- Tribunal papers reveal reconfiguration row between trusts over cancer services
- Whittington Health Trust’s former lead cancer clinician loses whistleblowing claim
- Judgment shows management reluctance to merge “dysfunctional” service because of internal resistance
A hospital trust delayed making changes to a “dysfunctional” cancer unit because staff were against closer working with a neighbour, evidence to a tribunal has alleged.
The judgment in a whistleblowing case, released last week, revealed claims senior management at a London trust were hesitant to make changes to its lung cancer service “as the team were opposed”.
The employment tribunal judgement said London Cancer, the cancer network for north London, had produced analysis showing “a marked contrast between the survival rates one year on, from diagnosis of patients with lung cancer, treated at University College London Hospitals Foundation Trust, compared to patients treated at [the Whittington Hospital Trust]”.
The judges hearing the case brought by the Whittington’s lead cancer clinician Pauline Leonard were shown minutes of a meeting of London Cancer which said the trust’s medical director and chief executive “advised that they felt they could not argue with the [London Cancer] specifications, but [were] not in a position to commit to it, as the team [was] opposed to it”.
The judgment said it was not in dispute that “historically” the trust’s lung cancer multidisciplinary team had been “dysfunctional” and noted that an externally-led mediation had taken place in November 2014.
It said: “An issue arising at the lung cancer MDT was [Dr Leonard’s] concern about the impact on the lung cancer service at the trust, if [it] worked more closely with the cancer service at UCLH; the claimant of the view that there was a risk that if UCLH became involved in direct diagnostic and treatment interventions, there was a risk that UCLH might then influence patients to have all their subsequent treatment at UCLH instead of the trust.
“It is fair to say that the claimant was somewhat protective of cancer services and the way they were run within the trust.”
The tribunal also saw a letter from Geoff Bellingan, one of UCLH’s medical directors, to the Whittington raising concerns about the “behaviour” of the latter’s lung cancer service and patient care.
The judgment said Professor Bellingan’s letter pressed the Whittington’s medical director Richard Jennings “to commit to a merger of the lung cancer MDT, based on the concerns raised by the colleagues at UCLH”.
The tribunal’s judgement quoted extensively from a letter sent by London Cancer to the Whittington in 2015, saying the trust appeared to have the worst one-year survival rate of all its members.
The letter said: “We know that [chief executive] Simon [Pleydell] and [medical director] Richard [Jennings] share our concerns about their lung cancer outcomes and MDT functioning. Late last year, the trust invested in a major piece of work to improve relationships and address unhelpful behaviour within the MDT.
“However, this is yet to bear fruit and we have now reached the point where several members of the UCLH lung cancer team that gave expertise to the Whittington MDT have withdrawn because they feel the practice is unsafe and decisions are inappropriately dominated by a single individual.
“[Lung cancer pathway director at London Cancer] Sam [Janes] has spoken with three members who are based at UCLH and all feel that barely a patient decision is made that they agree with, but they are fearful to communicate this.”
In evidence to the tribunal, Dr Leonard said, when she was read the letter by Dr Jennings, she felt “numb and ganged up on”.
She said: “I felt betrayed by the assertions that three UCLH consultants, all of whom had signed up to the lung mediation agreement. There was no truth in the allegations and yet it felt as if a very large and powerful mob were now determined to betray me in a very negative light…
“Dr Jennings went on to inform me that a meeting had been held in my absence and that he had acted on this highly defamatory letter as the commissioners had asked him to make a decision to merge the lung MDT with UCLH’s MDT.
“I was upset and unhappy to be informed of this, and I told him he did not have the authority to make the decision and I would be challenging it as lead cancer clinician as part of that remit which I held.”
Dr Leonard said the analysis was flawed and did not take account of the fact that the Whittington’s caseload included patients who presented with later-stage cancer than those at UCLH, skewing the numbers.
Dr Leonard, who had joined the trust in 2009, resigned as lead cancer clinician in 2016.
The tribunal ruled she had not made a protected disclosure in reporting a series of disputes with another member of the team at the Whittington, including an incident in which a more junior member of the MDT ordered a drug costing £8,000 for a patient without going through the normal process.
Dr Leonard was given a final written warning by the trust for bullying and harassment in 2016. The tribunal said it could “find no substance to the claimant’s contention that the outcome of the disciplinary hearing [was] because the claimant had made protected disclosures”.
Irwin Mitchell, representing Dr Leonard, said an appeal hearing is listed for 14 May.
Dr Leonard told HSJ there was an ambitious plan by Professor Janes to create large lung MDTs across north central London. As lead cancer clinician, she stated this did not serve the trust’s patients, most of whom presented via the emergency department and rapidly died as they presented with end stage disease with multiple co-morbidities.
Dr Leonard said: “Creating a separate extra ‘treatment’ MDT is not a good use of public money and does not fulfil any of the quality surveillance (new peer review) measures. The National Lung Optimal pathway has now been rolled out and [the trust] is not compliant with this new and expensive arrangement.”
The trust said in a statement: ”The joint Whittington/UCLH lung cancer treatment MDT has been working well since it was established nearly 3 years ago. It is compliant with Quality Surveillance Team measures and the latest National Lung Cancer Audit shows that we are a positive outlier for our surgical resection rate. We continue to explore further improvements to the lung cancer pathway to meet the challenging requirements of the National Optimal Lung Cancer pathway.
”As the judgment is now subject to an appeal, it would be inappropriate to comment further on the specifics of the tribunal.”
This story was updated at 9.39 on April 30th to include the trust’s revised comment.