The scale of what is now emerging from the investigation into the breast unit at County Durham and Darlington Foundation Trust is shocking. We are not talking about an isolated incident or a single patient who has experienced poor care. The review has so far identified over 300 patients who have been harmed, with 77 suffering significant harm. The trust itself has issued an apology, stating that it is 'deeply sorry' to the women and families who have been harmed and let down by failings in its breast services.
The magnitude of these findings should not be underestimated. The question now has to be whether the harm caused can properly be understood as the actions or errors of one clinician, or whether what has emerged points to wider and more systemic failures in clinical governance, oversight and the operation of the breast service. That the trust are discussing potentially extending the scope of the review to include up to 10,000 cases demonstrates just how important it is that the full picture is established.
The harm will inevitably vary from patient to patient. For some, there may have been delays or changes in diagnosis or treatment; for others, unnecessary or excessive surgery and profound physical and psychological consequences. But for anyone undergoing investigation or treatment for cancer, confidence in the healthcare system is fundamental. Once that trust has been damaged, rebuilding it will be extraordinarily difficult.
The finding that 20 women underwent mastectomies that were subsequently determined to have been unnecessary is particularly disturbing. A mastectomy is not a minor intervention. It is major surgery with physical, psychological and emotional consequences that can remain with a patient for the rest of their life. Once a breast has been removed, that decision cannot simply be undone. For a patient who has already received a cancer diagnosis, the decision about whether to undergo a mastectomy is one of the most significant and personal decisions they may ever have to make. To subsequently be told that the surgery was unnecessary will, for many, be devastating and incomprehensible.
The position concerning Mr Amir Bhatti also needs to be understood in the context of the ongoing investigations. His clinical practice is currently restricted while an internal trust investigation takes place. He remains employed by the trust and receiving full pay. It is important not to pre-empt the outcome of those proceedings or attribute responsibility before the relevant investigations have concluded, however, equally, patients are entitled to ask serious questions about how concerns were identified, escalated and acted upon, and about the governance structures that were supposed to protect them.
What happens next is crucial. An apology is important, but for patients who have suffered life-changing consequences, an apology on its own cannot be the end of the process. The trust needs to establish what went wrong, why it happened, whether concerns were raised and, if so, whether they were acted upon appropriately. It must also ensure that patients receive clear and honest answers about their own individual care. The trust has said that significant changes have already been made to the breast service and that its ongoing review is intended to identify patients who may have experienced harm and ensure they receive appropriate information and support.
It is important to recognise that the vast majority of NHS patients receive cancer care of the highest standard and are supported through the incredibly difficult times by conscientious and skilled clinicians. Where there are concerns that care has fallen short, however, patients deserve timely answers and accountability.
Although I am not currently representing any of the women affected in this matter, I have seen first-hand the profound impact that failings in cancer diagnosis and treatment can have on patients and their families.
Patients should not be afraid to ask questions about their care. If something does not make sense, if they have been told that their treatment may have been inappropriate, or if they have concerns about what happened during their diagnosis or surgery, they deserve clear answers.
The important thing now is that this review is comprehensive, transparent and patient-focused. It is not enough to simply identify individual errors. The review must address how these failings were able to occur, why they were not identified sooner, and what changes are needed to ensure that patients can have confidence in the breast cancer services they rely upon.
Isobel Foenander is a medical negligence partner at Tees Law
No comments yet