A top hospital boss identified serious problems with outpatient services three years before cancer referral referral failings came to light, a Watford Observer investigation has found.
Former West Hertfordshire Hospitals NHS Trust chief executive, Jan Filochowski, identified there was "confusion" over the system of dealing with patients coming in for appointments in a 2010 report.
The executive, whose £243,000-a-year salary made him the fifth highest NHS earner, set up a investigative group and brought in a consultant to sort out the problems.
Yet the serious failing at the cancer unit, which affected more than 800 patients and may have contributed to two deaths, were not discovered until three years later.
Meanwhile, as the problem unfolded, Mr Filochowski received more than £40,000 in performance bonuses before leaving in November 2012 to become chief executive of Great Ormond Street Hospital.
He retired last year on focus on his work as a management consultant and has released a book called "Too Good To Fail?: Why Management Gets it Wrong and How You Can Get it Right".
In February trust announced it was reviewing 810 cases after problems came to light with the way it was handling urgent cancer referrals.
Patients who have symptoms that could be cancer are meant to been seen for further tests within two weeks. The West Herts issue related to patients who missed their first appointment at the trust hospitals for cancer tests.
In many cases it was discovered these patients were not being offered a second appointment, in line with NHS rules.
The issue was only discovered in November when the trust started retraining staff dealing with cancer referrals.
However the Watford Observer has seen a report by Mr Filochowski from January 2010 where he identified "worrying performance" and "confusion about responsibilities and systems" with the hospitals’ management.
He said: "One area where people expressed confusion about responsibilities and systems was outpatients."
Mr Filochowski later added: "There is something clearly wrong as far as patients are concerned and we have to do something about that."
In response he said he was setting up an Outpatient Project Steering Group and asking a former NHS CEO, Stuart Marples, to review outpatient services.
Yet the problem with cancer referrals remained undetected for another three years.
An independent report published last week uncovered that the hospitals’ management had missed a number of warning signs during that period.
It referred to evidence from one unnamed manager at the trust who said concerns had been raise by senior people in the outpatient team but there was "no visible action as a result".
An opportunity to discover the failings was missed again while the current chief executive, Samantha Jones, was at the trust’s helm.
In November 2012 a GP complained about the way the trust was handling urgent cancer referrals. Over the next eight months the trust carried out an investigation that concluded in July last year there should an audit of cancer services.
Current chief executive, Samantha Jones.
The audit was never carried out.
Antony Tiernan, the trust's director of corporate affairs and communications, said Mrs Jones was on holiday at the time the audit was supposed to be undertaken.
He said: "The response to the GP complaint was signed off by the deputy chief executive in the absence of the chief executive who was on leave, which is in line with standard NHS best practice.
"However, as with all hospitals, it is the responsibility of our clinical teams to track actions (including audits) which result from complaints. This clearly did not happen for the GP complaint.
"As is clearly stated in the cancer review independent external investigation report, the deputy chief executive then left the Trust and, as a result of the systems not being in place around complaints not being followed up, this was not followed through."