X-rays scandal - ‘not fit for purpose’

It has also emerged that the retirement of two senior radiologists - who formerly dealt with 48 per cent of plain film X-rays at the hospital - in June 2008 ratcheted up pressure within the department.

Dr Philip Gishen and a team of consultants from Imperial College Hospital in London were invited by the Health and Social Care Board (HSCB) to independently review practices at the hospital after it emerged four cancer patients had to be recalled - one patient later died - after 18,500 X-rays (including 3,400 chest X-rays) could not be completed within the 28 days agreed standard last year.

Dr Gishen found a 1990s standard radiology department that was under-staffed and under pressure.

He was advised Trust Chief Executive Elaine Way was aware of problems within radiology stemming from the retirement of the two senior X-ray specialists in June 2008 but that alarm bells had not started ringing until she was notified of the suspected cancer X-rays in July last year.

She said the Trust had done everything in its power to replace the outgoing staff.

n APOLOGIES

At a briefing of the Stormont Health Committee last week there were apologies all round from Ms Way as well as from lead radiologist Dr Brendan Devlin and Health and Social Care Board Chief Executive John Compton.

Ms Way said: “I would just like to join John in offering my own personal apology. I will take responsibility for what I see as a failing on the part of the Western Trust in this area.

“I’m profoundly sorry if any patient or their family has a delayed diagnosis. I hope that in the process today we will have the opportunity to explain what happened, why it happened and the measures we have taken to make sure that it can’t happen again.”

Dr Devlin also apologised saying: “I am apologising for what has happened in the past - and it is not the way I would like our service to be able to perform.”

n DISASTROUS

The radiology boss did, however, believe good could come from the disaster.

“Out of this disastrous situation that has occurred here we can see some benefit from it. And I think if you look at it again in a year, 18 months, two years time, you will find a very dynamic and growing organisation and a service that we will be proud of,” said Dr Devlin.

The briefing was told how a combination of understaffing, two retirements, a difficulty in recruiting replacements and increased demand all contributed to the debacle.

Ms Way also said a switch from the old Northern Ireland Radiology (NIRAD) system to the new Northern Ireland Picture Archive and Communication (NIPAC) system - the Trust was amongst the last in NI to do this in May/June 2010 - was also a factor.

n FIVE BOSSES

Another difficulty facing the Trust was the lack of continuity at the top of the department responsible for X-rays with five different bosses in less than four years.

Since the Western Trust’s establishment in April 2007 there have been five Directors of Acute Services - the directorate with responsibility for radiology.

When Dr Gishen carried out his review in late November 2010 he told Trust bosses the Londonderry medical imaging facility was at least a decade out of date.

He said there should be 17 radiologists employed there as opposed to the 13.5 currently budgeted for but not filled - only seven permanent posts were filled at the height of the backlogging “disaster” as Dr Devlin described it.

Ms Way told the Committee: “The radiologists we have at Altnagelvin Hospital are working very hard.

“They are working very hard and they are working to the appropriate standard. But there aren’t enough of them and the equipment is not fit-for-purpose in terms of a 21st century medical image Department.”

She told members one short term recommendation in the Gishen report was a second CT scanner, an MRI scanner and 3.5 full-time equivalent additional radiologists.

n £9M IN CUTS 2008/11

But under the Western Trust Comprehensive Spending Review (CSR) Ms Way pledged a reduction in the Acute Services budget by £9m over 2008-2011 - with £2.747m in efficiency savings targeted this year 20010/11.

Therefore money is tight and as regards the cost of the new scanners and staff Ms Way explained: “Now that actually is a very significant sum of money when you add it all up and I think what I would say is that that money will be given to me by John Compton because I don’t have any money other than the money that John gives me but I doubt if John actually has a lot of money lying around at this point in time because I know what the pressures are - increasing demand - and so where we are is that we are both agreed that we need to meet to say ‘well, look, what can we do immediately to try and resolve this problem.’”

Mr Compton said some progress had already been made in terms of securing an additional CT scanner with a new machine either on the way to Altnagelvin or already arrived.

“We also are working on the basis of planning for additional MRI coming into the area,” Mr Compton told the Committee.

“Now with regards to workforce we will have to sit down and have a long conversation - not just about money, money will be an issue - but I wouldn’t want anyone to run away from the point that we need to fix this and you can’t blame everything in the world on money.

“Money is very important in running the health service but it’s not the exclusive issue. There are about 13.5 radiology posts in the Altnagelvin area and for a variety of reasons the organisation has not been successful in recruiting that - partly that’s because there is a shortage in radiologists right across - nationally - across the UK.”

n TEN RADIOLOGISTS SHORT

Whether it was an issue of funding radiologists or one of paying them both Ms Way and Mr Compton accepted capacity at the Altnagelvin radiology Department was at worst 41 per cent of what Dr Gishen deemed a modern 2011 facility should have and even if the Trust succeeded in filling its 13.5 post target it would still be running at just 79 per cent of the London doctor’s ideal.

Ms Way explained: “At the time when the backlog was at the peak we had seven permanent posts out of 13.5 and that was one of the issues in terms of why did this happen.

“Because in fact, in June 2008, we had two experienced radiologists retired and between the two of them they reported 48 per cent of all the plain film X-rays in Altnagelvin.”

Equally Mr Compton said: “The report says yes - the 13.5 is fine but it should be closer to 17. We don’t have a problem with that. So the first port of call for us is to work with the organisation to see how we get to 13.5 substantive posts.

“The organisation has been working with a range of permanent posts and locum support. There has been no commentary or no criticism of anyone who has been working there, I want to make that very clear.”

n RECRUITMENT DRIVE

Trust Medical Director Dr Anne Kilgallen said the health authority strived to fill the posts over the past two-and-a-half years and that X-ray reporting had also been outsourced to a private firm employing trained radiologists to help clear the backlog last year.

She said: “We advertised four times to fill posts. We have made strenuous efforts to attract suitably qualified doctors as locums and we had some very good locums during that period.

“But we’d also arranged to transfer some films for reporting outside the Trust. So those are the measures, which were ongoing prior to the serious adverse incident.

“Once we became aware of the serious adverse incident we formed a small team and escalated what we had done previously.”

n JULY 13 ALARM BELLS

During the briefing the Trust Chief Executive also revealed alarm bells only started ringing for her on July 13 when she came back from her holidays - coincidentally at the height of the McDermott brothers’ controversy which was also subject to the newly-published Trust review - to be told of an event with the potential of becoming a “serious adverse incident.”

Consequently HSCB boss Mr Compton was informed on July 29; correspondence between Ms Way and Mr Compton followed through August and the last patient affected was informed by early September.

Ms Way told the Committee she had been aware of pressures building in radiology before July 2010 but the alarm bells didn’t start ringing until then.

She also said she was faced with pressures across a range of the 200-250 service areas under her stewardship.

““I was aware through our Governance Committee and Directorate report to the Governance Committee - amongst a whole range of issues mentioned as risk that we were managing - that there were problems in radiology.

“But in terms of - as Chief Executive - when did that alarm bell go: ‘hang on, there could be a serious problem.’ That was in July 2010.”