Review into Heart of England Trust uncovers “secrecy and concealment”


    Ian Paterson, a surgeon who worked at Good Hope and Solihull hospitals from 1998 until he was suspended by HEFT in 2011, flouted clinical guidance by leaving behind tissue for cosmetic reasons during mastectomy operations.

    His procedure, which became known as a “cleavage sparing mastectomy”, was not a recognised procedure and his patients did not properly give their consent. Leaving behind tissue increases the risk of cancer recurrence.

    4.41pm One year survival rates for lung cancer are improving but female incidence rates are increasing according to figures from Public Health England’s National Cancer Intelligence Network.

    Between 1990 and 2011, almost 720,000 people were diagnosed with lung cancer in England. During this time, the number of male lung cancer diagnoses declined, whereas the number of female lung cancer diagnoses increased.

    The sharp decrease in the incidence of male lung cancer over the past two decades reflects the decline in smoking prevalence among men. However, due to the rise in women who took up smoking after World War 2, the incidence among women continues to increase according to PHE.

    4.23pm The BBC reports that a stress gene has been identified that could increase the risk of heart attacks

    US researchers said that those with the gene had a 38 per cent increased chance of a heart attack or death.

    3.54pm Some interesting reader comments on the story about ambulance queues outside A&E.

    “Here we go again - there is NO evidence that patients are queuing at A&E because they cannot see a GP - the problem with A&E is that we are seeing increasing numbers of frail elderly being shipped there as a default “place of safety” (haha) because NHS England is doing little to facilitate proper integrated care in the community. There are too many perverse incentives in the system for big providers NOT to engage in such activity. Give us the tools to provide integrated care with nurses paramedics and GPs all working for the same team (instead of for the ridiculous number of different organisations which only create boundaries instead of joint working) and we will be able to tackle this problem. This is all the natural end result of the flawed market approach to state funded healthcare provision.”

    “How many times have we been here before? Why have the solutions of the past not been sustained? Yet again we are reinventing the wheel. It is a whole system problem which cannot be resolved by just ‘sorting’ A&E or GP access. It involves every partner in the local community working together to do their bit and not dumping on each other - it’s a vicious circle of poor demand management in primary care, poor GP access, NHS 111 signposting, A&E being clogged with patients who are not being supported where they should be e.g. mental health, social care; inefficient processes in A&E and admissions, bed blocking because of inadequate social services and intermediate care and so it goes on…… The sooner we move to integrated providers and pathway commissioning the better.”

    “Nothing to do with A&E really. I’ve seen hardly any delays to ambulance turnarounds caused by lack of A&E nurses or poor A&E performance in my experience. It is just universally due to the fact that the A&E is full and that’s because patients whose A&E care is complete cannot be moved on to a ward space. If we can’t get ‘em out, then we can’t get ‘em in. I’m not sure it could be any simpler to understand. Of course tackling it … ah, well, now that’s another thing altogether. Ward rounds everyday starting at 08:00 on the dot. Seeing the potential discharge patients early on rather than in order as you go, doing the TTOs as you go rather than batching at the end, using the discharge lounge etc - still a ways to go on all of that stuff in most places I’d suggest.”

    “It would also be helpful if the ambulance services could accurately record handover times - certainly a problem in our region. You may well find that the majority of reported handover breaches aren’t recorded accurately and therefore aren’t actually breaches at all.”

    3.17pm In response to the CCG allocations announcement NHS Clinical Commissioners has said that it is pleased that NHS England has recognised the need to give all CCGs allocations that are as a minimum, flat in real terms, but also gives above inflation increases for those CCGs furthest away from their ‘target’ funding levels.

    The decisions made this week and published today by NHS England affect the next two years’ worth of allocations. NHSCC said it will be incredibly tough for all parts of the health system -  with CCGs facing  efficiency challenges over the next two years of making savings of  9 per cent -  alongside all of their other expectations.

    Dr Amanda Doyle, Co-Chair of the leadership Group of NHS Clinical Commissioners, said: ”Overall, while this is positive news for CCGs who will not see a decrease in their budgets for the next two years with funding prioritised to the areas historically underfunded, it will still however be challenging for all.

    “We already know from the recent NHSCC  ‘ways of working’ survey that CCGs are directing part of their  limited resource towards supporting the commissioning of primary care, which they are not currently resourced to do, but essential  if they are to work towards transforming primary and community care.

    “NHS Clinical Commissioners calls on NHS England to look flexibly at where the resource for  the commissioning  of primary care sits so that CCGs do not see a reduction in their running cost allowance during a time when they are taking on more responsibility, not less.

    “Not to do this would be short sighted and risks CCGs being impotent in delivering what they have been established to do in transforming care and improving health outcomes for their local populations.”

    Also commenting about the allocations for commissioning, Dr Charles Alessi, interim chair of NHS Clinical Commissioners, said: “CCGs must  be sufficiently resourced to enable them to focus energies on service transformation and on realising the significant efficiency challenges expected of them.

    “The reduction in running costs  announced for 2015/16 will not help CCGs to achieve this.”

    3.01pm In a round-up of our best of 2013 we focus on international best practice, including how the earthquake in Canterbury, New Zealand prompted improvements to the region’s health service.

    2.55pm Colchester Hospital University Trust’s cancer services, which are also being investigated by the police, have been found “unsafe” in five areas, NHS England has announced.

    NHS England carried out an immediate review into the quality and safety of cancer services at the trust, after a CQC inspection found cancer patients’ records had been changed to fit with waiting time targets.

    It found cancer services were unsafe in five areas: urology, cancer of unknown primary origin, sarcoma, brain and central nervous system and skin cancers.

    2.38pm At least 30 NHS trusts employing around 140,000 people will be helping their staff to go alcohol-free at the start of the new year, marking the launch of the first co-ordinated Dry January campaign within the NHS.

    NHS Employers and Public Health England are working with Alcohol Concern to take the charity’s Dry January campaign into the heart of the NHS.

    Lost productivity and absenteeism due to alcohol costs the economy 17 million working days and £7 billion a year. It is estimated that around a quarter of people in the UK drink above the lower risk guidelines.

    Dean Royles, chief executive of NHS Employers, who himself will be alcohol-free throughout January, said:

    “It’s hard to talk about alcohol consumption without sounding like a killjoy at Christmas time, when people’s shopping trolleys are filling up with festive favourites. It is a really important health issue and right that we help set a good example.

    “This season is always tough on the NHS and alcohol plays a big part in this. It increases demand on A&E and puts pressure on staff, who want to enjoy the celebrations without it affecting their life-saving work. The alcohol consumption of NHS staff is pretty typical of the wider population but I’m confident many will go the extra mile and have a Dry January, helping signpost others to change where alcohol has become a habit. The health and wellbeing of staff is important to us and this is just one way we can help the NHS show leadership in an important public health debate.”

    2.35pm A reader comment on our story summarising chief executives’ thoughts on the acute sector sheds some light on local level issues:

    “My hospital is under more pressure than ever. It has implemented its winter plans but still the patients keep coming in ever increasing numbers including ambulance conveyances up 5% on same time last year. At other end of patient pathway the number of over 30 day lost is at an all time high, majority of whom have no medical need to be there. Our CCG tells us it can only focus on one thing at a time and that it is trying to reduce elderly admissions, which they are spectacularly failing to do. Meanwhile the community hospital is closed due to D&V and has been for some time and social services seem to operate to their own agenda, promising support but failing to deliver. The named GP will help only a limited number if any and anyway it’s not yet in place. How is the £400 million being spent and by whom and where is the evidence that this is enough indeed it’s unlikely it can be deployed quickly enough to make a difference. Meanwhile hospitals are blamed for things way outside their control yet continue to deliver as high a quality service as possible. I think the CEOs in your survey are being overly optimistic- how well are health economies coping - I’d give it a 2!”

    2.29pm Elsewhere in our comment section Matthew Swindells say that open source technology in the NHS is much discussed but little understood.

    1.53pm Over in our comment section, Simon Stevens (not the incoming NHS England chief executive) highlights some issues that his namesake might have to consider.

    1.27pm Here is the full Kennedy review into Ian Paterson’s surgical malpractice.

    1.21pm The Royal College of Surgeons has responded to the Kennedy Report released today, where surgeon Ian Patterson was found to have performed unregulated procedures on breast cancer patients.

    RCS Council member and lead for patient safety Clare Marx said: “This report reveals an appalling breach of patient trust. Patients rightfully expect to be treated with dignity and trust those charged with looking after them.

    “The systemic failure of all those involved shows how crucial it is to have appropriately trained staff, at all levels, ensuring that concerns are raised and acted upon at an early stage. It is profoundly disturbing to hear that, yet again, a series of failures that could have been avoided have led to serious patient harm.

    “The College offers an invited review service that provides independent, professional advice on surgical services to trusts. We were not approached by the trust concerned to look into Mr Paterson’s practice. Our service can help managers, surgeons and other healthcare staff to promote the right action at an early stage and act in the best interest of patients.

    “It is vital that managers and all those involved clearly set out how they intend to take forward the recommendations in this report to ensure a tragedy on this scale never happens again.”

    1.08pm Gooroo and NHS England have released the latest waiting time figures. Here are the key findings:The number of patients waiting over 18 weeks has slightly risen, from 168,951 in September to 169,175 in October.

    However, the number of patients waiting over 26 weeks, 39 weeks and 52 weeks has gone down. This is most notable for patients waiting over 52 weeks, from 386 in September to 256 in October.

    Admissions are up since last month, from 309,388 in September to 336,192 in October.

    12.37pm “Weak and indecisive” bosses at Heart of England Foundation Trust covered up failings by a surgeon reports The Telegraph.

    An independent review found that Ian Paterson was able to perform unregulated “cleavage-sparing” mastectomies at Solihull Hospital and Good Hope Hospital for fifteen years despite an internal review in 2004 raising concerns about his work.

    Nearly 1,100 women have been recalled to the trust because they may need further treatment.

    12.28pm The Centre for Workforce Intelligence has published ‘Think integration, think workforce: three steps to workforce integration’.

    Aimed at workforce leaders and senior workforce specialists, the paper identifies a range of workforce implications arising from integrating health and social care and identifies steps to support workforce integration.

    The paper identifies three steps for workforce leaders to promote integration from a workforce perspective:

    • Be clear about the local integration agenda, including the various routes to integration.
    • Address the integrated workforce management challenge to ensure the right people with the right skills and behaviour are in place to deliver integrated services around individuals’ needs.
    • Implement successful workforce change by addressing a range of operational and strategic questions by taking an inclusive approach.

    The CfWI worked with the Institute of Public Care at Oxford Brookes University.

    Keith Moultrie, Director at the IPC said: “Integration is not a panacea - but better joined up services offer the potential for better outcomes for service users. Our paper explores different approaches that can be taken to integration, and explores how leaders can use better workforce management as a fundamental factor in making integration work.”

    12.13pm The government has published amendments to its Care Bill to enable it to implement the Better Care Fund, under which CCGs will be required to pool part of their budget with local authorities for the purpose of integration.

    The amendments are listed at section NC2 in this document.

    12.08pm Cancer services at Colchester Hospital University Foundation Trust have been found “unsafe”, amid a police investigation that staff felt bullied into manipulating cancer waiting time data.

    NHS England found cancer services were unsafe in five areas: urology, skin cancer, brain cancer, sarcoma, and radiology.

    It reviewed hundreds of cancer cases at the trust, after a CQC inspection found the records of cancer patients had been changed to fit with waiting time targets. Police are also investigating whether staff were pressurised into changing patients’ records.

    In a report, NHS England said it identified “a number of serious failings in cancer services organisation management”, including “unsafe information” and “unsustainable levels of staffing in key services”.

    The report added: “More worryingly the immediate review confirmed the CQC finding that some Trust staff had a lack of confidence that concerns would be listened to.”

    12.00pm NHS England chief executive Sir David Nicholson has made a pledge for NHS Change Day 2014 which falls on 3rd March.

    You can watch a video of his pledge here:


    11.52am We’ve just heard that the Secretary of State for Health has approved Monitor’s official guidanceon the NHS Procurement, Patient Choice and Competition Regulations 2013, which implement section 75 of the Health and Social Care Act 2012.

    This statutory guidance is intended to support commissioners of NHS services in understanding and operating the rules around purchasing high quality services for patients.

    Monitor will be publishing the guidance immediately so that commissioners can start to use it in their decision-making.

    We haven’t seen the guidance yet but its imminent publication follows an intense political debate over the implications of section 75.

    Documents will become available later at

    11.45am Fears over proposals by the Office for National Statistics to stop producing annual data on child mortality are being voiced by leading children’s charities, including the Royal College of Paediatrics and Child Health, NSPCC, Lullaby Trust and the National Children’s Bureau.

    The statistics, which cover childhood and infant mortality numbers, unexplained death in infancy, suicides and avoidable mortality, are set to be scrapped as part of a cost-cutting initiative.

    The UK’s childhood mortality rates are amongst the worst in Western Europe, and the charities are warning that without the ONS data, it will difficult to know exactly why children are dying, what policies should be introduced to  reduce unnecessary deaths and whether interventions are working.

    They also point out that no other central body collects this information or has the infrastructure to collate or quality assure such data – and international organisations such as the World Health Organisation use the ONS data to compile international information on child health and well-being.

    Dr Hilary Cass, President of the Royal College of Paediatrics and Child Health, said: “We are gravely concerned at the implications of the ONS no longer producing child mortality statistics. The UK is already lagging behind its European counterparts – with around 2,000 excess child deaths a year compared to the best performing country.  We need robust annual statistics to help reduce that figure by allowing us to delve deeper into why children are dying, propose solutions for preventing avoidable deaths and track progress.

    “Put simply, not producing these stats poses a real threat to improving child health.”

    Those in support of maintaining the publication of annual child mortality statistics by the ONS are being asked to tweet their support using the hashtag: #savethestats

    11.39am In a comment piece on our trust chief executive barometer, Peter Edwards and Sharon Lamb suggest that the findings indicate an acute care sector that is ‘close to the edge’.

    11.36am The Telegraph reports that internet safety filters that are designed to protect children from pornography are also blocking access to sexual health advice.

    Research by BBC Newsnight found that several reputable sexual health sites were blocked, and a number of pornography sites were not blocked.

    Speaking at the regulator’s board meeting, chief executive David Behan said he supported a duty which applied to cases where “serious” harm had been caused to patients, and not just incidents which resulted in death or “severe” harm.

    Mr Behan said “being on the side of patients” had led him to back “a much more comprehensive reporting policy…consistent with serious [harm]”.

    The firm has administered the health service’s electronic staff record system since its inception in 2001 but its current contract is set to end in August 2015, following a one-year extension agreed with the Department of Health.

    “McKesson and its ESR team is extremely proud of its track record of operating the NHS ESR,” a company spokesman said. “With the 10-year ESR contract now coming to a successful conclusion we are looking forward to the new and exciting challenges posed by the forthcoming re-procurement.”

    Chief executive Sir Andrew Witty said the changes were about putting the needs of patients first and “meeting the wider expectations of society” though he did not link them to the allegations.

    Glaxo said it would stop the practice of paying for healthcare professionals to speak on its behalf about products or diseases to audiences who can prescribe or influence prescribing, as well as no longer funding individuals to attend conferences.

    10.40am Here’s an update on the final recommendations for Mid Staffs -

    Accident and emergency services will remain open and a midwife-led maternity unit will be opened at Stafford Hospital, but consultant-led obstetrics services will move to University Hospitals of North Staffordshire Trust.

    Inpatient paediatric services will also move but a paediatric assessment unit will run alongside the A&E.

    10.33am Also in The Times, the family of a British doctor, believed to have been killed in a Syrian prison, has criticised the British government for allowing him to die and not doing enough to bring his body home. Abbas Khan, an orthopaedic surgeon from Streatham, travelled to Syria last year with a humanitarian charity. He was captured by Syrian troops last November.

    Asked to rate out of 10 how obstructive the current regulations were to service change, with one being no impediment and 10 indicating impossibility, the average across chief executives was 6.8.

    Eighty-eight per cent of respondents to the latest HSJ/Capsticks survey of hospital chiefs said securing change to competition and choice rules should be a priority for incoming NHS England chief executive Simon Stephens (see graphs below).

    10.27am The Health and Social Care Information Centre will now include staff earnings and absences in its monthly workforce data round-up.

    10.24am The Times reports on figures from the Health Survey of England, which suggest the London Olympics failed to encourage children to exercise.  According to the survey, fewer children exercised last year than they did in 2008.

    Themi Nkala, senior cardiac nurse at the British Heart Foundation, said: “These disappointing figures show that even an Olympic year could not boost dwindling levels of physical activity in England.”

    10.22am The Care Quality Commission is to inspect more health services provided in the community. Inspections will be carried out by larger teams who will spend more time visiting services.

    The starting point will be inspections of large organisations that are commissioned to provide a wide range of NHS services to local people.

    10.18am A comment piece in today’s Financial Times argues that the pharmaceutical industry’s attempts to positively change its own behaviour have been too slow.

    John Gapper writes that as stricter regulation on the way in which branded drugs are marketed, pharmaceutical companies may be tempted to reproduce ‘murky practices’ abroad in developing markets.

    Such practices include effectively giving doctors financial rewards for pushing their colleagues to prescribe a particular drug.

    10.15am The NHS has a “significant problem” with ambulances queuing at accident and emergency departments waiting to drop off patients, a senior official has said.

Dame Barbara Hakin, chief operating officer of NHS England, was answering accusations that ambulances are “stacked outside A&E departments like planes”.

She told a hearing of the Commons public accounts committee that everything was being done to get ambulances back in service as quickly as possible.

The agreement formally sets out an understanding that the FTN represents the specific interests of all NHS foundation trusts and trusts while the confederation works across the health sector to bring together the different interests across the NHS.

FTN chief executive Chris Hopson said: “A lot of people, both our members and the people we work with, weren’t exactly clear what the distinction between the two organisations was and what we’ve really tried to do is make that very clear.”

10.09am The NHS Trust Development Authority has announced that Dr Anthony Marsh will become the new chief executive of the East of England Ambulance Service from 1st January.

Dr Marsh, who is currently chief executive of West Midlands Ambulance Service Foundation Trust, is being brought in “to accelerate improvement in service delivery and performance and build on the foundations for long term sustainability”. He will combine his new role on secondment to EEAS whilst continuing to be in charge of WMAS.

Dr Geoffrey Harris OBE, chair of the trust, said: “This is an important step forward for the trust as we focus on transforming the ambulance service. I am pleased that we have been able to bring in such an experienced chief executive.

“Transforming our ambulance service is going to take time, but we have made a start. We are making changes and seeing early signs of improvement. Anthony will undoubtedly help us build on and accelerate this work.”

Anthony Marsh said: “I am delighted to have been offered this opportunity to work with the staff in the East of England Ambulance Service. During my review I met many of the ambulance crews, control room staff as well as those who work in the support functions. The overwhelming message I got from them was wanting to make the service better for patients.

“I am absolutely determined to work with the staff to continue the improvements that have been started and take them to the next level.

“During my 26 year ambulance service career, I have worked in many ambulance services around the country and together with the review that I undertook, I know many of the issues that we face going forward.  Whilst it will not be easy, I have every confidence that with the support of the staff, we can really make a difference to the care that we provide to patients.”

Dr Marsh will be working 4 days a week at EEAST.

10.05am The Daily Mail reports that an elderly stroke patient was turned away from King’s Mill Hospital in Mansfield because he arrived three minutes before the cut-off time of 5pm. Mr Mallalieu was taken to a hospital further away and is now on a life support machine.

A hospital spokesman said they will be conducting an investigation.

9.58am The Daily Mail leads on the Office of National Statistics figures, reporting that millions of women are depressed, in constant pain and inactive.

25 per cent of adults spend four hours a day watching TV, 25 per cent of women and 20 per cent of men are inactive, one in six men and one in ten women drink alcohol nearly every night.

9.39am Local NHS leaders have insisted there is “no battle of Oxford”, following HSJ’s revelation that the clinical commissioning group’s ambitious plans had been delayed amid provider concerns.

A joint letter from Oxfordshire CCG, Oxford Health Foundation Trust and Oxford University Hospitals Trust has instead emphasised the joint working going on between the three organisations.

It comes after HSJ revealed that the CCG’s plan to tender three large capitated outcomes-based contracts had stalled after the trusts raised objections. The plans, which would have seen contracts in place by summer 2014, are now under review. If implemented, they would cover adult mental health, maternity, and older people’s services.

7.00am Good morning and welcome to HSJ Live. In the HSJ’s latest Trust Chief Executive Barometer, hospital leaders predict this winter will be worse than the last and warn their health economies are not coping well already.