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14 July 2011

Bristol children’s heart services now amongst the best

Paediatric cardiac services in Bristol are amongst the best in the country 10 years after the report of the public inquiry into children's heart surgery at the Bristol Royal Infirmary between 1984 and 1995 was published. The report was published on 18 July 2001. 

"The Kennedy Inquiry was of enormous national significance and led to wide ranging changes in practice across the NHS, particularly in the area of clinical governance. All staff involved in children's heart services have worked extremely hard to deliver real improvements for children and their families. As chief executive of University Hospitals NHS Foundation Trust (UH Bristol), I am very proud that children's heart services at the Bristol Royal Hospital for Children (BRHC) are now amongst the best," said chief executive Robert Woolley. 

All children's heart surgery moved from the Bristol Royal Infirmary to the Bristol Royal Hospital for Sick Children in 1995. Then in 2001 the new Bristol Royal Hospital for Children opened and all children's heart services have been delivered from this modern hospital since then.  

Dr Jacqueline Cornish, head of division for Women's and Children's Services, said:  "Moving into the new purpose designed hospital 10 years ago enabled us to deliver care of the highest quality to local and regional children and to grow our services. We are now investing nearly £30 million to centralise all specialist paediatric services for the South West region here at the Children's Hospital. When this work is completed we will have new and extended facilities to house the existing and transferring services from North Bristol, as well as a brand new state-of-the-art hybrid cardiac catheter lab and other additional facilities for children's cardiac services."

The paediatric cardiac service now employs three surgeons, seven cardiology consultants and utilises extensive multi-disciplinary support services including a 15-bed paediatric general intensive care unit caring for children from the South West and South Wales. In 2010/11, a total of 704 procedures were carried out comprising 354 surgical procedures and 350 catheter procedures. These figures are subject to final validation by the Central Congenital Audit Database (CCAD). 


The servicebased at the BRHC has consistently demonstrated the quality of its care with outcomes that are amongst the best in the country. This is demonstrated by the results of the comparative outcomes assessment for 2000 - 2008 undertaken as part of a recent review which showed that the Bristol service has the third best mortality rates when mortality rates are compared between the 11 current surgical centres in England. Mortality figures for 2007 - 2010 show that the Bristol centre had a 1.6% mortality rate for surgical procedures in the under one year age group and 1% in the one - 15 year old age group. 

"These results are testimony to the dedication of the whole clinical network, from early and accurate diagnosis to the necessary teamwork in the theatre and intensive care arenas, as well as the support following discharge home by our colleagues in Cardiff and the peripheral hospitals in the South West and South Wales," said Mr Andrew Parry, lead consultant paediatric cardiac surgeon, BRHC. 

Bristol has a proactive cardiology programme and cardiologists and cardiac surgeons work together to ensure that the most appropriate care for the patient is provided.  

"Where we can, we will often choose to perform a cardiology procedure on a patient rather than opt for surgery. Performing an interventional cardiology procedure rather than open heart surgery often means that the patient does not need intensive care and can very often go home within 24 hours," said cardiologist Dr Robin Martin. 

A well-established network

The Bristol paediatric cardiac service works successfully as the hub surgical centre in a network that extends across the South West and South Wales, enabling it to care for children from a wide geographic region, in partnership with their referring hospitals. 

The Bristol team can be contacted 24 hours a day by clinical  staff in regional hospitals and Bristol-based cardiologists hold clinics in Bath, Barnstable, Cheltenham, Exeter, Gloucester, Plymouth, Swindon, Taunton, Torbay and Truro. 

The team also works closely with consultant paediatric cardiologists in University Hospital Wales, and, for the last 10 years, both teams have worked successfully in partnership to care for children from across South Wales. Children from South Wales who need cardiac surgery, a cardiology intervention or cardiac intensive care come to Bristol for treatment with the Cardiff cardiologists providing an in-patient service at University Hospital Wales and a network of peripheral clinics across South Wales.

"The Bristol team is also developing a telemedicine service which we will extend. Using live links with hospitals in Exeter and Truro, we can work with paediatric staff there to diagnose and treat patients. This is especially valuable if a patient is admitted as an emergency. We support local clinicians by providing a specialist diagnosis which helps us and the referring paediatricians decide whether and how to transfer a child to Bristol and what course of treatment to take," said paediatric cardiologist Dr Andy Tometzki. 

Care from the womb into adulthood

The treatment of cardiac conditions often starts with diagnosis before birth. The Bristol team works closely with the fetal medicine team at St Michael's Hospital and with other maternity staff across the South West. Cardiologists, obstetricians and midwives co-ordinate the care of mothers of unborn babies with diagnosed heart conditions to ensure the babies are born in the most appropriate location. 

"Once the baby is born, we can treat the child through childhood and adolescence at the Children's Hospital and then transfer care at the right time to adult services at the Bristol Heart Institute, a few hundred metres away. With these services located so close together we are able to provide continuous care from the womb into adulthood," said Dr Andy Tometzki. 

The future

"Children's heart services in Bristol have gone from strength to strength. We provide  high quality, safe care, that is amongst the best in the country and we work successfully with colleagues across South Wales and the South West to meet the challenges of  providing specialist cardiac services  to children across a wide geographic area. In addition we have a very well developed research programme co-ordinated through the Biomedical Research Unit. We have a strong future as we await the outcome of the Safe and Sustainable review of children's congenital heart services in England," said Dr Jacqueline Cornish.