in government today and that, somehow, it is down to me, the shadow Health Secretary. Somehow, if I had uttered the magic words, “Don’t go ahead,” the RMT would have said, “Oh no, the shadow Secretary of State for Health has spoken now. We better put a stop to it.” [Interruption.]

Health and Social Care

Felicity Buchan Excerpts

Friday 3rd December 2021 Commons Chamber

[Felicity Buchan (Kensington) (Con)]

This Government are investing an additional £34 billion in the NHS this year alone. Does my hon. Friend agree that this money needs to go to the frontline and that we need to ensure that we get value for money?

[Edward Argar]

I am grateful to my hon. Friend for highlighting both the investment and the need for us, as the custodians of the taxpayer’s pound, to make sure that the money is well spent by implementing innovation and reform so that it gets to the frontline and delivers patient care, which is exactly what we are doing.

Coronavirus

Felicity Buchan Excerpts

Wednesday 16th June 2021 Commons Chamber

[Felicity Buchan (Kensington) (Con)]

I have been contacted by many constituents who are concerned about the extension of these restrictions, especially when cases and hospitalisations are still at an absolutely low level. I also represent a central London constituency, and central London is suffering badly, as a result of people still being encouraged to work from home and our having very few international business visitors and residents, with the result that unemployment in central London is looking very bad.

However, I acknowledge that, clearly, with two shots of the vaccines, there is no question but that there is better resistance to hospitalisation. I will support the Government tonight for one final heave over the line, but I urge them to make sure that we do not lose the benefit of two vaccines. For instance, why are we still encouraging people to work from home when they are double vaccinated, and why are we asking people to quarantine at home if they have been in contact with a case when they are double vaccinated? We need to refine and perfect all these features, because this is having a meaningful impact on people’s lives. I will support the Government, but we have work to do and we need to get out of these restrictions.

Covid-19 Update

Felicity Buchan Excerpts

Monday 7th June 2021 Commons Chamber

[Felicity Buchan (Kensington) (Con)]

I represent a very international constituency where people travel for business, family and personal reasons, and not just for two weeks in summer in the sun. I am concerned that the cost of PCR tests is prohibitive, and the lack of certainty beyond three weeks under the traffic light system has a material effect on business and wellbeing. Will my right hon. Friend’s Department consider further whether lateral flow tests can be substituted for PCR tests to at least alleviate that concern and cost?

[Matt Hancock]

Part of the purpose of the international testing regime is to get genetic sequences to spot variants, which we cannot do from a lateral flow test. That is the literal answer to my hon. Friend’s question. More broadly, the approach we are taking instead is to try to drive down the costs of PCR tests. Bringing a private market for PCR tests for travel has led to a significant reduction in cost, and that is another good example of harnessing private markets to improve people’s lives. The companies involved are strongly incentivised to deliver tests for a lower price. That is the approach we have taken for the reason I set out, and that is the decision we have made.

Covid-19 Update

Felicity Buchan Excerpts

Tuesday 9th February 2021 Commons Chamber

[Matt Hancock]

I spoke to my Irish opposite number, Minister Donnelly, this morning and he has assured me that that data will be provided appropriately and securely; we have been working together to ensure that that happens for some time.

As I said in my statement, we have been working with the Irish Government to ensure that there are appropriate measures, both in the Republic of Ireland and in the United Kingdom, to ensure that the border on the island of Ireland can be kept completely open, as it must, yet we have adequate protection against arrivals of variants of concern internationally. It is the two countries working together, putting in place similar arrangements both in the Republic and in the United Kingdom, that will allow us to deliver that goal, which I am sure we all share.

[Felicity Buchan (Kensington) (Con)]

I am increasingly concerned about the effect of lockdown on the mental health of children; I am receiving so many emails from adolescents and teenagers. Will my right hon. Friend assure me that when he feeds into the 22 February road map, the mental health of children, and indeed their parents, is taken into account?

[Matt Hancock]

Yes, of course I will.

Covid-19 Update

Felicity Buchan Excerpts

Thursday 17th December 2020 Commons Chamber

[Matt Hancock]

The hon. Lady is absolutely right about the impact of the virus on the NHS in her part of the world in north-east London. Whipps Cross Hospital is under significant pressure. The case rate in her Waltham Forest local authority is 431 per 100,000. We have to work together to get the cases down, especially in east London, where they are very significant. We publish a huge amount of data on hospital admissions and the impact on the NHS, and I am publishing further data on this today and putting it in the Library of the House.

[Felicity Buchan (Kensington) (Con)]

I am glad to see that three areas are coming down a tier. That is vital for compliance, because the general public need to see that if they follow the rules and get their cases under control, there will be a pay-off. Does my right hon. Friend agree that what is important is complying with existing restrictions, rather than ever more severe restrictions, and it is critical that we take the public, including the young, with us?

[Matt Hancock]

I agree with every word that my hon. Friend just said. I strongly agree that the best way to get out of tier 3 is by everybody coming together to comply with the restrictions—and not just to comply with them because they are the law but to take responsibility to ensure that we do not spread the virus, which each one of us can do unwittingly because of its asymptomatic nature. I thank my hon. Friend for her question and for the message that it sends: we can get areas out of tier 3 and we can get areas out of tier 2 and into tier 1, but we all have to work at it.

Covid-19 Update

Felicity Buchan Excerpts

Monday 14th December 2020 Commons Chamber

[Matt Hancock]

On the contrary, all the safety checks that are necessary have been carried out and we continue to monitor the roll-out of the vaccine throughout the UK. The Medicines and Healthcare Products Regulatory Agency has done a terrific job on that and continues to do so. For instance, my team and the MHRA were having an update assessment on Saturday morning to check the progress of the first week’s roll-out, and I am delighted to say that we are able to keep doing that. I say to the hon. Gentleman and everybody else who wants to see the impact of the vaccine: look at the faces of those who have had their first dose, and how pleased they are to have it and to be able to get that step closer to protection from this awful disease.

[Felicity Buchan (Kensington) (Con)]

I note that Essex and Hertfordshire have been split into two—partly tier 2, partly tier 3. However, Greater London has been treated as one. In central London, our cases are significantly below the national average and, whether this House likes it or not, central London is the powerhouse of our national economy. Will my right hon. Friend tell me why London has been treated differently from Essex and Hertfordshire?

[Matt Hancock]

As you know, Mr Speaker, we look in great detail and at a granular level at the geographies that these restrictions have to cover. Unfortunately, central London’s case rates are rising, and we know that if an area is surrounded by other areas where there are significant increases then those high rates tend to move into that area if it is left out of a set of restrictions. I understand, of course, the impact on the economy, but the very clear public health advice was that London should move together because all areas of London are seeing an increase in rates and we need to stop that.

Covid-19

Felicity Buchan Excerpts

Wednesday 11th November 2020 Commons Chamber

[Felicity Buchan (Kensington) (Con)]

I warmly welcome the encouraging developments on the vaccine front, and I am glad that my local authority, Kensington and Chelsea, will be a beneficiary of the rapid-testing scheme.

I am also glad that case rates in my local authority are tailing off—in fact, in the past week they were down 28% and are now almost back down to 100 cases per 100,000, standing at 111 yesterday. Indeed, the data for London for the past week, released yesterday, shows that cases were down in 26 of the 33 boroughs and hospital admissions were also down on the week.

I strongly encourage those on the Front Bench to ensure that, when 2 December comes, we leave lockdown and review the tier that London comes out into. A case is beginning to develop that London—which is the powerhouse of our economy, accounting for 25% of our total tax revenue—should come out into tier 1. We still have a few weeks to go and I encourage Londoners to do everything that we can to get the R down and the number of cases per 100,000 down. I ask my hon. Friend the Minister to give proper focus to the tier into which London leaves lockdown.

Oral Answers to Questions

Felicity Buchan Excerpts

Tuesday 6th October 2020 Commons Chamber

[James Cartlidge (South Suffolk) (Con)]

What steps he is taking to improve cancer outcomes.

[Felicity Buchan (Kensington) (Con)]

What steps he is taking to improve cancer outcomes.

[Jo Gideon (Stoke-on-Trent Central) (Con)]

What steps he is taking to improve cancer outcomes.

--- Later in debate ---

[Matt Hancock]

Yes, I do. I share my hon. Friend and neighbour’s enthusiasm for the rebuild of the West Suffolk Hospital. For treating both patients with cancer and patients with all other conditions, the West Suffolk is a brilliant local hospital that is much loved in the community; however, its infrastructure is getting very old and it needs to be replaced. I am delighted, along with the Minister for primary care, my hon. Friend the Member for Bury St Edmunds (Jo Churchill), in whose constituency the hospital is and will be rebuilt, that we are able to make the funding commitment and get this project going.

[Felicity Buchan]

I understand that we continue to requisition private hospitals. Given that there are patients who are nervous about attending hospitals, could those be used as covid-secure environments for cancer analysis and treatment?

[Matt Hancock]

Yes, absolutely. The private hospitals of this country have played a very important role in responding to covid, and we have a contract with them to be able to continue to deliver much needed services, including cancer services. Because by their nature they rarely have the pressures of emergency attendance, we can ensure that they are part of the green part of the health service—that they are as free as is feasibly possible from coronavirus—and therefore safe to carry out all sorts of cancer treatments. They are an important part of the recovery plan.