Patients wrongly given cancer all-clear in NHS X-ray scandal

CANCER patients are wrongly being given the all-clear by hospitals using untrained staff to interpret X-rays, watchdogs fear.

The Care Quality Commission (CQC) has launched a national review after patients at one hospital were found to have come to “significant harm” when junior doctors were left to analyse scans, including those for suspected cancer.

Inspectors found a backlog of 23,000 chest X-rays which had never been reviewed by radiologists, or by any other staff with training in how to detect signs of the potentially fatal disease.

The investigation found that the practice had been allowed to go on for a decade, with interpretation of chest and abdominal scans routinely done by staff without training. The scandal, uncovered after a member of the public contacted the CQC, meant patients with cancer were given the allclear, with the disease only later being detected when other checks were ordered.

Three patients at Queen Alexandra Hospital in Portsmouth have so far suffered serious harm as a result, including a patient found to have advanced lung cancer, just 10 months later.

All 23,000 scans will now be checked for signs of disease, and patients informed if their disease has been overlooked.

Last night the CQC took the unusual step of ordering checks at every NHS hospital in England, amid fears that the failing was not an isolated incident.

Prof Ted Baker, chief inspector of hospitals, said “a clearer national picture is

needed to ensure that other patients are not being put at risk.”

Last night the president of the Royal College of Radiologists said the situation was “alarming and dangerous”.

Dr Nicola Strickland said shortages of trained staff meant the problems found in Portsmouth were unlikely to be isolated, with four in five hospitals reporting backlogs of at least a month before scans were interpreted.

All NHS bodies have been ordered to provide details on their backlogs, turnaround times, staffing, and arrangements for routine reporting of images. Trusts have been told to report vacancy levels of radiologists, and whether they outsource interpretation of scans.

A national staff shortage has left the UK spending £88million on outsourcing such duties, with some hospitals using private companies and others sent abroad, including to Australia.

The three cases identified at Portsmouth Hospitals NHS Trust involved patients who had chest X-rays after arriving at A&E. In the first case, a junior doctor interpreted the X-ray and reported “no abnormality”. A year later, after a GP referral, a radiologist detected lung cancer on a second X-ray which, they said, was also visible on the one taken a year before.

The second case was similar, with advanced lung cancer found in a second set of scans, 10 months after the patient was given the all-clear. A third case is under investigation.

A decision had been taken in 2007 to delegate interpretation of some scans to the doctors who requested them, amid a shortage of radiologists. By the time CQC investigated, chest X-rays ordered by hospital doctors were only being reviewed by radiologists if they were for children.

Some of those reviewing X-rays were junior doctors – some not appropriately trained and who felt they were “not competent or confident to undertake such duties”, the CQC said.

Prof Baker said the failings were “unacceptable,” as he ordered checks on every NHS trust in the country.

“When a patient is referred for an X-ray or scan, it is important that the resulting images are examined and reported on by properly trained clinical staff who know what they are looking for – this is a specialist skill,” he said. “We are aware that radiology reporting practice varies among trusts; a clearer national picture is needed to ensure that other patients are not being put at risk.”

Mark Cubbon, chief executive of Portsmouth Hospital NHS Trust, said: “We have issued an unreserved apology to the families of the three patients who experienced harm because of the delays to their care. It is of deep regret to all of us that we did not deliver the high standards of care everyone should expect from our hospital.”