Even in the hands of highly skilled surgeons and nurses, this is a life-or-death situation and anything less than optimum staffing levels risks being unsafe.

The criticism of low numbers of surgeons and cardiac consultants at the Royal Hospital for Sick Children at Yorkhill, Glasgow, by an independent inspection team must be a cause for concern. Parents should not panic, however. It is the case, as Scotland's Chief Medical Officer Sir Harry Burns emphasised yesterday, that the outcomes for heart patients at Yorkhill are "as good as if not better than anywhere across the UK". That is a tribute to the dedication of the staff. A major worry highlighted by the inspectors was that the cardiac surgery unit operated with only three consultant surgeons, compared with four, the standard for units in England. This was seen to impede the ability to deliver a safe surgical rota around the clock. It may be that three surgeons are sufficient for the smaller numbers in Scotland but, with the working relationship between the cardiology and surgical teams deemed poor (along with 18 other elements of cardiac surgery services), and a lack of clear strategic leadership identified as a failing, radical action is required and promptly. Greater Glasgow Health Board has now filled one consultant post and is recruiting another paediatric cardiologist but specialist nurses are equally important. Budgets are tight but losing highly specialist staff because they are overstretched is the cost we cannot afford to pay.