New measures to monitor the performance of heart surgeons are being introduced.

It follows widespread public concern over the case of the Bristol cardiac surgeons who were ruled by the General medical Council to have continued operating on babies and children despite high death rates.

Three doctors from the Bristol Royal Infirmary face being struck off after the deaths of 29 babies in their care between 1988 and 1995.

In the biggest ever medical disciplinary inquiry, the cases against two cardiac surgeons - James Wisheart and Dr Janardhan Dhasmana - and their manager, Dr John Roylance, were proven on Friday, May 29.

The investigation was the biggest in medical history.

Now all heart surgeons will have their performance independently assessed.

Under investigation

It has also emerged that 18 of the 199 consultant cardiac surgeons in Britain have been investigated following concerns expressed by colleagues or hospital managers.

The Society of Cardiothoracic Surgeons, which has developed the new measures, hopes the move will greatly reduce the risk that patients will receive substandard care.

In a separate move, the society has joined forces with the Royal College of Surgeons to set up a rapid response team of trouble-shooters to investigate units where standards are under question. A team of experts, including senior consultants, will be despatched within 48 hours of a problem coming to light.

Comon procedures

Julian Dussek, president of the society and a consultant surgeon at Guy's Hospital, London, said death rates would be collected for four relatively common surgical procedures.

Janardan Dhasmana, one of the surgeons under investigation

These are coronary bypasses and lobectomies (removal of part of the lung) in adults, and two paediatric operations, holes in the heart and widening of the major artery.

If a surgeon's performance gives cause for concern, the society will arrange a meeting to discuss the figures. If it is decided there is a genuine cause for concern the society will consider re-training or a period of observation. Referral to the GMC is considered a last resort.

Mr Dussek hoped the new system would be sufficient to stop another Bristol happening.

Overwhelming rebuff

"The Bristol case has acted as a stimulus to get this up and running perhaps sooner than it might have been," he said.

"In retrospect, there should have been a system like this in operation before, but one has to remember that there has been a huge change in the climate of opinion.

"Not long ago, surgeons were very secretive about their perform. If I had gone to my members ten years ago and said, okay, we want your personal mortality rates for coronary graphs, we would have received an overwhelming rebuff."