Essential insight into England’s biggest health economy, by Ben Clover

The worst scan problems in England

London trusts were three of the four with the biggest backlogs on radiology reporting, the Care Quality Commission recently reported.

The first thing to say is radiology reporting is complex, and not every late report is a patient who didn’t receive a diagnosis. In most cases they likely did, it just wasn’t signed off in the system.

The point is if your records are not good enough to tell whether someone has completed their treatment, or even if they have had their scan results, it will appear that you have a serious problem – and you won’t be able to prove you do not.

A similar thing happens in lots of performance data, particularly elective waiting times.

All three trusts’ radiology reviews found no one had come to harm. Great news but it’s fair to say the NHS’s harm review processes are not universally admired.

And let’s remember, people died needlessly in Portsmouth from cancers that were treated late because of radiology delays. Some were a year late in being looked at and the trust had a backlog of 23,000, the CQC found.

King’s College Hospital Foundation Trust had the single biggest backlog in the country at 33,400 when the CQC carried out its audit in December – more than the next three trusts combined.

The teaching hospital trust still has 13,000 “non-urgent” images to work through and said urgent images and suspected cancers were being prioritised for 48 hour turnaround.

It said monthly harm reviews had not yet picked up any patient harm, and it had outsourced some of the work and recruited radiologists.

It would not confirm how long its longest waiter had been missed for, something Lewisham and Greenwich Trust was able to do.

Some of L&G’s 8,300 unreported images went back as far as January 2017.

As of the end of July it had only 1,200 non-urgent left to check and like its neighbour King’s had outsourced some of the work while hiring more staff.

Neither trust specified what had caused the backlog in the first place. Whether the backlogs developed gradually or were discovered following a change in reporting methodology (common with referral to treatment hidden waiters) is not known, but either would be worrying for different reasons.

Chelsea and Westminster Hospital FT doesn’t normally feature on problem lists, but had 15,000 unreported images, according to the CQC’s data.

The trust was candid about the cause, putting the blame on the WannaCry cyber attack which hit organisations across the NHS (and world) in May 2017.

The clinical review process again found no one had come to harm.

Not so cash-strapped after all?

King’s has had an interesting 12 months in performance, finance and governance terms – but there is one way in which it is really pretty fortunate.

Even as it was going off the rails financially it still managed to get its new critical care unit funded. Late and reportedly significantly over-budget, it is due to open at some point over the summer. A second stage will see a further set of beds opened in 2020.

The 60 bedded unit was supposed to cost £30m and has come in more like £70m, London Eye understands.

This huge capital investment from the centre might be a little galling for some of the other trusts in the capital with arguably no less worthy schemes languishing for lack of funds.

This is a trust that ended 2017-18 with a deficit of £132m.

To be fair, the strain on London’s critical care base was becoming dangerous, and the new unit will double the trust’s capacity.

But there is another potential issue with the unit: having sufficient step-down beds when patients are moved out of it. London Eye understands this question has not resolved.

Another question that needs answering: why haven’t we seen the PwC report into what actually went wrong in the trust’s finances for 2017-18? It’s been finished for a while but is being clutched tightly.

Pathology novelty

Pathology has always been hard to organise/reform. Lord Carter has been pushing that agenda for roughly a decade (declared interest: he is chairman of a north London NHS pathology LLP that works with the Royal Free and University College London Hospitals).

NHS Improvement has run into significant difficulties as its suggestions for how pathology services should be networked went out into the regions.

London was no exception. It is home to one of England’s two hold-out trusts, who have rejected the regulator’s plans altogether. Epsom and St Helier University Hospitals Trust on the London/Surrey borders was always going to have more options than an inner London trust and could feasibly look outwards across the Home Counties for trust(s) to partner with, rather than being lumped in with the rest of south west London.

But far stranger is East Sussex Healthcare Trust, the other hold-out. The south coast hospital trust’s proposed partnership is with the south east London trusts. Guy’s and St Thomas’ FT and King’s have their pathology services run by Viapath – a joint venture between the FTs and Serco. Maybe it is not such a stretch, given the partnership has provided services to Bedford Hospital since 2009 (the 10 year contract is up next year). The nature of NHS Improvement’s objection to the counties-spanning plan is not known.