Please provide me with a copy of the “agreed escalation protocol for clinicians to raise their concerns which will ensure rigorous and swift investigation” that is referred to by Mrs Brunt (NBT Chief Executive) in her statement issued on 8th December 2011, regarding the Histopathology Inquiry”

NBT has attempted to charge fees for responding to this request on the grounds that that this and other requests related to service specifications for pathology services fall “on a handful of staff, particularly senior
clinicians, and this is having a detrimental effect on clinical care.”

What can we infer from this?

1. That the escalation protocol Mrs Brunt referred to on 8th December 2010 in her press release doesn’t actually exist because the burden of writing it is currently falling “on a handful of staff?

2. That the payment of a fee for a copy of a document that must already exist because Mrs Brunt said it had been “agreed”, will somehow alleviate a detrimental effect on clinical care rather than line NBT’s pockets for no justifiable reason?

3. That NBT thinks that a member of the public, requesting a copy of a document whose purpose is to provide assurance that it has proper clinical governance in place following the Histopathology Inquiry, and that its Chief Executive said in December 2010 has been agreed, is somehow detrimental to clinical care?

Or is it just avoidance by the Trust of being held to account to produce documents publicly to demonstrate genuine commitment to patient safety and be held to account by the public to do what is says it will do.

Perhaps the Trust is worried that the public might want to see evidence that the latest UH Bristol misdiagnosis, which occurred a matter of days after the publication of the Histopathology Inquiry Report and was spotted by NBT in January 2011, but apparently not until after a patient had had surgery for a cancer they did not have, had been properly handled according to NBT’s escalation process.

The misdiagnosis was discussed at the meeting of Bristol Health and Adult Social Care Scrutiny Commission in March 2011, whose minutes state that “There had been a serious incident which was being investigated; the family were being kept informed”

Plus ça change? How can we tell when the NHS Trusts in Bristol continue to be so secretive?

Histopathology

“The exhaustive Inquiry found no evidence to suggest that the histopathology department at University Hospitals Bristol provides anything other than a safe service.”

pardon???

Extract from FOI request to UHB:

Q. Please describe the process used by the Source BioScience reviewers to reach their opinions. Did they have access at any time to the UBHT and NBT reports and the reports of any external reviewers who had been requested for opinion? If so, at what points in the process did they refer to these opinions before writing their final reports?

A. Copies of relevant UHBT and NBT reports were sent to Source BioScience together with the slides. We do not know the process used by Source BioScience reviewers.

Q. Please provide the names, specialist interests and qualifications of the 12 RCPath. reviewers who reviewed the 26 cases, correlating the name of the pathologist to the reviewer ID numbers shown in Annexe 4(i).

A. We do not have this information.

Q. Please describe the process used by the RCPath. reviewers to reach their opinions. Did they have access at any time to the UBHT and NBT reports and the reports of any external reviewers who had been requested for opinion, including the reports of the Source BioScience reviewers? If so, at what points in the process did they refer to these opinions before writing their final reports?

A. Copies of relevant UHBT and NBT reports were sent to the RCPath with the slides. Copies of the Source BioScience reports were not sent. We do not know the process used by RCPath reviewers.

Q. Please describe the details of any external quality assurance procedures that were implemented to provide evidence that all the relevant slides and reports, both internal to NBT and UHBT, and external, were sent
for review by Source BioScience and RCPath.

A. This was not externally assessed.

The Report of the “exhaustive” Inquiry contains a case where the opinion of six histopathologists, including two national experts, was that a patient had squamous carcinoma of the vulva.

Panel – “College reviewers’ opinions support the original benign diagnosis by the histopathologist at UHBT” (UHBT diagnosed keratoacanthoma, a condition that is associated with sun exposure!)

President of the College “Both (reviewers) consider the possibility that this could be a squamous cell carcinoma.”

“Both believe that a diagnosis of keratoacanthoma is unlikely to be correct.”

Six opinions that already existed, that confirmed a malignant diagnosis, including those of two national experts, were disregarded by the President of the Royal College and the Panel.

On 30th August 2010, the following FOI request was made via the website http://www.whatdotheyknow.com/

Dear North Somerset Primary Care Trust (PCT),

Please answer the following questions:

1. When was your Chief Executive, Mr Chris Born, first made aware of serious allegations of histopathology misdiagnosis made against University Hospitals Bristol NHS Foundation Trust (UHB)?
2. By what means was Mr Born first made aware of the allegations?
3. When did Mr Born inform his Board about the allegations?
4. When Mr Born found out about the allegations, what actions did he take to protect the safety of the patients on whose behalf his PCT commissions services from UHB.
5. There have been at least three further allegations of misdiagnosis raised since the UHB commissioned inquiry started.
6. When and by what means was Mr Born made aware of them?
7. What action has Mr Born taken to protect the safety of patients on whose behalf his PCT commissions services from UHB, given the the ongoing issue of lack of implementation of common standards of
quality and safety in labs in the locality that has led to the recent allegations.

The existence of the UHB commissioned histopathology inquiry will not be accepted as a reason to claim exemption under FOIA as the actions of NHS North Somerset are not within the published terms of
reference of the Inquiry.

Yours faithfully,

Mrs D Havercroft

The same request was made of NHS South Gloucestershire, whose Chief Executive is Mrs Penny Harris.

On 20th September, it seems that Chris Born had a stab at this response, which somehow found its way onto the internet, even though it’s obviously work in progress:

From:
Sent: 20 September 2010 10:32
To: [FOI #45966 email]
Subject: FW: Freedom of Information request – Bristol Histopathology -
allegations of misdiagnosis 2010-228

Thank you for your email of 30^th August 2010 regarding a freedom of
information request on Bristol Histopathology.

Please find below my response to your questions:

1. 14^th June 2009

2. Bristol, North Somerset and South Gloucestershire PCT Chief
Executive’s meeting

3. Awaiting results of investigation

4. Agreed that NHS Bristol would continue as lead commissioner to assure patients were protected.

6. Specific clinical incidents are dealt with through a trust’s normal incident procedure and are normally not reported to PCT Chief Executives.

7. Included requirements for quality and safety in contracts for
services from acute trusts. This includes………………….

Many thanks

Chris Born

Chief Executive
NHS North Somerset
Tel: 01275 546681
Fax: 01275 546767

`Making it right for you’

[3]www.northsomerset.nhs.uk

On 22nd September, Deborah Evans, Chief Executive of NHS Bristol commented on Chris Born’s draft. This found its way onto the internet as well:

Evans Deborah

22 September 2010

Link: [1]themeData
Link: [2]colorSchemeMapping

Dear Chris and Penny,

Our advice would be to stick with the answers to 1 and 2 as you have
written them.

Question 6 I would just leave it at the words “specific clinical incidents are dealt with through a Trusts normal incident procedure.”

Question 7 I would say “we do not accept the premise on which this statement it based” – otherwise you are accepting the generality that there is a lack of implementation of common standards etc and this could
be twisted in a subsequent request or statement.

I hope this is helpful
————————————————————————–
Mrs Havercroft finds it very helpful indeed.

NHS South West did, but claims it didn’t keep a copy of what it said to the Department of Health. A Freedom of Information Request is now with the DoH. Presumably they did keep a copy of NHS South West’s comments.

Dr Ian Barnes letter to SHA QIPP Pathology Leads – 3 June .

Dr Barnes says that “The case for consolidation is based on the activity and cost data collected from a representative sample of NHS pathology pilot sites in England”.

The details of the activity and cost data appear to be shrouded in secrecy.

On 11th August 2010, in response to a Freedom of Information response for details of the data, the Department of Health replied:

“You requested the activity and cost data, which is the basis of the case for consolidation. I am afraid that the Department does not hold this information, as it was submitted to the Independent Review in confidence and as such, the Review did not share it with the Department”.

It will be interesting to see how the Department is going to be able to demonstrate that pathology reconfigurations across the country demonstrate  “clarity on the clinical evidence base”, (one of the four tests for Service Reconfiguration), when the Department claims that it does not possess the clinical activity evidence and cost data evidence for consolidation.

“I refer to your Freedom of Information request of 22 June 2010.  In compliance with the Freedom of Information Act 2000, the South West Strategic Health Authority is able to respond to your request as follows.

1. Who made the decision that Taunton should become a Gynaecological Cancer Surgery Centre, despite not meeting Improving Outcomes Guidance recommendations in terms of population numbers?

The decision to designate Taunton as a gynaecological cancer surgery centre was made by the National Cancer Action Team in 2004, in response to an action plan signed by the Dorset and Somerset Strategic Health Authority and the Taunton Deane Primary Care Trust in June 2004. The proposal took into account the population size of 0.5 million and proposed that Taunton would be part of an Avon, Somerset and Wiltshire multi-disciplinary team with subspecialist support and continuing professional development provided by the Bristol specialist team.

The National Cancer Action Team provisionally agreed to Taunton as a centre subject to it performing well under external peer review in early 2006. The Peer Review Report for the Avon, Somerset and Wiltshire Cancer Network published in September 2006 indicated that the Taunton specialist gynaecology team scored 97% on 1* measures and 80% on level 1 and 2 measures. Against all measures the Taunton centre scored better than either UHBT or RUH Bath.

Therefore the decision to designate Taunton as a gynaecological cancer centre was made by the appropriate bodies and it does meet Improve Outcomes Guidance standards, as the Guidance allows for a centre serving a population of 0.5 million provided it is part of a multi-disciplinary team with a larger centre.

2. What were the reasons for making Taunton an exception?

It is not an exception.

3. Please describe what, if any, consultation took place with Somerset patients, the public and Health Scrutiny Committees to obtain their views about whether they supported the establishment of a non IOG compliant centre for their community.

No consultation took place with Somerset patients and the public and Health Scrutiny Committees about establishing a non IOG compliant centre as the centre was compliant with the IOG.

4. If patients, the public and Health Overview and Scrutiny Committees were not consulted under Section 11 Health and Social Care Act 2001/Section 242 Health & Social Care Act 2006, why was that?

Consultation with Somerset patients, public and health Scrutiny Committees was not necessary as this was the designation of a service as opposed to a substantial variation.

5. Please send me copies of all the documentation to show the audit trail for the decision to make Taunton an IOG exception for Gynae. Cancer Surgery.

Documentation on the 2004 designation process and the 2006 peer review is not held by the South West Strategic Health Authority. It is not an IOG exception for gynaecological cancer surgery”.

Note to NHS South West. The RUH serves a population of approximately 500,000. Taunton and Somerset NHS  Foundation Trust serves a population of approximately 340,000 (source NHS Education South West – Severn School of Medicine).

Despite what the SHA says, serving a population of only 340,000 certainly makes Taunton look very much like an IOG exception to patient & public campaigners – an exception that seems to be performing better than Bristol, the PCTs’ preferred site for a centralised Bristol/Bath Service.

However in Somerset, despite Taunton not serving a sufficiently large population to be IOG compliant, a Freedom of Information response confirmed that “the establishment of Taunton as a specialist cancer centre for gynaecology was approved by the National Cancer Action Team, the Strategic Health Authority and the Avon, Somerset and Wiltshire Cancer Services (ASWCS)Network. The rural nature of Somerset as a county and its distance from Bristol was a strong influence on this decision”

Campaigners involved in an NHS Bath & North East Somerset (BaNES) led controversial review on reconfiguration of Bristol/Bath Gynaecological Cancer Surgery questioned why Taunton was allowed to be an IOG exception. One was told by a management consultant employed by the NHS to “forget Taunton”.

When quizzed at a July Steering Group 2009 meeting, NHS BaNES’ official transcript of the meeting records its former review Chair, Dr Kieran Morgan saying “Yes, well we took the view…….. NHS BANES took the view that that was Taunton and this is here. Whatever the reason for taking that decision is in the past and isn’t really anything to do with us”

The Steering Group was unable to agree whether the service should be centralised at Bath or Bristol. Later in the transcript, the former Medical Director of the Royal United Hospital, Bath, is recorded saying to Dr Morgan “you set up a process, you have reached the end of that process and beyond that we are now making up a series of things on the fly”

According to NHS BaNES, the Bristol/Bath Gynae. Review is now on hold following “a new policy direction from the Secretary of State for Health requesting PCTs to review health service reconfigurations”. Presumably to see whether local people have been properly consulted or had change foisted on them “on the fly”.

Health stories are often difficult to get to the bottom of, and complex to understand, but generally benefit from having a light shone on them.  Please feel free to post here, particularly any Freedom of Information responses (enlightening or otherwise) you’ve managed to drag out of the system, and responses to posts you’d like to challenge or clarify. The aim is to debate.  I’d rather you added your name, but understand that whistleblowers can still be vilified in the NHS. However, please don’t use anonymity as a mask for something clearly libellous.  The bottom line is simple. If it’s true, it isn’t libel. And who knows, we might gather enough truth for another book!

PS The title FOI Balls was suggested by tenacious patient advocate Daphne Havercroft who already has enough FOI responses to fill two books.