• Reports reveal extent of long waiters and harm reviews at large teaching hospital
  • King’s College Hospital had 525 patients with no guaranteed admission date waiting more than a year
  • Audit of patients removed from long waiters list showed in nearly half of cases there was no record of why

Patients waiting more than 150 weeks for treatment, clinicians resisting outsourcing and mass breaches of the 52-week waiting time target at a large teaching hospital have been revealed by reports released under the Freedom of Information Act.

Reports from NHS England and Improvement, released last week, lay bare the dire state of elective waits at King’s College Hospital Foundation Trust.

The documents from March show the trust, one of the largest in England, had around 4,500 patients with no guaranteed admission date for treatment. Of these patients, 525 have waited more than a year.

The NHE and I report said 300 of these patients were for endoscopy, where the trust has recently had to admit five patients may have come to harm after a delay in their diagnosis.

It added the trust’s elective treatment group had not met between September 2018 and January 2019, “which limited the oversight of the pathway”.

A high turnover of middle management staff was also noted and “there appears to be a lack of understanding of RTT at all levels of the organisation”.

An analysis of very long waiters showed two patients waiting more than 150 weeks for treatment and 21 waiting more than 79 weeks.

NHSE and I’s intensive support team for long-waiters audited 62 of the trust’s 52-week waiters who had been taken off the waiting list and found in 29 cases there was no evidence as to why they had been removed.

It said the trust was now rebooking some of these patients for treatment and including them on a harm review.

The trust has organised significant amounts of outsourcing to private sector and other NHS providers.

The NHSE and I report said the organisation had spent £1.3m with company 18 Weeks Support on ophthalmology alone. However, it also noted “outsourcing was not completely supported by clinical teams, particularly in orthopaedics”.

The trust told NHSI and E’s director of operations and delivery that inpatient capacity was a problem “but when pushed we uncovered some significantly long outpatient waits”.

“Despite this there were no examples given of outpatient/diagnostic pathway analysis and mapping to try and understand and reduce pathway length,” the report said.

Ophthalmology outpatients waits were “very long”.

It also noted that “trauma and orthopaedics remains constrained and at the edge of 52 week compliance”. Bariatric services were only able to “balance supply and demand, with limited progress on long waits”. It said the trust’s outsourcing to three separate private providers for this work was not sustainable and “additional capacity and/or diversion” needed to be considered.

King’s appointed a new chief operating officer in April and now has a board-level turnaround plan.

It has also rewritten a significant number of consultant job plans in trauma and orthopaedics.

A spokesman for the trust said: ”We recognise that patients have waited longer than they should have and we apologise for these delays. We are taking all the necessary steps to ensure that appointments are booked and accept that we have not provided the best service to these patients.”