A Guardian investigation has led to calls for greater transparency in the NHS after it emerged that heart surgery patients at an elite teaching hospital were exposed to "serious clinical risk", according to a report that was not made public.
The hitherto confidential report by Sir Bruce Keogh, one of the most eminent cardiothoracic surgeons in Britain, said facilities for heart patients at St Mary's hospital trust in Paddington in west London, were "almost certainly the worst in the country".
He found that:
· Doctors providing overnight cover in the patient recovery unit might have "little or even no cardiothoracic surgical experience."
· The trust had "no routine system for reliably counting the number of cases performed."
· "Disharmony" existed within the surgical unit, caused by "interpersonal difficulties" between consultant surgeons and between surgeons and the intensive care staff.
Kevin Barron, Labour chairman of the Commons health select committee, said yesterday: "I don't see why this report should have remained internal. There was certainly a public and patient interest in this, even if it was going to be used to improve things internally.
"I am pleased it is now reported that the trust has taken action, but it appears the NHS has got a long way to go if patients are going to be asked to make an informed choice as to where they want to go for treatment."
Niall Dickson, the chief executive of the King's Fund, an independent research institute, said: "We are moving into a new era when patients will expect much more openness from those responsible for providing health care. This will require a big cultural change in the NHS.
"If choice is to mean anything, it must be informed choice and that will only come about when accurate and transparent performance data is made available on a routine basis across the whole system."
Prof Keogh was called in by the trust in May 2005 after the Guardian discovered inconsistencies in data provided under the Freedom of Information Act, which we reported to the Healthcare Commission. His report was never published, but it came to light after a widow recently asked the Guardian to find out what happened when her husband died at St Mary's during a heart bypass operation six months after the report was written.
By then, the trust had improved facilities and procedures in its cardiothoracic unit and was well on the way to implementing Prof Keogh's recommendations.
But its policy of silence meant that patients coming into the unit had no opportunity to form a view about safety issues or take advice on whether they had been addressed. Most heart bypasses are planned in advance, providing time for patients to weigh up the risks of where to be treated or whether to have the operation at all.
St Mary's said it had sent Prof Keogh's report in May 2005 to the Healthcare Commission and the Department of Health, which did not dispute the decision to keep the findings confidential.
This was at odds with a policy of maximum openness instituted by the former health secretary Alan Milburn after an official inquiry into a scandal at the paediatric heart unit of Bristol Royal Infirmary, where 29 babies died before a problem was exposed. In 2002 Mr Milburn decided to publish the results of every cardiothoracic consultant surgeon, showing how many of their adult patients had died during the most common cardiac procedures. The consultants agreed to provide individual risk-adjusted mortality rates for publication in 2004, but some have not yet done so.
Despite encouragement from ministers, no other branch of surgery has published the mortality scores of individual doctors, leaving patients to exercise their right of choice within the NHS without reliable information on the record of consultants.
Prof Keogh's 2005 review of St Mary's was done at the trust's request and his report was written in a personal capacity, leaving the trust responsible for making the results known to the authorities. He was not available for comment last week.
The report concluded: "There is a clear failure of teamwork within the cardiothoracic unit, which, when coupled with the poor facilities, staffing practices and inadequate medical cover of the fast-track [recovery] unit, poses a serious clinical risk.
"The trust has ignored the well-recognised requirements for clinical data collection and audit required to monitor and improve quality of service in a specialty under scrutiny since the Bristol Royal Infirmary inquiry.
"This led to the inability of the trust to quickly report accurately attributed activity and outcomes for individual surgeons when requested under the FoI Act."
Prof Keogh acknowledged that unvalidated returns from the trust showed death rates from 2001 to 2003 were only slightly above the national average and "well within acceptable limits". He also noted "unambiguous indications" that the trust was "committed to resolving these problems and has already commenced measures to rectify some issues".
A spokeswoman for St Mary's said: "It was an internal report commissioned from an independent leading expert ... Staff needed to feel they could be completely honest and open when providing information to Prof Keogh and they did so on the understanding that the report was for internal use only.
"By identifying the causes, problems could be then be addressed effectively and the cardiothoracic department could move forward with improvements to working practices and facilities." All 13 recommendations in the report were implemented, with benefits for patients and staff, she added.
