As we use the time of reflection gifted by the Covid-19 pandemic to imagine a better world, will any attention be given to the harm caused by the cover-up culture rampant in the NHS? The present system of accountability for all public services, not just the NHS, is not fit for purpose as so recently demonstrated by the Health Service Journal. Without accountability you get impunity.
Revealed: The serious care failings the NHS tried to keep secret
By Alison Moore25 June 2020
- Vast majority of safety reviews never made public, contrary to guidance
- 70 external reviews at 47 trusts over three years
- Regulator not given reports despite Kirkup ruling
The NHS has kept secret dozens of external reviews of failings in local services – covering possible premature deaths, unnecessary and harmful operations, and rows among doctors putting patients at risk – an HSJ investigation has found.
At least 70 external reviews by medical royal colleges were carried out from 2016 to 2019, across 47 trusts, according to information provided by NHS trusts.
More than 60 of these have never been published – contrary to national guidance – while several have not even been shared with the Care Quality Commission and other regulators. These include reviews which uncovered serious failings.
The reviews – generally known as royal college reviews or “invited reviews” – are commissioned by local trusts from national medical royal colleges for the relevant speciality, which receive a fee for the work.
It emerged in January that a 2016 report into East Kent hospitals’ maternity services — subsequently the subject of major national concerns — was not seen by the CQC until 2019, and was not published.
Bill Kirkup’s review into the Morecambe Bay scandal in 2015 recommended trusts should “report openly” all external investigations into clinical services, governance or other aspects of their operations, including notifying the CQC.
Since then the CQC has asked trusts for details of external reviews when it reviews evidence, and in July 2018 it began to ask for copies of their final reports.
But HSJ’s research suggests this does not always happen. Trusts were only able to confirm to us for 14 of the 70 reviews that they had been shared with the CQC. Many would not say or could not find evidence of whether they had done so. Several said they had informed the CQC but had not been asked to submit the final report.
James Titcombe, the patient safety campaigner whose son’s death led to the inquiry by Bill Kirkup into the Morecambe Bay maternity care scandal, said a review was now needed of whether its recommendations had been implemented.
“It is not acceptable that five years [on], there are still secretive royal college reports and patients are kept in the dark,” he said.
He said it was “really concerning that so little has happened” in ensuring the CQC was informed of findings. “Where are the patients in this? How are patients who are using these services meant to know about serious concerns which are being uncovered?”
Trusts which did not send review findings to the CQC included:
- The Royal Cornwall Hospitals Trust – the subject of four reviews in three years – said only two reviews were shared with the CQC, while the other two missed the timeframe for which the CQC had requested information.
- Kettering General Hospital Foundation Trust said there was not enough space to include a 2017 report into breast services in its CQC return, as only six documents could be submitted.
- Dartford and Gravesham Trust, which had commissioned three reports, two of which have been completed, said: “It would not be normal practice to inform CQC when commissioning reports.” It later added that it “has regular contact with its CQC nominated engagement lead where information, incidents of concern and progress on action plans is shared”.
- Rotherham FT said there was no “statutory requirement” to share a report into ophthalmology it commissioned in 2016. Its medical director said: “I can confirm that this report has not been included in any CQC [provider information requests]. The report was commissioned by my predecessor and we are unable to confirm if he made the CQC aware of this himself.”
Details of the reports have now been released to HSJ in response to Freedom of Information requests, although many were redacted.
The majority are what are known as “invited reviews” – where a trust has called in a royal college because of concerns about care problems in a particular service. In some cases, trusts may ask for a review of a particular medical consultant’s work or a review of options for a service’s future.
The CQC indicated trusts should share findings. Chief inspector of hospitals Professor Ted Baker said: “There has always been a clear expectation for trusts to be transparent where they know there are significant issues with the quality of their services…
“Our inspection teams are in regular communication with trusts outside of inspections and as part of that regular engagement we expect trusts be open and honest with us about any concerns or issues.
“Inviting an independent review is a proactive step towards improving care and we regard it as evidence that the trust is addressing quality concerns.”
The Academy of Medical Royal Colleges said its “operating principles” for “invited reviews” state that where there are care quality issues, the trust involved should make public a summary of the report and actions it plans to take. It also says that royal colleges have a responsibility for ensuring serious patient safety issues are shared with regulators either by trusts or by taking action themselves.
AOMRC chair Carrie MacEwen said: “It is important that organisations commissioning a review are aware of the framework and we expect that all involved in reviews would follow the principles in the document.”
Information released to HSJ and other sources