University Hospitals of Morecambe Bay NHS Trust (UHMBT) asked the Royal College of Surgeons to carry out a clinical records review into its Trauma and Orthopaedics department earlier this year.
The review was commissioned jointly by UHMBT and NHS England and NHS Improvement (NHSE/I) after concerns were raised by UHMBT staff in March 2018 about the clinical care provided in a number of cases, and that, following a number of internal and external investigations and/or reviews during 2019, concerns remained and were subsequently outlined both to the chief executive of UHMBT and NHSE/I in December 2020.
The review of 43 patients’ records was undertaken specifically to look at learning for the trust and to examine if there had been any patients who received less than optimal care.
The report agreed with concerns in 26 of those cases, and trust bosses say they have now undertaken many of the actions recommended in the report.
The review team considered the standard, quality and safety of care provided to patients where concerns had been raised including, including clinical assessment and investigationsm history taking, examination and diagnosis, the timeliness and appropriateness of investigations and imaging undertaken, the patient pathway of treatment (operation or procedure) provided, clinical decision making and assessment, including all relevant x-rays, case selection and threshold for surgical intervention/decision to operate, potential effectiveness of treatment based on best available evidence/compatibility of treatment with other treatments the patient was receiving, perioperative care, pre-operative, intra-operative and postoperative (including discharge planning) and any complication, team working, appropriate communication, consultation and discussion with colleagues, communication with the patient, the patient’s family and GP and the appropriateness of the care provided by the surgery team.
As a result, urgent recommendations were made to address patient safety risks, including:
*A review of clinical activity in performing unicompartmental knee replacements is required given the review may indicate an insufficient number of these procedures being undertaken to maintain the appropriate skill set required for the techniques involved.
*Assure evidence of training in anterior approach surgery before further anterior approach hip replacements are performed.
*In respect of more complex cases, improve governance in respect of clear decision making, transfer/handover of care documentation and ensure appropriate consultant surgeon involvement.
*Ensure that the potential risks of the planned surgery are clearly documented for the patient to assimilate and space to record that these have been explained to the patient.
The trust was also told it should take steps to improve the continuity of care for patients through their pre-operative, intra-operative and post-operative care pathway.
Additionally, it was recommended that if trust identifies primary concerns about an individual surgeon, then a formal review of their clinical practice is recommended.
If the trust identifies concerns associated with the surgical service then a review of the service is recommended.
Aaron Cummins, UHMBT chief executive, said: "We fully accept the findings of the report. At all times the trust has been open and honest in wanting to establish the truth behind allegations relating to a small number of cases within our Trauma and Orthopaedic service.
"Once concerns were raised about cases, we undertook immediate investigations and conducted both internal and external reviews of cases.
"However, we recognised that there were still concerns and so asked the Royal College of Surgeons to conduct an independent review of the cases.
"We have already undertaken many of the actions recommended in the report and have met and discussed with the colleagues who raised the initial concerns.
"We have made improvements to the Trauma and Orthopaedic service as part of our Enhanced Support Programme, we now need to work hard to ensure that the improvements we have made will become fully embedded.
"We welcome the report and would like to thank the Royal College of Surgeons and NHS England and Improvement for their help.
"We would also thank members of our Trauma and Orthopaedic service and all our teams for being open and honest and for giving their time to support the progress that has been made so far within the service.
"We continue to encourage and support colleagues to raise any issues which causes them concern.
"We thank those individuals who have raised their very genuine concerns and hope this report fully answers the questions they had."