IF anyone knows the mark the Bristol heart scandal had on the city it is Jacqueline Cornish, the current head of women's and children's services at the city centre hospitals.

The consultant was a junior doctor in the cardiology department at the old Bristol Children's Hospital in St Michael's Hill at the time when babies and children died unnecessarily during heart surgery. She saw youngsters leave for operations at Bristol Royal Infirmary, never to return up the hill.

But Dr Cornish also knows more than most how far cardiac surgery for babies and children in Bristol has come since the 1980s and 90s.

Now the city's paediatric heart unit is unrecognisable from the accounts of what happened 20 years ago – and its results show that youngsters are getting some of the best care in the country.

The Bristol Heart Inquiry, led by Professor Sir Ian Kennedy, looked at the concerns over children's heart surgery in the BRI during the 1980s and early 1990s and the number of youngsters who died during or after operations.

Anaesthetist Steve Bolsin, who shared his personal view of what happened with the Evening Post this week, started work at the hospital in 1988 and was concerned about the time surgeons took to operate in Bristol compared to other hospitals where he had worked – and at the number of deaths.

He raised the issues with colleagues and gathered data prior to the situation eventually coming to a head in January 1995, when the death of a child on the operating table led to an external review.

A General Medical Council hearing followed two years later and surgeon James Wisheart was struck off for continuing to operate on children despite warnings over his poor success rate. Fellow surgeon Janardan Dhasmana was suspended from operating on children for three years and the former chief executive of the health trust, Dr John Roylance, was also struck off for failing to stop the surgeons from performing operations.

The Bristol Heart Inquiry followed, looking at surgery in the unit from 1984 to 1995 when "too many children died". It made almost 200 recommendations with far-reaching implications for safety, management and regulation within the NHS.

Even before the hearings into heart surgery at Bristol, changes were made to improve the outcomes and experiences for young patients.

In 1995 all paediatric heart surgery was moved to the old children's hospital in St Michael's Hill. And in April 2001 – before the Kennedy report was published – the new purpose-built children's hospital opened.

"The children's hospital was the solution. It was never the problem," Dr Cornish said.

"Bringing babies out of the BRI in 1995 and the move to the new unit has allowed us to grow and develop and achieve what we have now, which is great.

"We are very proud to be providing the excellent care we do now."

Surgeon Ash Pawade was credited with starting the turnaround and in 1999 he was joined by Andrew Parry, who is now the senior surgeon.

Mr Parry was determined that Bristol could rise from the ashes of its old reputation like a phoenix and believes it is still rising.

"It is not in full flight yet," he said.

"We will never be satisfied, that is the whole point, because as soon as we are complacent that is when things start to slip.

"We want to be the best. The whole team wants to be the best and that is the most important thing."

There are now three children's heart surgeons and seven cardiology consultants.

The unit carried out 704 procedures in 2010/11, including 354 operations, and in the most up-to-date comparable figures from April 2007 to March 2010 there were 431 open heart operations and just one death.

A marked difference from the 1990 to 1995 figures in the inquiry report, when 30 to 35 youngsters did not survive.

New techniques have now been carried out at the unit, such as hypoplastic left heart syndrome surgery, which has been successful so far.

As well as new procedures, the team is involved in research projects to improve the care of youngsters born with heart conditions, working alongside the team at Bristol Heart Institute.

In the 80s and 90s youngsters had surgery and recovered in the BRI intensive care unit alongside adults.

Now there is a dedicated service just for youngsters in a purpose-built children's hospital.

"It is a huge success story," Dr Cornish said.

"And that was illustrated in us being named in all four options for the Safe and Sustainable Review."

That review, also being led by Sir Ian, is looking at the future organisation of paediatric heart surgery centres across the UK to ensure the best possible results for children in need of heart surgery. It will mean fewer, larger specialist centres where the most complicated operations will be carried out. Bristol featured in all the lists of possible centres drawn up and put to public consultation, which ended on July 1.

Dr Cornish said that one of the strengths of the current children's cardiac service is a shared care network across the south west, with Bristol Children's Hospital as the central cardiac surgical hub.

It is backed up by telemedicine technology, using video links to help with the diagnosis and treatment of patients from a distance.

Live images can be beamed between Bristol and other hospitals so that patients from across the region will only attend the city centre hospital when they really need to and be dealt with closer to home wherever possible.

Dr Cornish also credited the work of the fetal medicine team within St Michael's Hospital, who detect potential heart problems before babies have even been born and ensure that the right care is available for them immediately after birth.

As well as the unit itself, training of surgeons has moved on since the dark days in Bristol. The Bristol Simulation Centre is the only one in the UK that uses a specific simulator for training.

"The whole trend of this is 'safe and sustainable' because we can sustain the unit, particularly because we have got the critical mass to be able to deliver services with three surgeons, and it is safe because there are enough cases to operate on," Dr Cornish said.

And with the planned expansion of the children's hospital to prepare for more paediatric services moving to the city centre from Frenchay, the unit is looking forward to adding a special "hybrid" theatre, where open heart surgery and less invasive procedures can be carried out alongside each other.

Dr Cornish said that the unit now works very much as a team and has a holistic approach to patients and their families.

"I think the capacity to recover from where we were very, very quickly to a good unit with safe care, with good results up to the point of having the third best operational outcomes in the UK, is fantastic," Dr Cornish said.

"After such a very heart-rending, traumatic, bruising time, everybody from that period was able to pick themselves up and, with great determination and sheer love of what we are doing, we took it forward very quickly."