Clinical negligence lawyers from law firm Leigh Day have voiced their concern following the revelation that some patients at the Queen Alexandra Hospital in Portsmouth came to "significant harm" after more than 20,000 x-rays were not reviewed by a radiologist or an appropriately trained clinician at the hospital.
Emmalene Bushnell from the medical negligence team at Leigh Day said she was shocked by the announcement, by the Care Quality Commission (CQC), she said “We deal with many cases of mis-diagnosis; however, we have never come across such an apparent widespread failure in diagnostic services.
“It goes without saying that diagnosing serious illnesses, such as cancer, quickly and accurately is crucial as early detection can improve the patient’s prognosis.”
Inspectors from the CQC found three "serious incidents" involving patients from the hospital after junior doctors were left to interpret chest x-rays, including those for suspected cancer.
Now the CQC have ordered all NHS bodies to provide details on their backlogs, turnaround times, staffing, and arrangements for routine reporting of images.
According to the CQC the incidents at the hospital included two where lung cancer had possibly spread due to doctors who were inexperienced being left to interpret scans. The CQC said that two patients had attended as emergency cases.
They were sent for a chest x-ray but neither received a formal radiological report. In the first case, a junior doctor interpreted the x-ray and reported that "no abnormality was detected".
However, a year later a radiologist detected lung cancer. The radiologist reviewed the initial x-ray and said they felt the "abnormality" was evident in that chest x-ray, which had been taken a year earlier.
The second case was very similar, the CQC said. "The notes showed no formal review by the referrer, so it is unclear whether the referrer either failed to spot the pathology or did not review the x-ray at all," the CQC report said. "Ten months later the patient was re-x-rayed and found to have advanced spread of lung cancer."
Inspectors added: "There was a reliance on the referrer to interpret their patients' x-rays. The delay in diagnosis caused significant harm to both patients."
A third case is under investigation. Inspectors found that between April 1 2016 and March 31 2017, 26,345 chest x-rays and 2,167 abdomen x-rays had not been formally reviewed by a radiologist or an appropriately trained clinician.
The CQC's chief inspector of hospitals Professor Ted Baker said: "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.
"During our inspection of Portsmouth Hospitals NHS Trust, however, some junior doctors told us that they had been given responsibility for reviewing chest and abdomen x-rays without appropriate training although they felt that they were not competent or confident to do so.
"We then learned of some cases where signs of lung cancer were missed, with serious consequences for the patients involved. This is clearly unacceptable. 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. "Any delays to patient care are totally unacceptable. We take the CQC's concerns extremely seriously and fully accept the findings of the inspection report highlighting delays in reporting chest x-rays.
"When these issues were raised with us in the summer, we immediately put in place a range of improvements to address the concerns highlighted by the CQC.”