CQC publishes results of inspection with Royal College of Pathologists at Sherwood Forest Hospitals NHS Foundation Trust

The Care Quality Commission (CQC) has recently (Friday, 5 April) published its report into a Nottinghamshire NHS trust following a detailed inspection to look into concerns about breast cancer testing results.

CQC carried out an inspection at Kings Mill Hospital, part of Sherwood Forest Hospitals NHS Foundation Trust, in October last year after 79 women with breast cancer were recalled by the trust due to issues surrounding test results.

Concerns had also been raised by the health care regulator, Monitor. It has taken its own action to ensure the trust has the strong leadership required to address its issues, while delivering quality services for its patients.

As part of the inspection The Royal College of Pathologists was asked to investigate concerns that the treatment of women with breast cancer, between 2004 and 2011, may have been based on incorrect test results.

Both CQC’s report and that of the Royal College of Pathologists are published today.

CQC’s inspection found that Kings Mill Hospital is meeting the national standard concerning the care and welfare of people.

However, processes to assess and assure the trust of its own quality of service had not been effective or robust enough.

There had been poor communication between pathologists and the trust’s board of directors and weaknesses in communication between the clinical governance committee and board of directors.

The pathology department was without a leader for five years between 2003 and 2007, with the role being covered by locum staff, and a number of permanent posts were not filled.

Equipment used by the department was identified as outdated and manual techniques were used in the department, leading to inconsistent results.

Decision making in the clinical governance committee was not always clear.

The hospital’s action plan in relation to mortality rates was not being clearly monitored by the trust board and had not been subject to in-depth analysis.

Processes to detect changes in performance or risk were not robust enough.

Dr Andrea Gordon, CQC deputy director of operations (regions), said: “Kings Mill Hospital must make sure it has robust processes in place to assure itself that it can manage and identify any risks or issues. Where issues are identified these have to be clearly communicated to trust leaders so any necessary action can be taken. It is imperative that any improvements the trust makes are sustainable and maintained for the future.

“Women already enduring the stress and trauma of cancer have been at the centre of these issues and the trust has been liaising with people affected by this.

“During our own inspection we found patients spoke positively about their care and treatment and we have been receiving updates from the trust on the work it is doing to improve.”

CQC has been working closely with Monitorand other regulators throughout this process.

We will continue to monitor the trust and will return to check on whether the necessary improvements have been made.

The Royal College of Pathologists added: “The findings of our report have implications far wider than Sherwood Forest NHS Foundation Trust. The report raises important questions about the organisation of pathology departments and their workload, and the effectiveness of pathology quality assurance. We hope that the recommendations that we have made are taken forward by the relevant authorities. The Royal College of Pathologists is examining potential improvements to existing quality assurance processes and will develop and implement a core set of principles that improve the system and its oversight.

“The College has a significant role in making sure people have a clear understanding of quality assurance, how it works and why it matters. Anyone providing pathology tests should feel secure in coming to the College for explanation and advice.”

During the inspection of Sherwood Forest Hospitals NHS Foundation Trust CQC was accompanied by specialists in pathology and clinical governance.

The full report of our inspectors’ findings, including The Royal College of Pathologists’ findings, will be published on our website recently (Friday, 5 April).

Read the reports from our checks on standards at Kings Mill Hospital and Sherwood Forest Hospitals NHS Foundation Trust.