Three patients died after delayed cancer tests at teaching hospital

A harm review investigation into delays in diagnosis for patients at the Princess Royal University Hospital in Bromley, south London, was carried out after a backlog of patients was uncovered in May.

Newly published minutes show that a September report to the quality assurance and research committee of King’s College Hospital Foundation Trust, which runs the hospital, said a backlog of more than 1,000 patients requiring endoscopy had been identified.

It also said that a review of the harms to patients affected — which “focused on [those] that had a confirmed cancer” rather than reviewing all cases — identified: three deaths, eight cases of “severe harm”, and three cases of “moderate harm”.

The trust told HSJ today that the number of cases of severe harm as a result of the delays had since been revised to seven, and that these included the three deaths. 

A spokesperson added: ”The cases were externally investigated with serious incident reports… Ten patients have been identified, 7 (not 8) were judged to have had serious harm, 3 of whom died.

“Three patients were judged not to have come to harm, on the basis that the endoscopy delay did not alter their treatment.”

He said all severe harms including deaths related to cases in 2018-19 and 2019-20, and that duty of candour has been completed for all cases in which there was moderate/severe harm.

The trust’s report on the issue, sent to directors in September and disclosed in recent board papers, said the trust’s legal department should be informed about the cases brought to light by the review.

Another set of newly published minutes, from a meeting on 26 November, indicated that harm reviews still needed to take place for a much larger group of patients, who are thought to be those whose endoscopy was delayed, but who have not since been diagnosed with cancer.

The minutes said the trust estimated 8,500 patients still required a harm review. “This will demand a significant amount of additional resource,” they said. “Provided that the additional resource can be identified, the reviews should be completed within three months.”

A report on the trust’s risk register said the long waits were “due to insufficient capacity to manage increasing demand from colorectal and gastroenterology services and urgent referrals being treated as routine”.

In July HSJ reported the trust had declared a serious incident over the backlog.

Minutes said the trust had now improved performance with extra weekend capacity and the diagnostic backlog had dropped from 685 in May to 304 for the week ending 10 November.

The “endoscopy recovery programme” involved spending £1.5m on a private sector decontamination unit for endoscopes, and leasing other scopes. A longer-term plan for increasing capacity at the hospital had “yet to be agreed”, the papers said.

A King’s FT spokesperson told HSJ: ”We accept that the trust has not met the expectation of providing quality and safe care and have apologised to the patients and their families. Additionally, we are currently reducing the backlog of patients waiting for an endoscopic procedure.”

Endoscopy capacity at the PRUH has been an issue for two years with a business case for more decontamination facilities going to the board in November 2017.

In February 2018, the trust admitted it had a problem with PRUH endoscopy performance as its beds were used as overflow for patients coming through the emergency department.

The trust transferred some of the endoscopy work to Croydon Health Services Trust.

The February board report also said: “A significant number of patients were having endoscopy appointments cancelled because of faulty machines.” It said radiology services were also “unable to meet demands from cancer and emergency pathways at PRUH, impacting on waiting times”.

The trust appointed a new chief operating officer in April after waiting list problems across its whole elective workstream.

St George’s University Hospitals FT admitted last month that three people had died after failings in its radiology department.