FOI Request 10th April 2011 to North Bristol NHS Trust:

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?

University Hospitals Bristol (UHB) NHS Trust draft Quality Account 2010/11:

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.

Three apparently.

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.

According to Dr Ian Barnes’ 3rd June 2010 letter to SHA QIPP Leads (see Carterballs 1), SHAs should have commented on the national workstream plan for pathology.

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.

On 3rd June 2010, Dr Ian Barnes, National Clinical Director for Pathology, wrote to Strategic Health Authority Quality, Innovation, Productivity and Prevention (QIPP) Leads regarding implementation of the Carter Review of Pathology recommendation to consolidate services.

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.