Agenda item

Attending for this Item from Worcestershire Acute Hospitals NHS Trust (WAHT) were:

Rab McEwan, Chief Operating Officer

Julian Berlet, Divisional Medical Director

Caragh Merrick, Chairman

Lisa Thomson, Director of Communications

By way of presentation, the Chief Operating Officer provided some background to the issue, the action already being taken and the plan moving forward.

In July 2016, the Care Quality Commission (CQC) held an unannounced inspection of Radiology, which found a backlog of X-rays yet to be reported on by Radiology, including 5,574 from January to August 2016 and 6,986 from 2014-2015.

WAHT had since developed an action plan, which would tackle the backlog and clear the 2016 films by October 2016.   The Trust had also commissioned the Royal College of Radiologists to undertake a review to ensure best practice was being followed.

Although a clinically led review in 2013 suggested no harm could be found as a result of delays in radiology reporting, a formal harm review would be now conducted and as the backlog was cleared, any incidental findings would be logged for review on national software (DATIX).  If any potential harm to patients was identified it would be reviewed by the WAHT Quality and Governance Committee.

Since May 2016, when WAHT became aware of the increasing backlog, 8 radiographers had been successfully recruited and a Consultant Radiologist was currently being advertised.  In addition, in July 2016, 500 X-ray reports per week were outsourced for reporting, with the figure doubling from August.  Demand and capacity was under constant monitoring and regular updates were being provided to CQC.

It was reported that the current situation was more positive, with no further 2016 plain film X-rays outstanding, however, 1,000 images would not be reported on in this programme as the patients had subsequently died.

In the following discussion, the following main points were raised:

·         It was clarified that all X-rays are looked at, with the requesting Clinician initially looking and assessing the X-ray.  The backlog refers to the Radiologist reports, where they would do a second report to confirm the Clinician's assessment and look for secondary information, which may be out of scope of the Clinician's expertise

·         It was also clarified that all GP requested X-rays were reported on in a timely manner

·         The volume of work was increasing, including the more specialist work of MRI and CT scans for example.  The picture nationally was similar to that of Worcestershire and there was a recruitment concern across the profession.  Members commented that the review of Acute Hospital Services could only add to the issue, however, were pleased to hear that 8 Radiographers had been recruited

·         Concerns were taken seriously and there was a duty to provide assurance to the Trust Board, patients and all stakeholders that the situation would not be repeated.  Governance arrangements had been strengthened and by working with the Royal College of Radiologists, there would be no repeat of the extensive backlog experienced.  Despite this, Members felt that there was some way to go to reassure patients

·         The backlog was to be cleared in a specific order, with 2016 films being reported first, followed by those from 2015.  Films from before 2013 would not be reported on, however, Members were reminded that in the vast majority of cases, the images would have been seen by the ordering Clinician

·         When questioned why it took a Whistleblower to highlight the issue, it was stated that there was growing management concern from 2013 and despite measures that had been put in place, WAHT could not cope with the increasing demand.  From here on, it was suggested WAHT would compare favourably with other Trusts

·         From the CQC inspection, one of the required outcomes was a need to agree a set of standards with Clinicians and abide by them.  This change in policy was suggested to be a clear message which was now understood.  The Standard was for routine reporting to be undertaken within 2 weeks or within 48 hours if urgent

·         Some Members were concerned with the risks associated with the delay in reporting and were informed that a harm review had been undertaken and would be repeated later in the year.  Patients and their GP's would be contacted if there was anything untoward

·         In relation to the 1,000 films which were not reported on and patients had subsequently died, it was clarified that they would be reviewed in due course but the Trust was not expecting to find significant levels of harm

·         One Member queried whether any equipment failures had influenced the situation, to be informed that was not the case

The Chairman of Healthwatch Worcestershire was invited to comment on the discussion and stressed that Healthwatch was equally concerned with the evolving situation.  However, it was important to move on and ensure that it does not happen again.

The newly appointed Chairman of the Trust, Caragh Merrick, stressed that patient safety was non-negotiable and the perception of patient safety was vital.  It was a regrettable situation, however, moving forward, lessons had been learned and a clearer governance arrangement was now in place.

The HOSC Chairman thanked all those present for a useful discussion and called for a further update at an appropriate time in the future.