An investigation has been carried out by West Hertfordshire NHS Trust into alleged NHS errors, which has cost precious time for cancer patients. The Trust failed to follow NHS Guidelines for the follow up of patients with suspected cancer.
Clearly urgent change is needed at the Trust and the findings of the patient review are deeply concerning. This is the latest in a series of recent findings of substandard care being provided by the NHS. More must be done to safeguard the lives of individual patients and through this, rebuild public confidence in the healthcare system.
The review conducted was of patients referred for urgent appointments for suspected cancer between January 2010 and November 2013. It found that Watford General Hospital had discharged some patients after they failed to attend the first appointment arranged, for whatever reason. Those patients then effectively dropped out of the system, and were not called back. This contravenes NHS rules, which say that a second appointment should be offered so that worrying symptoms can be followed up. Given the investigation was launched almost four years after the failures began, it is concerning how long it has taken for the Trust's managers to discover this.
The patient review revealed that out of the 810 patients affected, 686 people were told that there were 'no clinical concerns' as a result of the delays, whilst 121 individuals are still being assessed. This would be at the very least extremely worrying for those affected. Such mistakes could have significant and life-threatening consequences for some of the patients and their families. Indeed the Trust has disclosed that they have been in touch with the family of one patient who has since died. They acknowledge that the delay may have contributed to his death.
The Trust says it has recently introduced a more robust administrative system, including:
- A new IT system to track each patient's appointment, missed appointments and cancellations
- Weekly meetings to review the overall management of all referrals and appointments
- Retraining and better supervision of staff
- Daily review of all patients who miss a booked cancer appointment to ensure they receive a new appointment.
These basic steps could save lives. Where simple measures can be taken to prevent potentially devastating consequences for patients, there is no reasonable reason for this not to be done and all other Trusts should be reviewing their own procedures as a result of the outcome of this review.
Overall, increased awareness of failures in the healthcare system is leading to more accurate analysis of the NHS's performance, so that the changes needed can be identified. In line with this, whistleblowers should be supported and protected to ensure a culture of increased openness. The issues revealed by this process may cause public confidence in the NHS to drop in the shorter term, but we need to identify and address these issues in order to create a safe and robust healthcare system moving forward.
According to the *Eurocare-5 study, survival rates in England lag behind the European average for particular cancers, such as kidney, ovarian and bowel cancer. It is also clear that the earlier a diagnosis is made and treatment options considered, the better the outcome.
The findings of the review at Watford General Hospital show a failure within the Trust to follow NHS processes. The wider issues are the need for both public education to seek medical treatment at the earliest possible point, and for the NHS treatment provided to be robust. Individual patients should not fall out of the system because of missed appointments, or administrative error. The focus should always be on the patient's needs, ensuring that tests are done, a diagnosis is made and treatment carried out as soon as possible.
Whilst sweeping changes have been recommended in report after report, we must ensure that action is taken to remedy problems found. A year on from the Mid-Staffordshire NHS scandal, another review published only last week by Nuffield NHS Trust has said that financial barriers could hamper their ability to deliver widespread change. This cannot be the end of the matter - if a safe service cannot be provided, it should not be offered.
While resources may be limited, it seems that there is a growing acceptance that adopting a culture of openness and honesty is critical and will in time bring about improvement.
Suzanne Trask is a partner and medical negligence specialist at Bolt Burdon Kemp
*Published in The Lancet Oncology, Volume 15, Issue 1, Pages 23 - 34, January 2014, which refers to patients diagnosed up to 2007