Dr. Allan Goldman:

We are trying to do that as quickly as we can. We put in place immediately the clinical recommendations which came through, which we feel will make a big difference and which the Boston review had advised us to do. This is changing one of the techniques to standard length constructs, to changing the imaging in theatre, to ensuring that other teams are involved, such as the plastic surgeons and the neurosurgeons, to having a more specialised spinal team, to having two spinal surgeons in very complex cases working together on those cases, to improving the nutrition of children. We have put all of those in place immediately but there are also other very valuable recommendations which have come out of the Boston review which we embrace and will put in place as soon as we can, such as ensuring that we have a strong new specialty lead, which is going to be in place, and creating, very importantly, the theatre governance team with all the team representatives from all of the surgical teams and intervention teams to meet monthly, which will be going through the metrics and all of the standards we need to do for theatre. That is another important process.

The other bit which we need to evolve into is try to get good data collection on patient outcomes which we can benchmark with international registries. We do that for two of our teams, where these standards have already been in place for a long time, which is the ICU and the cardiac teams. We, however, now clearly need to expand that to other high risk specialties and the spinal team will certainly be the next. That requires infrastructure and people, with proper data collectors, data analysts and we need to be part of those registries. That is very much the most important bit going forward so that we can monitor our outcomes in real time and be able to compare ourselves with other centres of excellence.