Chest x-ray delays at Queen Alexandra Hospital Portsmouth and the potential impact on patients
In December 2017, the CQC reported that patients at Queen Alexandra Hospital in Portsmouth had suffered “significant harm” after it was discovered the junior doctors were carrying out specialist radiology work without the appropriate training.
This followed on from a previous finding by the CQC in July 2017 in which they found that there was a backlog of 23,000 chest x-rays and that none of the 23,000 images from the proceeding 12 months had been formally reviewed by a radiologist or appropriately-trained clinician. In August 2017 the medical care was rated as “inadequate”.
The “significant harm” referred to 3 patients, 2 of whom subsequently died after evidence of their lung cancer was missed.
- A further report carried out on behalf of the Trust has now been released. This identified 27 potentially missed cancers. The report states that errors were within the “accepted rate of discrepancy” for trained reporters on chest x-rays.
- The report accepts that there remains insufficient radiology staff. Whilst there are plans for the training of 2 radiographers, this process takes two years and means they will not be in place until at least November 2019. Even once in place, this will not be sufficient to report on all chest x-rays.
- In other proposals to make the reporting timescales more achievable, it is suggested that images are subject to “demand management”, so that they are done when ‘clinically appropriate’, not as ‘routine’.
It is hard to see that these changes will benefit patients. Whilst greater reporting of x-rays as standard is to be belatedly welcomed, the report accepts that there will be insufficient staff to actually review these. That will lead to outsourcing of the work, presumably at greater cost to the Trust. That is money that will not be able to be used elsewhere.
The removal of ‘routine’ scans will reduce this workload, but at the very real risk of missing signs at the earliest opportunity. The sooner you identify cancer, the more effectively you can treat it and the better a patient’s prognosis. Delay to this could potentially leave patients in a much worse position than they would have been and in the worst case scenario, the cancer could have progressed to the point where there is nothing that can be done about it.
What can you do if you find yourself in this situation? A legal claim is always a possibility and we have dealt with patients that have succeeded with this. To succeed though, you will have to demonstrate that there has been a breach of duty and that the breach has caused you to be in a worse position.
If there has been an x-ray in which something has been missed, the breach of duty on care is fairly obvious. But under the suggested new policy, what would the case be if no x-ray was ever carried out? There is no scan in the first place so nothing on the scan would have been missed. Instead, patients will be left in the much more difficult position of having to demonstrate that the failure to refer them for a scan was in itself a breach of duty.
The net result of the proposed changes is that for the foreseeable future, the Trust will still be in the position of having insufficient numbers of staff to review all chest x-rays. As a result, funds will need to be diverted for this to be outsourced. But more crucially, patients that could have previously expected to undergo an x-ray that may have picked up their cancer at an early stage, will now be forced to wait until it is deemed to be ‘clinically appropriate’. Even if there are errors in making this decision, it will then be much more difficult for these patients to seek legal redress.
Chris Unsworth is a solicitor in the catastrophic injury and clinical negligence team.