Scandal-hit heart surgery unit warned for third time over ‘toxic’ culture

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Junior doctors have been prevented from returning to scandal hit heart surgery unit previously criticised over “toxic” culture, The Independent has learned.

This week, a coroner defended cardiac surgery at St George’s University Hospital, criticising an NHS-commissioned review into 67 deaths that warned of poor care.

However, The Independent has learned the unit received a critical report from Health Education England (HEE), the body responsible for healthcare training, just last year.

The NHS authority was so concerned about culture problems and “inappropriate behavior” within the unit that it took away the junior doctors working there.

This is the third time HEE has intervened since 2018, when the unit was criticised in an independent review for having a “toxic” culture.

In a statement, Professor Geeta Menon, postgraduate dean for South London at Health Education England, said: “HEE carried out a review of cardiac surgery at St George’s University Hospital in July 2021 and concluded that further improvements were required to create a suitable learning environment for doctors in training.

“We continue to work closely with the trust to implement our requirements and recommendations and will reassess their progress this summer. HEE is committed to ensuring high quality patient care and the best possible learning environment for postgraduate doctors at St George’s.”

The Independent understands that a report issued in December, following the HEE visit, identified problems of “inappropriate behaviour”, poor team working from consultants and raised concerns the culture problems previously identified at the unit persisted.

It also found multiple reports of a "blame" culture among consultants, The Independent has been told.

Several reports have highlighted poor care and cultural problems within the cardiothoracic surgery unit between 2018 and 202, including a independent review commissioned by NHS Improvement after high motality rates were identified there.

The review, published in 2020, looked at the care of 202 patients between 2013 and 2018. It found failings in care which either, definitely, most likely or probably, contributed to the deaths of 67 patients. As a result, the cases were re-referred to the local coroner.

In a report issued on Tuesday, Coroner Fiona Wilcox, criticised the findings of the review claiming they were “unfounded” and had not been carried out in line with guidance.

She also questioned the validity of the initial morality rate alerts, as she said they did not reflect the complexity of the patients being seen.

Coroner Wilcox also criticised NHS Improvement for placing restrictions on the unit over the surgeries it was allowed to complete. She said the reviews had caused “unfounded damage to the reputation of the cardiac surgery department will take years to repair”.

The report added: “That restrictions on training, collapse of research and staff leaving, further damages not only the cardiac surgery at SGH but also the wider cardiac surgery field.”

The restrictions on the trust’s surgeries put in place in 2018 were lifted in April 2021.

St George’s University Hospital Foundation Trust has been approached for comment.

A spokesperson for St George’s said: “We continue to work with our cardiac surgery team to strengthen the unit and help create a positive learning environment where trainees can thrive, including taking steps to measure and improve the culture within the cardiac department.”