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January 24, 2018

External Review of missed cancers in Wexford raises serious questions for Health Services

Reacting to Professor Robert Steele’s review of Safety Incident Management Report into missed cancers at Wexford General Hospital, the Irish Cancer Society has said that the review raises serious questions about how incidents are reported, why staff concerns weren’t acted on promptly, and how long Clinician Y would have continued to perform colonoscopies without the intervention of two surgeons at other hospitals.

The Society has expressed its confidence in the BowelScreen service, which it says is “truly transformative” and “save lives”. However, in light of the serious incident at Wexford General Hospital and the handling of staff concerns, it has called for immediate action from the Minister for Health, Simon Harris, to implement the report’s recommendations, beginning with a the establishment of a formal process for expressing concerns based on the National Clinical Assessment Service in the UK.

Donal Buggy, Head of Services and Advocacy at the Irish Cancer Society, said: “We, at the Irish Cancer Society, want to express our deepest sympathies with the families of the two patients who have passed away, and to offer our support to patients currently dealing with cancer diagnoses, identified in the recall of more than four hundred patients at Wexford General Hospital. This incident has turned the lives of many families and individuals upside-down, and we have to remember the significant distress it has caused.”

Speaking on the review, Mr. Buggy said: “Prof. Steele’s review unfortunately raises more questions than it answers. What is clear from the report is that a staff member at Wexford General Hospital raised concerns about the performance of Clinician Y on five separate occasions over the course of nine months. It took a further year before a recall of patients under Clinician Y was approved.”

“I would like to personally commend the professionalism of that particular employee for continually highlighting their concerns around the performance of Clinician Y. Their persistence in pursuing this issue is a testament to their determination to see action taken where they believe patient safety is being compromised, and to the courage of their convictions.”

“Unfortunately, the report raises serious questions for local and national governance structures about why staff concerns did not prompt an urgent response. It is evident, in light of Prof. Steele’s report that mechanisms for raising concerns need to be strengthened, so that staff who have legitimate clinical concerns are listened to, and their concerns are followed up in a timely manner with appropriate action. Had the concerns of the HSE employee been addressed early in this case, it is likely that the poor performance could have been identified and acted on promptly, improving outcomes for those undergoing colonoscopy procedures.”

Prof. Steele, in his report, recommends the establishment of a National Clinical Assessment Service, as used in the UK, might be considered. We are firmly of the belief that actions must be taken to establish such a formal process.

“We ask all parties mentioned in the report, including Wexford General Hospital and BowelScreen, to give clear assurances to the families who have been affected by the recall as to why they were not informed of the employee’s concerns, and why these were not raised in the Safety Incident Management Report published last year.”

“There are clear learnings for both BowelScreen and our endoscopy services outlined in the report. We want to assure people that BowelScreen has taken steps to ensure an incident like this doesn’t happen again and the Irish Cancer Society has full faith in a service that saves lives. In its first round completed in 2015, BowelScreen detected 517 cancers, almost 3 in 4 of which were at an early stage, making it a truly transformative programme.”

“We are aware, however, that the recommendations of this report have to be fully implemented, to ensure public confidence in BowelScreen, and in the wider health service. This was, unfortunately, a failure of institutions to sufficiently address problems at a local level. Our health service has to do better. This report recognises that, and those issues need to be addressed urgently.”

“While it will offer little solace to people affected by missed diagnoses, the opportunity has to be taken now to prevent incidents like this happening again. It is evident from this report that more oversight, reporting and quality assurance guidelines are needed to prevent another such incident. We welcome the initial steps taken by BowelScreen, but are calling for full implementation of the recommendations of the report, and will be asking for timelines and an implementation plan around this from the Minister for Health and the National Screening Service in the coming days.”

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