NHS England on behalf of the Incident Management Team has published the findings of its review of cancer services at Colchester Hospital University NHS Foundation Trust. The primary aim of the immediate review was to answer the question “Are the cancer services safe?”
The Review took place between the 14th November and the 9th December 2013. The review was conducted as part of the work of an Incident Management Team (IMT), led by NHS England in response to a Care Quality Commission (CQC) inspection into cancer standards at the Trust, published on 5th November 2013.
The CQC report identified a number of failings in cancer services in the Trust including unwarranted delays to diagnosis and treatment. The IMT includes NHS England, North East Essex Clinical Commissioning Group (NEECCG), Monitor, Healthwatch Essex and Essex County Council.
This immediate review goes beyond the issues identified by the CQC and was a rapid but thorough review of current processes in the Trust’s Cancer services. This review provided an expert external assessment of the current safety of the Trust’s cancer services. It identified immediate remedial action necessary to make the services comply with standards and ensure safety, and indicated where longer term reform of services was needed to ensure improvement.
Findings and Recommendations
The cancer review team completed its checks and submitted its findings on 13th December. It concluded that of the 17 cancer pathways or services reviewed several cancer specialties were meeting safety standards, some specialties were already undertaking improvements following the CQC report but a smaller number of specialties were not complying with standards and as a result the reviewers could not be confident they were safe. These assessments are summarised on a service-by-service basis in section 7.3 of the report.
The review has made 14 main recommendations that the Trust will need to act upon if it is to put its cancer services on a safe and sustainable footing for the long term. Improvements are needed to:
- basic governance processes
- information and record systems
- the documentation of clinical pathways
- the training of key staff
- levels of staffing in key services
- the handover of patients between cancer teams and with other hospitals.
The Trust has begun taking steps to address these safety concerns including recruiting extra staff, improving record keeping and clearer processes for sharing information between cancer specialities. These and other changes will form part of the Trust’s overall Cancer Action Plan.
The IMT has ensured immediate improvement measures have been taken to improve safety for all specialties, these undertakings by the hospital are being closely monitored on a weekly basis by the NEECCG and Monitor. NEECCG also now reviews on a weekly basis the cancer waiting time system at the hospital and audits the accuracy of the cancer waiting times.
The IMT will remain in place until all actions and continuing reviews are complete. Andrew Pike, NHS England Director of the Essex Area team said: “I’d like to thank all the clinicians and other specialists who have given their time to review cancer services at Colchester Hospital Trust. This has been a major undertaking but NHS England and its health partners is committed to do everything it can to ensure that the Hospital provides safe care to its patients. Publication of today’s report is part of the action being coordinated by the Incident Management Team to address the concerns about cancer services at Colchester Hospital and the IMT will continue in its work until cancer services are sustainable for the future.”
Retrospective Review of Cancer Services
Following feedback from the CQC inspection the Trust has now reviewed the care of approximately 910 patients to ensure that their treatment has been completed correctly or is progressing appropriately.
The Incident Management Team is committed to a thorough Retrospective Review of cancer services at CHUFT. This will examine the processes and performance of cancer services at the Trust from April 2010, the earliest date identified by the CQC where cancer waiting time records may be a cause for concern, to November 2013.
This review will check the accuracy of the recording of information on the historic Cancer Waiting Tool (CWT); it will also take the findings of this immediate review of cancer services to see if there is evidence of the stopping or removal of patients from cancer pathways without clinician oversight. In addition it will examine the cases of any patients or their families who have raised concerns through the Trust’s helpline and finally it will look at the numbers of patients with delays over 100 days and breaches of the national cancer wait time standards.
Colchester Hospital Trust is under significant scrutiny. Monitor is in the process of conducting a formal review of its governance and it has placed the Trust in Special Measures. Essex Police has begun a criminal investigation into the CQC’s findings.
Colchester Hospital Trust Cancer Helpline For patients or relatives:
0800 028 2026
Cancer patients (past and present), their relatives or the public who have any concerns as a result of the CQC or subsequent reports can contact the above helpline that the Trust has set up.
It is open 8am-8pm, seven days a week, except Christmas Day (25th December), Boxing Day (26th December) and New Year’s Day (1st January).