• Report reveals measures taken to resolve differences between staff at King’s Health Partners Haematology Institute
  • Follows row over patient safety in prestigious joint programme
  • Data indicates programme not outlier on mortality

Managers hired a behavioural psychologist to work with senior clinicians from two trusts whose disagreements about clinical practice had undermined a prestigious joint transplant programme.

The transfusion and transplant teams working at the King’s Health Partners haematology institute in south London “did not have an effective way to resolve issues and conflict at local level without significant escalation”, a report released to HSJ under the Freedom of Information Act said.

The report added that “a behavioural psychologist is conducting a data gathering and gap identification process” focusing on transfusion and transplant teams, which will “seek to expand and deepen existing collaborative practices”.

The teams from King’s College Hospital Foundation Trust and Guy’s and St Thomas’ FT had disagreed about the safety aspects of a procedure — a row which saw GSTT refer some patients to other centres instead.

The KHP haematology transplant programme is one of the largest in England and was consolidated on the King’s site in 2011.

However, in 2017 and 2018, “concerns about the quality of some aspects of the transplant programme prompted the sharing of letters between the two acute partner trusts”.

The analysis in the report, delivered in July to the trusts’ boards, said because of the “previously expressed quality concerns” and the relocation of some staff back to GSTT facilities, some changes to referrals were anticipated.

However, it added: “A review of data for equivalent periods in 2018-19, compared to 2017-18 has indicated that these changes have been more material than previously considered, and are larger than would be expected from natural fluctuations from year-to-year.”

Earlier this year, a GSST spokeswoman said some patients had been transferred instead to the Royal Marsden FT or University College London Hospitals FT.

The paper obtained by HSJ said the aim of the plans set out in the report was to “increase transparency, accountability and trust between the different parts of KHP’s transplant service” within six months.

It acknowledged key risks to achieving this were “challenges within the transplant team and clinician bandwidth to engage in the process — particularly one-to-one interviews”.

Part of the disagreement between the two trusts was over safety concerns raised by GSTT. The report said “targeted” work on mortality rates over the preceding 18 months and a “detailed review of mortality did not reveal evidence of excess mortality given the high-risk population that received transplants”.

Data from the British Society of Blood and Marrow Transplant also found KHP’s results were within the expected range.

The centre was endorsed by the European body which accredits haematopoietic stem cell transplantation in 2018, which allowed it to be signed off by NHS England as treatment centre for CAR T-cell therapy.

However, the European body — the Joint Accreditation Committee ISCT-Europe — had “significant concern regarding the estate for haematology outpatients”, the July report said.

The next JACIE inspection was expected in October or November of this year and the report said it was “mission critical that a remedy was in place”.

HSJ asked KCH if the estates issue had been resolved but received no reply.

NHS Improvement had refused to grant funds to KCH for the institute in 2018 because the trust was in special measures, a report to the GSTT board said.

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