Bosses at a crisis-hit Trust had ‘no knowledge’ of a shocking backlog of 36,000 x-rays - which HAD put patients at risk.
And Worcestershire Acute Hospitals NHS Trust has today been warned of further enforcement action from the Care Quality Commission unless it improves its radiology department.
The Birmingham Mail revealed in August how the CQC found the Trust had failed to report on more than 11,000 vital x-rays, raising ‘serious concerns’ about patient safety. The scans were to help diagnose serious health problems but had not been fully assessed or written up.
But today a report by the CQC shows the backlog was actually closer to 36,000 and dated back to 2013.
There was also clear evidence patients had been put at risk by the backlog, which was discovered following an unannounced CQC inspection on July 27.
The x-rays had been carried out at Alexandra Hospital in Redditch, Worcester Royal and Kidderminster Hospital.
Now Sir Mike Richards, the CQC’s Chief Inspector of Hospitals, has issued a statement outlining the watchdog’s concerns - including that the Trust board were not even aware of the huge backlog.
The Trust has apologised to affected patients and says it “responded promptly” to the backlog, with the plain film backlog now cleared.
But Sir Mike said: “At the time we inspected, we were concerned that patients using Worcestershire Acute Hospitals NHS Trust’s radiology services were experiencing a poor level of care and treatment.
“The board had no oversight or knowledge of the backlog, meaning we were not assured that there were suitable governance and escalation processes in place to protect patients from potential harm.
“There were not robust procedures in place to trigger the escalation of risk caused by these lengthy delays in reporting. Lessons were not being learnt from incidents and safety goals had not been set.”
Key findings in the CQC inspection found:
*A significant backlog in reporting of plain film x-rays dating back to 2013;
*An audit of 4,160 films from July 2013 showed 46 needed follow up imaging or a follow-up by specialist. The audit discovered 16 patients identified ‘where some delay in providing radiology report may have resulted in avoidable harm’. There had been ‘limited follow up’ to these patients;
*Length of time for reporting of diagnostic imaging tests had been on the Trust risk register since 2003, the report said, “and we saw no evidence of a review of the situation and clear actions to reduce backlog”;
*Some 10,442 plain film x-ray examinations remained unreported from January 1 to July 26 this year. Yet the Trust later submitted data to the CQC showing total number of unreported images from 2013 to 2015 was 25,622 - making more than 36,000 in total;
*Reports for patients referred into the department for urgent images were not always prioritised, meaning there was a significant delay with some reports taking up to 21 days from when image was taken before reported back to GP;
*There were 11 radiology vacancies at time of CQC inspection and reporting radiologists were not being released from clinical duties to carry out the reporting sessions.
“If, despite all these measures the trust fails to make sufficient progress, I have no doubt that we will take further enforcement"
Sir Mike had used CQC’s urgent enforcement powers to protect people using radiology services by ordering the Trust to make urgent improvements to its’ radiology services.
The Trust offered an action plan to the CQC days after the visit in a bid to clear the backlog and boost radiology performance.
Yet the watchdog has now warned that further action could follow unless sufficient improvements are made.
Sir Mike said: “The trust has submitted information to the CQC to demonstrate the progress made in clearing the backlog and improvements to governance and this will be monitored when we inspect this month.
“We will then decide whether or not it is appropriate to remove the conditions placed on the services at Worcestershire Royal Hospital.
“If, despite all these measures the trust fails to make sufficient progress, I have no doubt that we will take further enforcement action to protect the interests of the people who rely on this service.”
A spokesman for Worcestershire Acute Hospitals NHS Trust said: “We apologise for any distress this has caused and can confirm that the backlog concerns a secondary review of X-rays with the majority of these X-rays having been reviewed by the requesting clinician, mostly on the same day, to determine the patient’s care plan.
“Following the CQC visit in July 2016 to our Radiology department, we have responded promptly to the concerns raised and can confirm that the plain film backlog is now cleared.
“Our processes have been reviewed and strengthened, radiographer staffing levels are improved and we are now working to a standard of reporting all urgent X-rays within two days and all other ‘routine’ X-rays within two weeks.”
The CQC is currently undertaking a three-day visit to the Trust, which it had placed into special measures last December.
Yet rank and file staff criticised an i nternal blog from Andrew Short, chief medical officer, in which he had told them not to ‘dwell on the negatives’ when speaking to inspectors - and to instead treat the crunch visit like ‘selling’ a house.
