KGH apologises for waiting list handling errors – but report finds no evidence of fraud

Dr Andrew Chilton
Dr Andrew Chilton
  • Hospital admits it failed to identify full extent of its waiting list data problems, leading to some patients waiting longer
  • Systems and practices have now been reformed and brought up to date
  • Historic handling of waiting times was inadequate but well-intentioned and not fraudulent
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Kettering General Hospital has issued a ‘profound’ apology to patients affected by its handling of waiting list data.

An independent report, commissioned by the hospital trust, found that two patients’ symptoms worsened and their conditions deteriorated after having had to wait more than 52 weeks to be seen.

But the report also found that efforts to establish the true nature of the length of the waiting list were “well-intentioned but misguided” and that there was no effort to try to cover up the scale of the problem.

KGH Trust medical director Dr Andrew Chilton said this morning: “We want to highlight where we went wrong, and to demonstrate how we have subsequently acted to put things right.

“It is important for our patients to understand that we now have high standards of waiting list management and are working hard to rapidly reduce the number of long waiting patients.

“We also make a sincere and profound public apology to all of our patients who have had unacceptably long waits for care as a result of the way our waiting lists were handled historically.

“We also want to be clear that the continued public allegations of ‘fraud’ by a former employee and former Governor of the organisation are entirely without foundation.

“In autumn 2015 the trust became increasingly concerned about the underlying quality of our patient waiting list data and as a result suspended reporting of this data to the Department of Health in December 2015.

“To address our concerns we then commissioned a comprehensive independent review by an external body, CPA Consulting, in line with national best practice.

“The aim of this review was to find out why a number of patients had been discovered at the trust who had waited longer than 52 weeks - but had not been previously identified as long waiters on our systems.

“The review conclusively demonstrates that the root cause of our problems were a number of historic failings which together affected the accuracy of our waiting times data.

“They included inadequate operational management and reporting practices, under investment in IT, problems surrounding the implementation of a new computerised patient information system, and insufficient staff training.

“The report also found that senior managers who had been trying to address our problems and produce accurate information were “well intentioned”, but failed to recognise the scale and significance of our waiting time issues and failed to act appropriately to address them fully.

“Once the scale and nature of our problems were fully revealed in March 2016 we developed and implemented a comprehensive improvement programme.

“Our improvement programme was designed and developed to respond to the findings of the CPA report and to our own concerns.

“It was implemented in March 2016 and was sufficiently progressed in March 2017 for us to return to reporting our waiting list data to the Department of Health.

“The programme was designed to find any long waiters, make sure they received appropriate care, and to address all of the weaknesses in our systems, processes and staff training highlighted in the CPA review.

“At the launch of the improvement programme we knew that figures delivered by our IT system were flawed.

“They showed 25,000 patients waiting more than 52 weeks – more than half of our 46,000 open waiting list pathways.

“We knew this was very inaccurate as we had received very few complaints from our patients about long waits and our clinical teams told us this couldn’t be the case.

“To get to the bottom of this issue our improvement programme looked at all the various patient pathways that can make up waiting times in a validation exercise that covered some 315,000 records.

“The validation process demonstrated that at May 21, 2017, in fact 282 patients were waiting more than 52 weeks.

“The trust has subsequently reduced this to 170 (June 26, 2017) and aims to clear its backlog of long waits entirely by August 2017.

“Patients who had waited more than 52 weeks were subject to an internal review to ensure their care needs were met quickly and appropriately going forwards.

“At May 2017 this review found that two patients had experienced moderate harm which meant that their symptoms had worsened and their clinical condition had deteriorated.

“In addition 136 patients experienced a low level of harm which meant that their symptoms continued for longer and they may have required a modest increase in medication to help them to manage those symptoms.

“We would like to reiterate our sincere apologies to every patient who waited longer than they should have for treatment.

“If any additional patients feel they have waited longer than they should have they can seek guidance from their GP who will carry out the appropriate checks with us.”

Fraud allegations

Dr Chilton said: “We acknowledge that our attempts to get at a true picture of the size of our waiting list involved filtering of data.

“Data filtering is done to remove patients who are not part of the dataset measured by national referral to treatment time pathways.

“It is done so that a trust can establish the true size of its waiting list in order to plan resources and activity accordingly.

“The CPA Review found our use of filters - considering our underlying data quality issues - was inappropriate and we stopped using them in December 2015.

“Filters were part of what the report describes as our “well-intentioned, if misguided, tactical efforts to extract performance data which created a false sense of comfort and control.”

“We accept that using filters – when we had underlying data issues – was not appropriate did not help us establish the true lengths of our waiting lists.

“However, the allegations brought by the former member of staff that this was done to deliberately make our figures look better and to avoid fines from our commissioners for long waiting patients is entirely false.

“There is no evidence to support these allegations in the CPA report or indeed any of the other internal or external reviews carried out into our waiting times between 2014-2016.

“Fines for long waiting were initially imposed on the trust in 2015 by Corby Clinical Commissioning Group in line with national quality guidelines.

“These fines were all reinvested in the trust to help us address our waiting list difficulties through our improvement programme.

“Therefore there was never going to be a financial advantage to the trust to ‘hide’ waiting list problems which our commissioners were fully aware of by November 2015.”