Bristol Histopathology Inquiry statement

Mrs D Havercroft made this Freedom of Information request to Royal College of Pathologists
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Dear Royal College of Pathologists,

The Bristol Histopathology Report contains this statement:

"The UH Bristol department reports in excess of 20,000 tests per
annum. Professor Peter Furness, President of the Royal College of
Pathologists, comments in Annex 6 to the Inquiry Report:

I do not believe that the identification of only four very serious
(B1) errors from the workload of a department of this size over the
years from 2000 to 2009 can reasonably be considered to be
surprising."

We are intelligent people who are are at a loss to understand how
the Professor could possibly know how many serious errors were made
by the Department in the ten year period 2000 to 2009 inclusive
because the College did not carry out any review or audit of the
work performed in that ten year period.

Logic and common sense says the Professor cannot possibly know how many
serious errors may have occurred for cases that were only seen by
UHBT between 2000 to 2009 because neither the 3,500 case audit, nor
the 26 case review (which were claimed to be cases of concern
raised by NBT, and most of UHBT's cases would never be seen by NBT)
were capable of providing that information.

Please explain the Professor's reasoning to the people of Bristol, North Somerset and South Gloucestershire who are expected by UHBT to accept that its histopathology service is safe on the basis of his statement that there were only four serious errors identified over a ten year period.

Yours faithfully,

Mrs D Havercroft

on behalf of South West Whistleblowers Health Action Group

Stella Macaskill, Royal College of Pathologists

Dear Mrs Havercroft

Thank you for your email enquiry that has been passed to me for response.

I have been unable to identify the passage attributed to Professor Furness from Annexe six that you quote in your email dated 7 January 2012. However I am able to confirm that Annexe six of the 'The Independent Inquiry in histopathology Services. A report for University Hospitals Bristol NHS Foundation Trust' is a commissioned report authored by the Royal College of Pathologists and provides additional information for consideration by the Inquiry. The Royal College of Pathologists was commissioned to provide an independent assessment of an audit that had already been completed and to answer the following specific questions:

1. To what extent the result of the audit are consistent with a histopathology service of acceptable reliability and to identify areas of improvement
2. To comment on whether error or discrepancy rates give cause for concern about either individual pathologist or specific organs/systems (e.g. breast, gynaecology)
3. Whether the audit reveal any systematic pattern of diagnosis or error
4. To consider the reported discrepancies on a case by case basis and report on patterns as seems appropriate.

The conclusions drawn in Annexe six relate directly to diagnostic errors identified by the audit that had already been undertaken. The Royal College of Pathologists was not involved in the identification of any other diagnostic errors so is not in a position to speculate on their possible existence.

Yours sincerely

Stella Macaskill
Head of Professional Standards

show quoted sections

Dear Stella Macaskill,

Thank you for your reply. You say "I have been unable to identify the passage attributed to Professor Furness from Annexe six that you quote in your email dated 7 January 2012."

It is actually in Annexe 4, not Annexe 6. University Hospitals Bristol NHS Foundation Trust (UHBT) misinformed the public as to its location in the report.

http://www.uhbristol.nhs.uk/files/nhs-ub...

In Annexe 4, it is on the page entitled "Discussion" , seventh paragraph down.

"I do not believe that the identification of only four serious (B1) errors from the workload of a department of this size over the years from 2000 to 2009 can reasonably be considered to be surprising. To that extent, I am not convinced that these cases, when considered in isolation, justify the concerns about the performance of the department that have been repeatedly expressed in the media."

In fact the Professor was presented with only 26 cases for review ranging from 2000 to 2009, identified as cause for concern by NBT medical director Dr Chris Burton, without corroboration by the doctors who raised concerns.

It is apparent from the Professor's comments that he believes that only four of the cases represent serious errors, a view not supported by doctors who raised concerns, not all of which were considered by the inquiry.

However, whether there were 4 serious errors or 26 serious errors in the examples chosen by Dr Burton, it is clear from the Professor's comments that he does not regard the error rate from a review of the 26 cases IN ISOLATION as an indicator of the level of errors that might exist in the whole of the UHBT histopathology workload for the 10 years 2000-2009 inclusive.

Therefore it seems illogical and possibly even mischievous for anyone to present his comments as a statement by the College that there were only four serious B1 errors in the whole of the Department's workload for the 10 years 2000-2009 inclusive.

However it seems that this is what the UHBT Board has done.

To compound the problem, UHBT's Chief Executive even used this juxtaposition of these statements at a public meeting, apparently to promote the belief that there have been only four serious errors in the 10 years 2000-2009.

"6.2.9 The UH Bristol department reports in excess of 20,000 tests per annum. Professor Peter Furness, President of the Royal College of Pathologists, comments in Annex 6 to the Inquiry Report:

I do not believe that the identification of only four very serious (B1) errors from the workload of a department of this size over the years from 2000 to 2009 can reasonably be considered to be surprising."

You can see what has happened, UHBT has attributed the Professor's statement to Annexe 6, whereas it relates to Annexe 4. This reinforces the impression that the Professor has has made a judgment about the number of serious errors in the 200,000 workload for the ten year period 2000-2009. He could not possibly know the error rate for that 10 year period simply on the basis of a review of 26 cases selected by a medical director and a review of 3,500 cases for the year 2007, selected in a manner which dissatisfied UHBT's internal inquiry panel.

2012 is National Pathology year. I am sure you will agree that, particularly this year, it would be unfortunate if the college was, rightly or wrongly, associated with any activities that may have misled the public.

Yet that is what seems to be happening, as described above.

It seems to me, based on what the inquiry report says and what you have said, that Professor Furness, on behalf of the College, drew some conclusions based on:

1. a review of reports of the 377 discrepancies identified in the 3,500 case audit (Annexe 6)

2. a review of the findings of college reviewers for the 26 cases (Annexe 4)

Consequently he was not in a position to and has not attempted to comment on the overall error rate in the whole of the UHBT histopathology department's workload for the ten years 2000-2009 - hence his caveat about forming opinions based on a review of the 26 cases in isolation.

Is this a fair reflection of Professor Furness' and the College's position in relation to the histopathology inquiry?

It is notable that the review of the 26 cases in isolation seems to have been an invention of the UHBT and NBT medical directors and the UHBT internal inquiry. Doctors who raised concerns wanted a comprehensive peer review of the UHBT histopathology service to establish whether the 26 cases were an aberration or indicative of a much larger problem in the department.

The College had the opportunity to help to protect patients by encouraging UHBT and NBT to establish the full facts about the safety of Bristol's histopathology, with a proper peer review, but, in our opinion, the College missed that opportunity and this has damaged patient and public confidence in it.

Yours sincerely,

Mrs D Havercroft

on behalf of South West Whistleblowers Health Action Group