PERFORMANCE: Hundreds of patients waiting to start treatment at the Robert Jones and Agnes Hunt Orthopaedic Hospital were excluded from its referral to treatment waiting list on a monthly basis, an independent review has revealed.

  • Patients excluded from FT’s RTT list between December 2013 and January 2015
  • Deloitte review found this had the effect of performance being “overstated on a regular basis”
  • Specialist trust has made changes to improve its reporting procedures

The foundation trust commissioned consultancy Deloitte in March to carry out the review, which said patients waiting to start treatment were excluded from the waiting list over 14 months.

Between December 2013 and January 2015 an average of 424 patients, predominately those who had already been waiting over 18 weeks, were excluded from the list every month, the review found.

This had the effect of boosting the trust’s average monthly performance against the 92 per cent incomplete target from 85 per cent, which included the excluded patients, to slightly over 92 per cent.

Monitor is already investigating the trust over patients waiting too long for treatment and the accuracy of its reporting.

The regulator also investigated the trust in 2013 for its “persistent failure” to meet the 18 week targets.

Between April 2014 and January 2015 the trust narrowly met the incomplete target every month. However, in February it “became aware of inappropriate exclusions” and its performance fell to 83 per cent once these patients were included.

Deloitte found that exclusions were also applied to the admitted pathway on an “ad hoc basis”.

The review said: “The group of exclusions and validations had the effect of removing records, predominantly breaches, from the monthly performance submission. The impact being that the performance against the incomplete indicator was overstated on a regular basis.

“It is clear that the impact of removing the records under the exclusions improved the performance above the 92 per cent national target… As such, it is clear to see that without the removal of these, the trust would not have met the national target for this indicator.”

The exclusions criteria was devised by the director of operations, who has now left the trust. Deloitte did not interview them for the review.

The excluded patients were listed on a monthly sign off sheet signed by the patient access manager and one of the director of operations, the director of finance or director of nursing and service delivery.

A deputy director of operations was recruited in February to replace the director of operations, but left just one month later. A trust spokesman said they had left for “personal reasons”.

The review concluded that the “majority” of exclusions “automatically applied” by the trust “were not in line with RTT guidance or the trust’s patient access policy”.

The consultancy also found that some excluded patients had been listed as “patient cancellations” when there was no evidence of a patient cancelling an appointment or being discharged back to primary care.

George Rook, patient activist and a member of the trust’s patient panel, said the trust had “categorically denied” to him last year that any data submission rules had been broken.

He added that a “brave whistleblower” had brought the data inaccuracies to light. Concerns had been raised at board level but these had been “ignored or dismissed”, he said.

FT chief executive Wendy Farrington Chadd said: “We are committed to delivering outstanding patient care and we acted to address concerns over the reporting of our performance against the RTT standards immediately in March 2015. We amended our recording procedures and reported the issue to Monitor ourselves and our 2014-15 reported performance was adjusted to reflect these changes. 

“As a board, we have been assured that correct reporting procedures have been followed since March.”

Ms Chadd said the board agreed to take forward all the recommendations within the review and “huge progress” has already been made in making improvements through its action plan.

Caron Morton, accountable officer of Shropshire Clinical Commissioning Group, said the CCG’s priority was to make sure the trust does “all that is required to ensure patient safety and to implement the action plan in full”.