North by North West: Patient safety or administrative convenience?

The Northern Care Alliance is trying to resist pressure to contact all patients treated by its disgraced former spinal surgeon, John Williamson, over his 23-year career.

Two separate reports established clear problems with the techniques used by the former head of the spinal division at Salford Royal Hospital, which caused avoidable harm to multiple patients.

There were also issues around probity and duty of candour by Mr Williamson, as well as major governance failings by the hospital, which meant many of the harms were not exposed until years later.

In 2022, the trust began a process to review patients who received surgery from Mr Williamson, starting with his last five years at Salford, from 2009 to 2014. Cases from earlier years which had reported incidents, complaints or litigation were also included.

The initial plan was to review further five-year tranches, going right back to 1991, but after the first stage of the work, senior members of the review team decided to shelve the process.

They said no additional themes were likely to be identified, and cited practical issues in looking back further, such as the availability of records and imaging, and being able to contact patients.

Instead, the trust has issued general invitations via the media to anyone with concerns about the care they received, for their case to receive a desktop review. The trust said 31 patients had responded and the cases were being worked through.

Some members of the review team disagreed with this approach, however, and wanted the trust to continue the reviews, especially from 2004 to 2009.

Glyn Smurthwaite, an anaesthetist who was part of the team and recently retired, told NxNW it was essential to contact all patients, saying some may continue to suffer problems with their spine due to surgery by Mr Williamson, yet be unaware of the problems now recognised about his practices.

He says the issues around Mr Williamson’s probity make this especially important, as incidents may not have been recorded at the time, meaning concerning cases from pre-2009 would not have been picked up.

The national framework on recalling patients, while probably vague enough for the trust to defend its stance, stresses patient safety should be at the forefront of the process.

The decision to set a 2009 cut-off date feels arbitrary, while the practical issues cited around patient records appear unconvincing.

Royal Manchester Children’s Hospital, where Mr Williamson also practised from 1991 to 2011, also happened to look back at a five-year period, from 2006 to 2011 (which suggests there is value in looking at least as far back as 2006).

Is it really patient safety that’s encouraging both hospitals to limit their reviews to five years, or is this more about administrative convenience?

Compounded

Concerns about the NCA’s approach to patient safety were compounded last week when it emerged the trust had launched a major redundancy process affecting its corporate services.

The process is expected to cut service costs by 20 per cent, and headcount by around 14 per cent, with at least 100 positions set to go.

Teams in scope include patient safety, patient experience, complaints and PALS, which all feel rather important at the moment.

A&E

Most trusts in the North West did their bit to drive improvement on accident and emergency performance in March, after NHS England said it was crucial to restoring confidence in the service.

However, national leaders will have noted the few exceptions.

The importance of achieving the A&E target was rammed home in numerous meetings over the last few months, including an offer of financial incentives. Then right at the end of February, CEOs and chief operating officers were even sent a form to sign, committing to deliver 76 per cent performance in March.

The reason for the panic was never fully explained. But with a consistent narrative of the NHS failing to meet expectations, NHSE and ministers badly needed a key target to be hit, even if it was only for the final month of the year.

But despite the efforts and a significant improvement, the service still fell short, reporting an average of 74.2 per cent of cases meeting the four-hour standard in March, up from 71 per cent in February.

Only two acute trusts in the North West delivered 76 per cent – East Lancashire and Blackpool – but 13 others delivered an improvement close to or exceeding what was needed to meet the target nationally.

Black marks will go beside the four trusts which reported a decline in performance: Tameside and Glossop Integrated Care; Wirral University Teaching Hospital; Mid Cheshire Hospitals; and Lancashire Teaching Hospitals.

Wirral said its efforts were hampered by difficulties in securing admissions for mental health patients which hadn’t been experienced in February. The others did not respond.

Positive thinking

NHS boards always try to put a positive spin on their performance, but leaders in the Lancashire system went a little overboard this month.

The integrated care system – which includes the providers – planned a deficit of £80m at the start of 2023-24 but is now set to end the year £230m in the red. That’s among the worst variances to plan in the country.

In comparison to the previous year, L&SC’s deficit has more than tripled, while the combined deficit for all ICSs has only doubled.

However, non-executive director Jim Birrell thought this was “actually quite a good performance” as the system had started to deliver “solid savings”. “I don’t think we’re deteriorating as a system now, which is not the case nationally,” he added.

Indeed, the system has significantly improved its CIP delivery, but it was starting from a low base and still lags behind its neighbours.

Chief finance officer Sam Proffitt suggested the solutions were obvious because if the system focusses on clinical transformation and improvement the “money will follow”.

But I’m not sure it’s realistic to bridge that £230m financial gap simply by focusing on service improvements. It will surely need some pain and trade-offs along the way.