PRIVATE AND CONFIDENTIAL - Churchill Hospital · Case Unit at the Horton General Hospital is a...

PRIVATE AND CONFIDENTIAL

THE ROYAL COLLEGE OF SURGEONS OF ENGLAND

INVITED REVIEW MECHANISM

A SERVICE REVIEW REPORT ON BEHALF OF:-‐

THE ROYAL COLLEGE OF SURGEONS OF ENGLAND 35-‐43 LINCOLN’S INN FIELDS, LONDON WC2A 3PE

THE ASSOCIATION OF SURGEONS OF GREAT BRITAIN AND IRELAND

35-‐43 LINCOLN’S INN FIELDS, LONDON WC2A 3PE

REPORT ON THE GENERAL SURGICAL DEPARTMENT AT THE HORTON GENERAL HOSPITAL

OXFORD UNIVERSITY HOSPITALS NHS TRUST

13-‐14 SEPTEMBER 2012

REVIEWERS:

MR RICHARD CHARNLEY FRCS, THE ROYAL COLLEGE OF SURGEONS OF ENGLAND

MR GILES TOOGOOD FRCS, THE ASSOCIATION OF SURGEONS OF GREAT BRITAIN AND IRELAND

MS MARY PORTER, LAY REVIEWER

Registered Charity No 212 808 2

Acknowledgements The reviewers would like to thank the Horton General Hospital for the assistance given to them during the course of the review and in particular:-‐ Mrs Robinson and Mr Maynard Contents Acknowledgements..................................................................................................................2 List of Appendices ....................................................................................................................2 1. Background to the review ........................................................................................................3 2. Terms of reference for the review ...........................................................................................3 3. Details of surgical team being reviewed ..................................................................................4 4. Royal College Review team ......................................................................................................6 5. Visit timetable ..........................................................................................................................6 6. Documents reviewed as part of the Invited Review visit .........................................................7 7. Information reviewed that supports the conclusions reached ................................................8 7.1 Interviews with staff at the Trust and information from other documentation reviewed......8 7.2 Review of patient notes .........................................................................................................20 8. Conclusions ............................................................................................................................27 9. Recommendations .................................................................................................................30 9.1 Recommendations for the surgical service being reviewed ..................................................30 10. Signature of Reviewers ..........................................................................................................33 11. Appendices to the Report ......................................................................................................34 List of Appendices Appendix 1 – Brief biographical background of the reviewers Appendix 2 – Comments relating to an individual surgeon’s practice


1. Background to the review Please note that the description in section 1 of this report of the circumstances leading to this review being requested is based on information that was provided to the Royal College of Surgeons (RCS) by the Trust when they completed the RCS’ service review request pro-‐forma. It does not represent the view of the RCS or its reviewers on these circumstances On 15th April 2012, Mr Nick Maynard, Consultant Surgeon and Clinical Director of Surgery at the Oxford University Hospitals Trust wrote to the Chairman of the Invited Review Mechanism (IRM) to request an invited service review of the Trust’s general surgery service, in particular the service relating to gall bladder disease at the Horton General Hospital. This request was considered by the Chair of the RCS Invited Review Mechanism and a representative of the Association of Surgeons of Great Britain and Ireland and it was agreed that an invited service review would take place. A review team was appointed and an invited review visit was held on 13th and 14th September 2012. The request for the review was a result of the Trust receiving a letter from a GP expressing concerns about the outcomes from the laparoscopic cholecystectomies (LCs) performed at the Horton General Hospital (HGH or the Horton). This led to an internal audit which revealed poor outcomes. Pending the invited review outcome, all surgery for acute gallbladder disease ceased at the HGH with all patients requiring such surgery being transferred to Oxford. 2. Terms of reference for the review The following terms of reference for the RCS review were agreed prior to the RCS’s review visit between the RCS and the Trust commissioning the review, and were provided to the surgeons undertaking gall bladder surgery at the Horton Hospital. a) To consider the report of the internal review of this service by Mr Zahir Soonawalla, looking at

outcomes from laparoscopic cholecystectomy between January 2010 and September 2011.

b) Detailed analysis of the outcomes for each individual Consultant Surgeon from laparoscopic cholecystectomy at the Horton Hospital, Banbury from Jan 1st 2010 to the present – for both elective and emergency admissions.

c) To review the pathways for the management of gallstone disease at the Horton Hospital, Banbury, for both elective and emergency admissions.

d) To make recommendations for the consideration of the Chief Executive and Medical Director of the Hospital as to:-‐

• Whether there is a basis for concern about the laparoscopic cholecystectomy service in light of the findings of the review

• Whether there is a basis for concern about the clinical work and competency of any individual Consultant Surgeon in the treatment of gallstone disease


• Whether the elective laparoscopic cholecystectomy workload should be restricted to a smaller number of surgeons than at present

• Whether urgent/emergency laparoscopic cholecystectomies should be carried out at the Horton Hospital, or whether they should be all done in Oxford.

3. Details of surgical team being reviewed Oxford University Hospitals (OUH) is one of the largest NHS teaching Trusts in the UK. The Trust is made up of four hospitals – the John Radcliffe Hospital (which also includes the Children’s Hospital and West Wing), Churchill Hospital and the Nuffield Orthopaedic Centre, all located in Oxford and the Horton General Hospital in Banbury in the north of Oxfordshire. OUH provides a wide range of clinical services, specialist services, (including cardiac, cancer, musculoskeletal and neurological rehabilitation) medical education, training and research. In 2011/12 there were 727,448 outpatient appointments in the Trust’s hospitals, and 22,505 inpatient admissions, they also delivered 9,041 babies. The Trust employs around 11,000 people and its turnover in 2011/12 was £788 million. The Horton General Hospital in Banbury serves the growing population in the north of Oxfordshire and surrounding areas. It has both inpatient and day case beds and also provides outpatient clinics, and is an acute general hospital providing a wide range of services, including:

• Emergency department (with an emergency admission unit) • General surgery • Acute general medicine • Trauma and orthopaedics • Obstetrics and gynaecology • Paediatrics • Critical care/coronary care unit (used flexibly for intensive care) • Cancer resource centre.

The majority of these services have inpatient beds and outpatient clinics, with the outpatient department running clinics with visiting consultants from Oxford in dermatology, neurology, physical medicine, rheumatology, ophthalmology, radiotherapy, oral surgery and paediatric cardiology. Acute general medicine also includes a short-‐stay admissions ward, an emergency assessment unit, a day hospital as part of specialised elderly care rehabilitation services and a cardiology service. Other clinical services include renal dialysis, physiotherapy, occupational therapy, dietetics, radiology and pathology. The radiology service includes a managed mobile MRI and a breast cancer screening unit. Currently, there are also four main operating theatres and a large day-‐case unit. On the Horton General Hospital site emergency patients are assessed in the Emergency Department. Inpatient care is provided on E ward, a dedicated surgical ward.


The Day Case Unit at the Horton General Hospital is a small unit which shares an area within E ward. Patients undergoing elective laparoscopic cholecystectomy are assessed in the outpatient clinic for suitability for case surgery and if suitable are admitted to the Day Case Unit early on the day of surgery. Day case surgery is performed early in the day. Those patients who are planned to stay overnight are accommodated on E ward. The unit treats up to 30 patients each day. Most of the patients go home on the same day, providing it is safe for them to do so. The types of surgery undertaken include:

• General surgery • Vascular surgery • Urology • Plastic surgery • Minor trauma • Orthopaedics • Radiology • Cataract surgery

The general surgery service has the support of:

• 1 SpR (Specialist Registrars) • 5 CT1s (Core trainee 1) • 6 F1s (Foundation Year 1)

There are presently 5 consultant general surgeons based at the HGH, all of whom provide an on call service: Mr Griffiths (general and breast) who does not perform laparoscopic cholecystectomies Mr Dehalvi (general and breast) who does perform laparoscopic cholecystectomies Mr Mihai (general and endocrine) who does perform laparoscopic cholecystectomies Mr McCulloch (general and upper GI) who does perform laparoscopic cholecystectomies Mr Al Zein (general and upper GI) who does perform laparoscopic cholecystectomies Mr Marshall (general and upper GI) is an Oxford based consultant who regularly performs elective lists at the Horton. Additionally other Oxford consultants (Mr Sgromo and Mr Soonawalla) occasionally cover vacant lists at the Horton on demand. It was reported during the interviews that annually, approximately 200 gall bladder procedures were undertaken at the HGH and approximately 5-‐600 undertaken at the John Radcliffe Hospital in Oxford. 1Information taken from Oxford University Hospitals Trust website: http://www.ouh.nhs.uk


6. Documents reviewed as part of the Invited Review visit

• Organisational structure • Clinical management structure – configuration of clinical services • Division and service information • Clinical staff (Surgery) – Horton Hospital • General surgery rota • Guidelines for anaesthesia for day case laparoscopic cholecystectomy • Laparoscopic cholecystectomy traffic light scoring tool • Letter to Bob Marshall and Zahir Soonawalla from Mr Maynard regarding concerns at HGH

dated 26 July 2011 • Surgery for gallstone disease at the HGH – Audit and recommendations (Mr Soonawalla) • CVs and appraisals for consultant surgeons:

o Mr Najam Dehalvi o Mr Radu Mihai o Mr AlZein o Mr McCulloch o Mr Marshall

• Job plans for: o Mr Radu Mihai o Mr AlZein o Mr McCulloch o Mr Marshall

• Mr Dehalvi – Laparoscopic cholecystectomy activity and outcomes – January 2010 to June 2012

• Mr Mihai – Laparoscopic log book – January 2012 to June 2012 • Mr AlZein – Laparoscopic procedures performed – January 2012 to June 2012 • Mr Marshall – Cholecystectomy data 1 January 2012 to 4 September 2012 • Mr McCulloch – Audit of Cholecystectomy activity at Horton between June 2010 and

September 2011 • Cholecystectomy data for admissions between January 2009 to September 2011 • Morbidity and Mortality Audit Meeting minutes from 10 June 2012 to 1 April 2011 and 12

April 2012 • Statement from consultants, summary of concerns raised over the external review process, -‐

provided at interview Prior to the review visit, the Trust indicated that as Mr Abdul AlZein Consultant Surgeon, Horton General Hospital, was unable to attend the interviews the review team would be presented with a written submission from him. This was not available during the visit and when followed up after the visit the review team were informed by email that this would not be provided.


7. Information reviewed that supports the conclusions reached 7.1 Interviews with staff at the Trust and information from other documentation reviewed The following information represents a summary of the information gathered by the reviewers during the interviews held during the service review visit and is organised in themes under each of the headings of the terms of reference for the review. The information presented reflects the viewpoints of those individual staff members being interviewed; it does not necessarily reflect the views of the RCS or its reviewers on these circumstances. Terms of reference heading one: To consider the report of the internal review of this service by Mr Zahir Soonawalla, looking at outcomes from laparoscopic cholecystectomy between January 2010 and September 2011. The reviewers considered the audit report undertaken by Mr Soonawalla. Two versions of the audit report were provided to the review team. One was a draft for consultation which was dated 29 September 2011 and the other was undated but appeared to be the final version. It appeared that the interviewees whose practice was reviewed, with whom the audit was discussed, had only seen the latter version. They appeared not to have seen the fuller draft version that the review team had been provided with. This contained specific individual data including the data table entitled ‘numbers by consultant’ or the table relating to complications by consultant. This was not in the version they saw, but the review team were not aware of this when discussing the details with interviewees. The data analysed in the audit was for the period 1st January 2010 to 12th September 2011. During this time period it was reported that 284 elective laparoscopic cholecystectomies, 22 emergency laparoscopic cholecystectomies, and 22 open cholecystectomies were performed. Of the 284 patients who underwent elective surgery, 57 had previous admissions related to gallstones. In relation to individual surgeons the draft audit showed: Status Elective

LC Emerg LC

Open/ converted

Day cases

Readmissions Long Postop stay (days)

AA Horton 65 9 7 27 6 7, 35 ND Horton 55 2 4 31 3 9 RM Horton 51 5 3 27 3 PM Horton 42 6 8 23 5 6, 41 RM Oxford,

Horton elective

48 27 2 8

BS Oxford 13 5 2 ZS Oxford 4 2 0 GS Oxford 3 3 0


Complication rate The report outlined the incidence of bile leakage following LCs stating that it is expected to be in the region of 0.5-‐1.5%, bile duct injuries should occur in less than 0.3%, and bowel injuries in less than 0.1% of operations. The overall incidence of serious complications is not expected to be over 2%. The report noted that at the Horton with 328 cholecystectomies performed in the time period there were:

• 8 bile leaks • 1 bile duct injury • 2 intestinal complications

The incidence of serious complications was noted to be 3.35% at the Horton. The rate of complications was 2% for elective cases (6/297) and 16% for emergencies (5/31). In comparison, there were reported to be 11 biliary and intestinal complications at Oxford over the same time period in 872 cholecystectomies performed. This was an incidence of 1.26%. Conversion rate The report noted that there were 22 conversions during the study period. Of these, 9 were for emergency operations and 13 were elective procedures. The rate of conversion for elective procedures is 13/(284+3) = 4.4%. The rate of conversion for emergency procedures is 9/(22+9) = 29%. The report noted that the recommended conversion rate is less than 5% for elective cases. In Mr Soonawalla’s audit he states that although historically the rate for acute cholecystitis was as high as 20-‐30%, it was noted that with greater laparoscopic experience, conversion rates should approach 10% in the emergency setting. Day case rate The day case rate for elective cholecystectomy at the HGH was 51% which was higher than the national average (33%, but lower than Oxford at (62%). The report noted that an increase in the day case rate to 60% would be achievable at the Horton with the creation of dedicated laparoscopic cholecystectomy lists and focussed attention to the service. Length of stay Of the elective laparoscopic cholecystectomies who stayed in hospital, 114 stayed for 1 day, 13 stayed for 2 days, 4 stayed for 3 days, 3 stayed for 4 days and on each for 5, 6, 8, 35 and 41 days. The length of stay was reported to be within the range for the peer group and no significant trends were reported with respect to individual consultants for length of stay. Readmissions There were a total of 18 readmissions within 28 days of discharge. The incidence of readmissions was 5% (15/284) with elective and 14% (3/15 with emergency laparoscopic cholecystectomies. There was no evident trend reported for readmissions by consultant and it was reported that Horton was not an outlier in comparison with national data. Management of emergency admissions with gallstone disease


It was reported that the present level of activity indicated that most patients admitted as emergencies to the Horton with gallstone disease are being discharged home and returning for elective surgery. When emergency cholecystectomies are performed, conversion rates are reported at over 20% and complication rates are high. The conversion and complication rates at Horton are reported to be 29% and 16% respectively for emergency LCs. The audit report goes on to state that it is unlikely that the Trust will be able to provide an efficient service for acute gall bladder disease at the HGH on a daily basis. There is however an on-‐call upper GI surgeon at Oxford every day along with facilities for endoscopic retrograde cholangiopancreatography (ERCP). The findings were summarised in the report as: 1. ‘5 surgeons regularly perform gall bladder surgery at the Horton, average 28-‐43 cases per year

per consultant 2. The complication rate is higher than expected, particularly for emergency cases 3. The conversion rate is as expected for elective surgery, but higher than expected for

emergency surgery 4. The day case rate for elective surgery is 51%. Though acceptable, there is room for

improvement 5. The readmission rate is acceptable and Horton is not an outlier when compared to a peer

group 6. Theatre list utilisation and cross-‐over arrangements are poor (evidence from managers) 7. Emergency gall bladder surgery is the exception rather than the norm, with less than two

operations per month (of approximately 6 emergency admissions per month).’ Summary of report’s recommendations were:

1. ‘Concentrate elective gall bladder surgery at the Horton to fewer consultant surgeons 2. Introduce a system of cross-‐cover to improve efficiency of lists 3. Increase day case rates for elective LC to over 60% 4. Transfer emergency admissions with gallstone disease for urgent management to the on-‐call

upper GI surgeon at Oxford 5. Continue to monitor outcomes following this change, particularly with respect to the

complication rates and conversion rates from elective gall bladder surgery 6. If complication and conversion rates do not improve with the above measures, consider a

mentored service with increase cross site working.’ It was apparent to the review team from the above information there were some significant concerns about the performance of emergency cholecystectomy surgery at the Horton General Hospital for patients that were being operated on by the hospital’s general surgeons. Concerns regarding the complication rate, the conversion rate in emergency LCs and how the emergency service was being managed were apparent. Interviewee’s response to Audit


Of these 9 were performed acutely and 72 as electives. 1 major complication was noted and three minor complications. His conversion rate was 11% for acutes (1/9) and 2.7% for electives (2/72) His readmission rate was 1.2% (1/81) This data indicates that Mr Dehalvi is operating within the normal range of expected outcomes, although it is noted that his conversion rate is slightly higher than expected. However, this needs to take account of the low numbers of LCs performed by him each year and particularly the low number of acute procedures in the data provided. Mr AlZein Mr AlZein is a consultant general surgeon and describes his specialty as laparoscopic general surgery and upper gastrointestinal surgery. For the period covering 1 January 2012 to June 2012 Mr AlZein undertook a total of 145 LCs, 133 elective and 12 emergencies. There were no reported complications. 5 cases were converted to open procedures and the following reasons were listed:

• 2 due to cholecyst-‐colonic fistula • 2 due to massive adhesions (previous laparotomies) • 1 due to anaesthetic reasons (unable to tolerate CO2 pressure)

3 patients in total were readmitted following LC procedures:

• 1 was returned with right upper quadrant pain (managed conservatively) • 2 patients were returned with retained CBD stones (underwent ERCP)

Day case procedures for Mr AlZein were reported on average to achieve 70%. Mr AlZein’s submitted data shows that he undertakes a large number of LC procedures and comes second after Mr Marshall in terms of numbers performed. He reports that he has had no complications in performing these procedures and Mr Soonawalla’s draft audit did not list any under his name either. His reported day case procedures rate was higher than the average for Horton (51%) and well above the 60% figures suggested in Mr Soonawalla’s audit report that the Horton should aspire to. Mr Marshall Mr Marshall is an upper GI surgeon. 2010 Mr Marshall performed 83 LCs (15 with intraoperative cholangiography and 23 emergency)


Consultants can call and discuss their needs individually to arrange these scans urgently if required the team heard that this does not always happen. However, difficulties arise when consultants are not available and the responsibility lands on the junior doctors to arrange these scans. Transfers to Oxford for emergency laparascopic cholecystectomies Since the audit report written by Mr Soonawalla, emergency (hot lap choles) are required to be transferred to Oxford, and no emergency LCs are performed at the Horton. The process for transferring patients from Horton Hospital to Oxford was described as “awful” by interviewees and the majority of them said they had problems with this part of the service. One consultant who was based in Oxford said that he would personally call colleagues in Oxford when he needed them and even then he found it difficult. Interviewees reported a problem with transferring patients to Oxford in emergencies and there was a sense that junior medical staff at Oxford were not very helpful when asked to take these. Some interviewees reported difficulties if the junior doctors were tasked with requesting a transfer to Oxford, with the feeling that this should be done by consultants. It was reported that patients were sometimes sent to triage without a bed being available and there was sometimes a long wait for ‘hot choles’ with the longest wait being reported as 8 days. It was reported that there were no beds for patients whose care needed to be escalated at the Horton and that there were 10-‐20 escalation beds each day in Oxford but it was the consultants’ decision in Oxford as to which patients would be allocated a bed. Some reports indicated that patients may need to wait a few days before being transferred and there was suggestion that delays in transfers can occur if a patient is admitted to Horton but needs a transfer to Oxford on the grounds that they already have a bed. During the interviews it was reported that there were a number of patients on the ward at the Horton who were waiting for a bed in Oxford. From all accounts there are significant difficulties with how the transfer of patients is managed, which impacts significantly on patient care. Relationships between Horton and Oxford It was reported to the review team that the Horton general surgical team are invited to meetings in Oxford and there are also meetings held at the Horton with Oxford attendees. This included a monthly meeting arranged by the Horton where Oxford staff are invited and GPs also attend. The review team heard the surgical service described as “one unit on two sites” and there are surgeons who work between the two. However, several interviewees, including those based at Oxford, reported there was a sense of “us and them” with regard to the working relationship between Horton and Oxford. The review team heard that the consultants felt unsupported and heard the Horton hospital described as a “stand alone service”. There was a feeling that the Horton general surgery services were not well integrated into the rest of the Trust’s service. However, problems with integration with other services at the Horton and Oxford were also noted. Theatre lists


Senior Management and organisation review Although the Divisional Director (Surgery & Oncology) initiated the review, he was not present during the review visit and did not take part in the interviews. The person leading the review and being tasked with receiving initial feedback was Mr Nick Maynard, Clinical Director for Surgery. This put him in a difficult position in having to feedback to the wider management team and initiating any action to be taken in advance of this report being issued. The agreed terms of reference indicate that the College makes recommendations to the Chief Executive and Medical Director and it would have been helpful for the review team to have had their perspective on the situation and to have been able to discuss initial feedback with them.


It was noted that the relationships between Horton and Oxford were not as unified as desired. Although there were activities across the sites there was the impression of an ‘us and them’ service and that Horton staff did not feel sufficiently supported by their Oxford colleagues. Given the relatively low numbers of gall bladder procedures performed at the HGH and an even lower number of emergency cases, together with the issues outlined in this report the review team agree with the suggestion that the HGH would be better placed to focus their attention on elective and non-‐complicated cholecystectomy procedures and that these may be undertaken at the HGH by fewer consultants who can therefore maintain and develop their skills in this area. The review team were concerned about the lack of senior management involvement in relation to the review visit. Aside from one senior member of staff attending the interviews there was no higher management present at the feedback session which would have been expected. Next steps The review team recognise that the issues outlined in this report will now need to be addressed by the Trust and the surgical team. It was very clear to the review team that significant and sustained work would need to take place to ensure engagement from the surgical team and the wider community. However, in order for recommendations made for the laparoscopic cholecystectomy surgical services to be implemented and sustained there needs to be dedicated senior management involvement and improved organisation from the Trust.


9. Recommendations 9.1 Recommendations for the surgical service being reviewed

1. The Trust should commend Mr Soonawalla for his commitment to auditing the outcomes of the laparoscopic cholecystectomy service at the Horton and making recommendations for addressing his concerns. They should also commend Mrs Robinson and Mr Maynard for their support to this process and providing information and administrative support to the invited review team.

2. The Trust should continue to ensure that regular data is captured and reported to measure performance against a range of measures such as activity against targets, waiting times, length of stay, mortality, ranges of morbidity measures such as, return to theatre, wound infection, complications etc. They should also ensure that any such data that is captured is accurate and provided to the surgeons for their reflection and learning.

3. On the basis of the information available the review team consider that all acute cholecystectomy procedures continue to be undertaken in Oxford. However, the review team recommend that transfers from the Horton should occur on the same day as the patient presents, without prior admission to the HGH as once the patient is occupying a bed at the Horton, transfer is not a priority.

4. Trust should develop and agree standards and protocols with staff involved in the transfer of patients to Oxford. Audit data should be captured, including numbers of patients, transfer times, time taken to theatre etc, so that the efficiency and outcomes of transfers can be monitored.

5. The senior management of the Trust should also take steps to immediately improve the day to day functioning of the team and functioning across teams (Horton and Oxford) and the way in which its individual participants interact with each other. This should commence with an explicit agreement of what the team exists to achieve, the way in which it will work together to achieve this, and the basic standards of respect and behaviour that each team member can expect to experience from their colleagues when undertaking these activities. All surgeons, anaesthetists, radiologists and senior nurses should be involved in this process.

6. The Trust should consider reducing the number of surgeons carrying out laparoscopic cholecystectomy across both sites (Oxford and Horton) and restricting those undertaking this operation to surgeons who undertake sufficient numbers of them to ensure they keep their skills up to date and remain competent.

7. The Trust should ensure that there is a more consistent and structured approach to ward rounds within the general surgical service at the HGH which should be attended by the consultant and junior doctors at the beginning of the day and the end of the day. Decisions about the day’s treatment plans for all patients should be made at the morning ward round and information about each patient should be shared at the evening handover. In order to do this effectively, common protocols for conducting ward rounds and the management of common conditions and surgical events should be established and agreed by the consultants.


8. The Trust should take steps to ensure there is a hands-‐on approach from all consultants. As with recommendation four above, the Trust should ensure that clear expectations for on call are agreed amongst staff and implemented.

9. The Trust should ensure there are regular minuted general surgery morbidity and mortality meetings at the HGH and take steps to improve the quality of discussion at these meetings to ensure that learning is shared and decisions are made for future action.

10. The Trust should consider further investigation of the reported inconsistencies between the audit data provided by Mr Soonawalla and the general surgeon’s individually held data. Having done so, the Trust should take action they consider appropriate to the findings of these investigations.

11. The Trust should look at the organisation and booking of operating lists a the Horton. Currently the booking of cases is controlled by a non-‐clinical member of staff. Allocation of elective cases to a consultant’s list could take place prior to the patient’s clinical appointment when the clinic letters are sorted, according to the number of operating slots, rather than a week or two before surgery.


Responsibilities of the Trust in relation to the recommendations of this report. This report has been prepared by The Royal College of Surgeons of England and The Association of Surgeons of Great Britain and Ireland under the Invited Review Mechanism for submission to the Oxford University Hospitals Trust. It is an advisory document and it is for the Hospital authority concerned to consider any conclusions reached and to determine subsequent action. It is also the responsibility of the Trust to review the content of this report and in the light of these contents take any action to protect patient safety that it considers appropriate. Further contact from The Royal College of Surgeons following final report Where recommendations are made that relate to patient safety issues, the Royal College of Surgeons will follow up this report with the Trust to ask them to confirm that the Trust has addressed these recommendations. The College’s Lead Reviewer may be available to support this process. Where the College is not satisfied that these recommendations have been addressed within a reasonable period of time following the issue of the final report, the College, the Association and/or the Reviewers reserve to themselves the right to disclose in the public interest but still in confidence to a regulatory body such as the General Medical Council, the National Patient Safety Agency or the Care Quality Commission or any other appropriate recipient, the results of any investigation and/or of any advice or recommendation made by the College, the Association and/or the Reviewers to the Hospital. The College will also contact the Trust to carry out an evaluation of its services following the issue of the report.


10. Signature of Reviewers


11. Appendices to the Report Appendix 1 – brief biographical background of the reviewers Mr Richard Charnley FRCS, The Royal College of Surgeons of England Richard Charnley was appointed to the Freeman Hospital, Newcastle upon Tyne in 1995 as Consultant Hepatobiliary and Pancreatic Surgeon. He has developed a particular interest in the surgical and endoscopic management of pancreatic disease. He was a member of the original writing group for the Improving Outcomes Guidance in Upper GI Cancer and has an interest in the improvement of hospital services for patients with pancreatic and hepatobiliary disease. He has been invited to help develop services in other parts of the UK and abroad. His research interests include new treatments for pancreatitis, the genetics of pancreatic disease and the causes of pancreatic cancer. He was President of the Pancreatic Society of Great Britain and Ireland in 2006-‐07 and in 2008 was elected to the Council of the International Association of Pancreatology. He was previously a member of the AUGIS Council from 2002-‐04 and was elected to be Chairman of the Clinical Services Committee of AUGIS in January 2009. Mr Giles Toogood FRCS, The Association of Surgeons of Great Britain and Ireland Mr Giles Toogood is a Consultant in Hepatobiliary and Transplantation Surgery at St James’s University Hospital, Leeds, West Yorkshire (since 1998). Undergraduate Education University of Oxford Postgraduate Training Oxford, Cambridge and Adelaide, Australia Other Roles Intecollegiate Specialty Boards Examiner for General Surgery General Surgery Specialty Training Committee of Yorkshire Royal College of Surgeons of England Assessor for Consultant Advisory Committees European and African Hepatopancreatobiliary Association Education Committee and European Union of Medical Specialists Examiner Chairman of Great Britain and Ireland Hepatopancreatobiliary Association Chairman of Association of Upper Gastrointestinal Surgeons Education and Training Committee Research Mr Toogood’s clinical research is focused on outcome data of hepatobiliary and transplantation patients while laboratory work is aimed at novel treatments for people with colorectal liver cancer.

Date post:	10-Feb-2021
Category:	Documents
Upload:	others
View:	0 times
Download:	0 times