PROFESSOR Stephen Westaby has been a heart surgeon for 35 years, 28 of them in Oxford. He has done more than 11,000 heart operations for the NHS, many of these on children. But what is the future for heart surgery in the UK? In five years will children be going to France and Germany for their heart operations?
Since 2005 named heart surgeons have had their death rates published. The Government argues patients need that information to make an informed choice about heart surgery.
Prof Westaby argues that publishing the death rates obscures the bigger picture and shifts emphasis from patient care to self-preservation of the medical staff.
He told me: “If you want to get to the top of your league in heart surgery, you screen out the most serious, vulnerable cases and play it safe.”
The ‘name and shame’ policy has had an unintended consequence and stopped trainees coming in to heart surgery, particularly child heart surgery.
Prof Westaby said: “The British just don’t want to do it. It’s a high-risk speciality. A total of 55 per cent of surgeons in child heart operations are now qualified abroad. This policy is damaging the profession.”
Many medical people, including Prof Westaby, question the value of publishing the death rates.
They say some doctors will be labelled as worse than others when the reality may be that these surgeons are more highly skilled and take the most difficult cases, with more risk, where deaths are more likely. It could be that the best surgeons, the most skilful, have the highest death rates.
Prof Westaby believes “someone has got to get to grips with the sickest patients. If not it’s a dereliction of duty. These are the patients who have the most to gain from a successful heart operation or at least the attempt. If surgeons are risk averse and play safe, where do these patients go?”
Last week Prof Westaby operated on a patient who needed a third heart operation. The first operations were done elsewhere but the first doctors there were not prepared to do the third, more difficult operation.
The patient was turned down at two other hospitals.
Prof Westaby told me: “I’ve been a heart surgeon for 35 years.
“Protecting my reputation is not a priority at this stage. But risk averse behaviour does exist, and the drivers are self-protection or the prestige and private practice that come from topping the league.
“These death rate statistics hide the bigger picture and they are often the result not of individual surgeons but of systematic hospital problems, of outdated facilities, inconsistent teams and aftercare and patients unable to access ‘circulatory support devices’.”
These are artificial hearts, to you and me, which are much more available in other European countries. For instance, Slovakia has more artificial hearts per head of population than Britain.
The miniaturised blood pump can be a lifeline to millions
In a recent BMJ article, Prof Westaby is clear on this.
“Hospitals, not individuals must be held accountable for poor outcomes and the public disclosure of the surgeons’ death rates does not reflect their technical competence. This distorts the bigger picture. Because few deaths are related to surgical error, publication of death rates diverts attention from deficiencies in NHS infrastructure.
“An understanding of why patients die allows something to be done about it, attributing a pile of bodies to an individual surgeon does not.
“In a recent study of patients treated in Oxford, autopsies did not show a single surgical error. The very large majority of heart patients who die do so because they are elderly, very sick and have other life-threatening ailments. That does not mean it was wrong to try to improve their lives.
“The key point is that high technology surgery needs continuous investment to keep abreast of developments. In particular, surgeons need more circulatory support devices, artificial hearts. These are available only in a limited number of heart transplant centres.
“Currently there are 100 heart transplants annually in the UK. In contrast 12,000 to 15,000 patients under the age of 65 die of heart failure each year, and they are amenable to treatment. They could be treated with a heart pump, but each one costs about as much as a Ferrari.”
This is the reason Prof Westaby, heart surgeon, has developed into Stephen Westaby, inventor.
He is the unpaid co-founder and medical director of Swansea-based Calon Cardio-technology, a team of 22 highly motivated individuals who have developed a miniaturised blood pump with the help of motor car engineers and computer experts.
These scientists are experts at pumping delicate motor oil. They have transferred their skills to preventing blood damage in a motor that spins at 5,000 revolutions per minute. The invention can be a lifeline to millions of people.
Chronic heart failure, when the heart is unable to pump sufficient blood to meet the demands of the body, is often fatal, affecting around 20 million people in the developed world alone.
Prof Westaby pioneered a series of American artificial hearts, achieving the world’s longest survivor of almost eight years with Peter Houghton, who was operated upon in Oxford in 2000.
He has also developed a heart stem cell programme together with the Nobel Prize winner, Prof Sir Martin Evans, in Cardiff. They have used stem cells cultured from patients who were undergoing a heart attack. The cells have been injected into the hearts of coronary bypass patients in Greece with surprising improvement in heart function.
The current heart pumps are not only extremely expensive, around £100,000 each, making it difficult for healthcare systems to implant the numbers needed to satisfy the demand, but they often require surgery in both the chest and abdomen. This can threaten short-term survival. They are also associated with complications like thrombosis.
The new invention in Cardiff is being developed to address these problems and could herald a new dawn in heart therapy. It should be ready for patients early in 2016.
But these world class projects were not developed in Oxford. Why not?