Operation to keep city unit alive

But in recent weeks the world-famous cardiac surgeon has been immersed in a battle to save a children’s unit at the John Radcliffe Hospital, Oxford, which he believes could grow into one of the UK’s elite heart centres.

Not for the first time in his career Prof Westaby is conscious that the odds are stacked against him as, along with hundreds of local people, he steps up his efforts to retain children’s heart surgery services at Oxford’s main hospital.

For, on the face of it, the paediatric cardiac unit that Prof Westaby and many families want to save could hardly be in a more weakened state for a lengthy battle of survival.

With a national review into children’s cardiac surgery under way and a reduction in specialist units anticipated, children’s heart surgery services in Oxford were suddenly suspended in February following the deaths of four children.

When members of the Government-appointed panel visited Oxford to discuss the unit’s future it was still closed, with the findings of a separate inquiry into the baby deaths still a month away.

Prof Westaby had been one of only two paediatric cardiac surgeons at the JR. He was not, however, involved in the operations on the four children, whose deaths led to the suspension of paediatric cardiac surgery. They were all the patients of his former colleague, Caner Salih.

While Mr Salih left to work in London in March, Prof Westaby remains to fight for a unit that he has been largely responsible for creating.

The stakes could hardly be higher. Lose, and heart operations on young people aged 16 and under would be stopped at Oxford. Win, and the unit could be expanded into an elite specialist centre, with extra staff and the number of operations carried out quadrupled.

There are 11 children’s heart surgery centres in England — the others being in London (at Guy’s and St Thomas’s, the Royal Brompton and Great Ormond Street), Birmingham, Liverpool, Newcastle, Southampton, Bristol, Leicester and Leeds.

But everyone at the John Radcliffe knows that the Department of Health wants to close the smaller units to concentrate specialist children’s units at fewer, bigger centres, all performing at least 400 operations a year.

Worryingly, Oxford is the smallest, carrying out 100 operations a year on children before the suspension. If that were not bad enough, some already fear that the panel may be biased in favour of saving inner-city children’s hospitals.

But in recent weeks there have been some encouraging signs. Prof Westaby has been impressed by the commitment to the cause of Sir Jonathan Michael, the new chief executive of the Oxford Radcliffe Hospitals NHS Trust, which runs the John Radcliffe. And if patient power is indeed to be taken into account, than Oxford would be looking like one of the favourites.

When the panel arrived in Oxford last week to hear local views, they faced an impressive turnout of impassioned and angry parents.

Prof Westaby admitted the response from families and former heart patients brought a lump to his throat.

“I saw people there who I had operated on 20 years ago,” he said.

But there is nothing remotely sentimental about his assessment of what the end of children’s heart services would mean for Oxford, and the opportunity that could be squandered.

Speaking publicly for the first time since the suspension of services at the heart unit, he said: “In my view, if you have fewer units, they have to offer comprehensive treatment, and be capable of treating patients with congenital heart disease of all age groups.”

While Prof Westaby does not disagree with the principle of creating fewer, bigger heart centres for children, for him, the mistake is viewing children’s treatment in isolation. For him, continuity of care is the key and being able to provide a cradle-to-grave service for heart patients on one site.

“Because congenital heart disease is a lifetime situation, in the more complex cases you need sequential intervention, involving either operations or catheter procedures. Heart failure can develop any time between infancy and old age.

“But there are only a handful of teaching hospitals in the UK that offer a seamless pathway of treatment from the foetus to old age and Oxford is one of them. The model being put forward in this national review seems to focus on only the surgical part of treatment for infants and children. It is the expertise with the heart that matters, not the size of the patients.”

He describes a scenario of a newborn baby having to be transferred from an Oxford maternity unit to one of the new elite centres 50 or 60 miles away, with the mother being left behind.

“In many cases you shouldn’t move the babies from their cots. You shouldn’t even move them to a different part of the hospital because they are so fragile.”

He said he had seen more than ten cases this year where babies would simply not have survived a journey to another hospital.

Many of the patients he operated on as babies have continued to be treated in Oxford well into adulthood. “When a young person reaches 16, why should he be sent to another hospital to be treated by a different surgeon? That is fragmented care.”

And this is the key to what Oxford has to offer.

“Oxford has the best campus, as well as the capacity to expand. It is a university campus with new buildings, including a new children’s hospital and a new heart centre, which opened a year ago. We can provide foetal care, there is a large maternity unit, premature baby unit, accommodation for parents, even a helicopter pad and we are close to the ring road and motorways.

“If anyone can come up with a better site for a fully comprehensive unit, I would be very surprised.

“It just would not be acceptable to stop doing this sort of surgery in a big university centre like Oxford.”

It will strike some as unacceptable that a man of Prof Westaby’s experience would no longer be performing operations on children.

“I have been operating on babies and children for 30 years. I fully agree that you shouldn’t have just one surgeon being on call every night and every weekend.

“I have faced that for five years at a cost to my own family and have flown back from the United States to operate to avoid a patient being sent elsewhere.”

It would undoubtedly free him to focus on his onging research project to develop a permanent artificial heart that could be fitted into young children.

The artificial heart, a thumb-sized device that pumps blood around the body with tiny rotor blades, extended the life of Peter Houghton, a psychotherapist in his 60s, by more than seven years.

Remarkably, it meant Mr Houghton lived the last years of his life without a pulse, establishing the world’s longest survival record with this technology.

So how damaging has the national headlines about the four children’s deaths and the suspension of services been to Oxford’s cause to grow rather than go?

“I do not know. But the strategic health authority investigation should not stop Oxford becoming one of the centres.

“It is on record that Caner Salih performed the operations and that he planned to leave before the suspension of services. I would only say that he was a well-trained surgeon.

“He had my full support. He faced five difficult and complex cases in rapid succession. We await the findings of the inquiry but it may emerge that the children could have died in any other hospital. This is a high-risk business and the unit here has been producing safe results for years.

“When there are a number of baby deaths in quick succession it was right to stop and look at what had been going on here. That was the right thing to do.”

But was such a lengthy suspension necessary?

“After that, the matter was taken out of the hands of the clinicians,” he replies.

While the high level of scrutiny is something he welcomes, he fears a series of high-profile investigations into baby deaths and the huge pressure of the work is already leading to a shortage of clinicians wanting to specialise in children’s heart surgery.

The loss of the unit at the JR would certainly affect other staff, including Dr Neil Wilson, an interventional cardiologist, who frankly admits he would no longer be able to do the job that he is paid for.

Surgery is just one area of cardiac treatment. But he would simply not be allowed to undertake complex heart procedures, such as cardiac catheterisation and heart valve work, without the presence of a paediatric heart surgeon.

He warned: “It is relatively common for children born with congenital heart disease to have other major problem with their lungs, abdomen or the brain, for example.

“The hospital would not be able to admit some of these cases. Oxford presently ticks all the boxes.”

He warned that specialist skills of nurses would also be lost to children’s heart surgery, if the unit were to close.

Rather than transfer to one of the new heart centres, they would simply stay at the John Radcliffe, and work elsewhere With recommendations due to be drawn up over the next few months before a public consultation in the autumn, politics and even Oxford’s geographical position in the centre of England could influence the final decision.

And as for those four babies, perhaps the greatest tribute would be to create bigger and better services for young heart patients in the hospital where they died.