Hospital cancer failings: 'Confusion' over outpatients identified as far back as 2010

Watford Observer: Jan Filochowski Jan Filochowski

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.

Watford Observer: Samantha Jones

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."

Comments (10)

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6:15pm Fri 18 Jul 14

croxley46 says...

Absolutely criminal.
Passing the buck as usual.
People's lives at stake, bosses on holiday so nothing done and no audit undertaken - disgraceful.
Wat. Gen. should be ashamed.
Absolutely criminal. Passing the buck as usual. People's lives at stake, bosses on holiday so nothing done and no audit undertaken - disgraceful. Wat. Gen. should be ashamed. croxley46
  • Score: 5

7:36pm Fri 18 Jul 14

buzz bee says...

This is beyond belief! There should be a criminal investigation into this, at least 2 people have died, let's not go there with the "may of contributed to 2 deaths" , anyway that's 2 we are privy too, more than likely more, of course it would be covered up.!
Jeremy Hunt and this Government should have an inquiry about the failings of West Herts, the previous CEO is now selling his book! what was it called? "how to bury your head in the sand, and earn a lot of money for doing sweet FA" well I must purchase that.

I see he was then given the go ahead to **** up the running of GOSH...Great poor kids.

This was not the only failings within the Trust this is just the one you happened to find out or hear about.

Still I guess we should be grateful, he and the current CEO take home all that money whilst the workers get the blame, (well in this case they don't have to worry). It's good to see that there are large areas within the NHS which still get away with murder!
This is beyond belief! There should be a criminal investigation into this, at least 2 people have died, let's not go there with the "may of contributed to 2 deaths" , anyway that's 2 we are privy too, more than likely more, of course it would be covered up.! Jeremy Hunt and this Government should have an inquiry about the failings of West Herts, the previous CEO is now selling his book! what was it called? "how to bury your head in the sand, and earn a lot of money for doing sweet FA" well I must purchase that. I see he was then given the go ahead to **** up the running of GOSH...Great poor kids. This was not the only failings within the Trust this is just the one you happened to find out or hear about. Still I guess we should be grateful, he and the current CEO take home all that money whilst the workers get the blame, (well in this case they don't have to worry). It's good to see that there are large areas within the NHS which still get away with murder! buzz bee
  • Score: 8

6:27am Sat 19 Jul 14

bishopofwatford says...

I have long been concerned about the increased levels of management in the nhs. No wonder the nhs seems to be constantly short of funds as layer upon layer of paper shufflers and meeting attendees are added.

When something goes wrong at any organisation all we hear is "lessons have been learnt " or " appropriate measures put in place" well that ,for me is just not good enough. In my working career if i made mistakes i owned up, carried the can and took what ever remedial action necessary.thankfully no lives were put at stake , that however is far from the case withe the nhs and hospitals in particular.

This is going to sound like some old geezer sounding off about the good old days...well so be it. What is wrong with charging managers with neglect of duty and criminal responsibility when calamities happen?

It is pointless fining these organisations that compounds the financial situation and anyway those guilty individuals hide behind corporate responsibility.

Rant over ...i must go write my sermon, polish the pews and sample the communion wine! A tough life but someones got to do it!COYH.
I have long been concerned about the increased levels of management in the nhs. No wonder the nhs seems to be constantly short of funds as layer upon layer of paper shufflers and meeting attendees are added. When something goes wrong at any organisation all we hear is "lessons have been learnt " or " appropriate measures put in place" well that ,for me is just not good enough. In my working career if i made mistakes i owned up, carried the can and took what ever remedial action necessary.thankfully no lives were put at stake , that however is far from the case withe the nhs and hospitals in particular. This is going to sound like some old geezer sounding off about the good old days...well so be it. What is wrong with charging managers with neglect of duty and criminal responsibility when calamities happen? It is pointless fining these organisations that compounds the financial situation and anyway those guilty individuals hide behind corporate responsibility. Rant over ...i must go write my sermon, polish the pews and sample the communion wine! A tough life but someones got to do it!COYH. bishopofwatford
  • Score: 4

6:27am Sat 19 Jul 14

bishopofwatford says...

I have long been concerned about the increased levels of management in the nhs. No wonder the nhs seems to be constantly short of funds as layer upon layer of paper shufflers and meeting attendees are added.

When something goes wrong at any organisation all we hear is "lessons have been learnt " or " appropriate measures put in place" well that ,for me is just not good enough. In my working career if i made mistakes i owned up, carried the can and took what ever remedial action necessary.thankfully no lives were put at stake , that however is far from the case withe the nhs and hospitals in particular.

This is going to sound like some old geezer sounding off about the good old days...well so be it. What is wrong with charging managers with neglect of duty and criminal responsibility when calamities happen?

It is pointless fining these organisations that compounds the financial situation and anyway those guilty individuals hide behind corporate responsibility.

Rant over ...i must go write my sermon, polish the pews and sample the communion wine! A tough life but someones got to do it!COYH.
I have long been concerned about the increased levels of management in the nhs. No wonder the nhs seems to be constantly short of funds as layer upon layer of paper shufflers and meeting attendees are added. When something goes wrong at any organisation all we hear is "lessons have been learnt " or " appropriate measures put in place" well that ,for me is just not good enough. In my working career if i made mistakes i owned up, carried the can and took what ever remedial action necessary.thankfully no lives were put at stake , that however is far from the case withe the nhs and hospitals in particular. This is going to sound like some old geezer sounding off about the good old days...well so be it. What is wrong with charging managers with neglect of duty and criminal responsibility when calamities happen? It is pointless fining these organisations that compounds the financial situation and anyway those guilty individuals hide behind corporate responsibility. Rant over ...i must go write my sermon, polish the pews and sample the communion wine! A tough life but someones got to do it!COYH. bishopofwatford
  • Score: 2

11:44am Sat 19 Jul 14

r_anon says...

I don't know if this refers to one particular hospital, or if it's a general comment over all the Hospitals.
After a mammogram in November 2012 I was called into Watford General in December for a biopsy. diagnosis was confirmed on Christmas eve, I saw the Consultant in Barnet Hospital as I couldn't be seen in St Albans until 31st Jan
Right the way through my treatment, I only have good things to say, my care began in Watford.. HERTS.. and I was seen very quickly after my mammogram in Nov 2012 my Operation in Jan. Chemo and Radio therapy throughout the year. All of this treatment was excellent. The care was outstanding. The consultants, Surgeons, Onchologist, Nurses, especially the chemo Unit were all excellent, empathetic and caring.
I am now glad to say that my last mammogram was clear.. I am back to normal thanks to them all.
I don't know if this refers to one particular hospital, or if it's a general comment over all the Hospitals. After a mammogram in November 2012 I was called into Watford General in December for a biopsy. diagnosis was confirmed on Christmas eve, I saw the Consultant in Barnet Hospital as I couldn't be seen in St Albans until 31st Jan Right the way through my treatment, I only have good things to say, my care began in Watford.. HERTS.. and I was seen very quickly after my mammogram in Nov 2012 my Operation in Jan. Chemo and Radio therapy throughout the year. All of this treatment was excellent. The care was outstanding. The consultants, Surgeons, Onchologist, Nurses, especially the chemo Unit were all excellent, empathetic and caring. I am now glad to say that my last mammogram was clear.. I am back to normal thanks to them all. r_anon
  • Score: 3

4:42pm Sat 19 Jul 14

Cuthbert007 says...

Its all about saving money and cutting costs. The hard working front line staff are the people who suffer due to staff cuts and a pay freeze. Ward budgets being cut and relying on charitable funds to get by. All while we hear of the higher management merry go round moving from trust to trust and hiring consultants on thousands per day to do work that they are employed to do. How on earth the chief executive earned what he did and was given a £40k bonus is beyond belief. He should be sued and made to pay it back and all the money should go to the victims. And for the book.......... Unbelievable and no shame!!! Avoid at all cost!
Its all about saving money and cutting costs. The hard working front line staff are the people who suffer due to staff cuts and a pay freeze. Ward budgets being cut and relying on charitable funds to get by. All while we hear of the higher management merry go round moving from trust to trust and hiring consultants on thousands per day to do work that they are employed to do. How on earth the chief executive earned what he did and was given a £40k bonus is beyond belief. He should be sued and made to pay it back and all the money should go to the victims. And for the book.......... Unbelievable and no shame!!! Avoid at all cost! Cuthbert007
  • Score: 4

8:59am Sun 20 Jul 14

bishopofwatford says...

Cuthbert007 wrote:
Its all about saving money and cutting costs. The hard working front line staff are the people who suffer due to staff cuts and a pay freeze. Ward budgets being cut and relying on charitable funds to get by. All while we hear of the higher management merry go round moving from trust to trust and hiring consultants on thousands per day to do work that they are employed to do. How on earth the chief executive earned what he did and was given a £40k bonus is beyond belief. He should be sued and made to pay it back and all the money should go to the victims. And for the book.......... Unbelievable and no shame!!! Avoid at all cost!
Agreed ....you are so right but what can be done to actually make these people responsible ? They are all very happy to accept payment for supposedly doing a "management" job , but NEVER appear to be responsible when things go wrong. So it begs the question who and what are these people not only being paid for but also responsible for?

All we here when things go wrong is the usual trite , banal platitudes :
A) lessons have been learnt
B) measures have been taken
C) an internal inquiry has been launched

THAT IS NOT GOOD ENOUGH we ,the hard working people of watford
Demand answers!
[quote][p][bold]Cuthbert007[/bold] wrote: Its all about saving money and cutting costs. The hard working front line staff are the people who suffer due to staff cuts and a pay freeze. Ward budgets being cut and relying on charitable funds to get by. All while we hear of the higher management merry go round moving from trust to trust and hiring consultants on thousands per day to do work that they are employed to do. How on earth the chief executive earned what he did and was given a £40k bonus is beyond belief. He should be sued and made to pay it back and all the money should go to the victims. And for the book.......... Unbelievable and no shame!!! Avoid at all cost![/p][/quote]Agreed ....you are so right but what can be done to actually make these people responsible ? They are all very happy to accept payment for supposedly doing a "management" job , but NEVER appear to be responsible when things go wrong. So it begs the question who and what are these people not only being paid for but also responsible for? All we here when things go wrong is the usual trite , banal platitudes : A) lessons have been learnt B) measures have been taken C) an internal inquiry has been launched THAT IS NOT GOOD ENOUGH we ,the hard working people of watford Demand answers! bishopofwatford
  • Score: 2

12:16pm Sun 20 Jul 14

Trust hotlines says...

Trouble is the excuse made about annual leave and deputy chief executives leaving is all lies as is the tosh about audit sign off. More spin than Andy Coulson and look where he is now! All the comments above challenging the article are all true. This management team are as rotten as the last lot and covering up for their past present and future colleagues too. Its disgraceful. The truth of what is happening is poles apart from the shop floor staff not what management and their 'internal network' will have you believe.
Trouble is the excuse made about annual leave and deputy chief executives leaving is all lies as is the tosh about audit sign off. More spin than Andy Coulson and look where he is now! All the comments above challenging the article are all true. This management team are as rotten as the last lot and covering up for their past present and future colleagues too. Its disgraceful. The truth of what is happening is poles apart from the shop floor staff not what management and their 'internal network' will have you believe. Trust hotlines
  • Score: 0

1:22pm Sun 20 Jul 14

Trust hotlines says...

Not widely known but the author of the 'independent' review / Stephen Ramsden was actually the Chied Executive of the then Watford and Mount Vernon Hospitals NHS Trust prior to the merger pre 1999.
Also the latest press release from the Trust last Friday regarding the £33M investment in the IT system is more spin. Question 1. Where is the money coming from when the Trust's finances fall even further into the red due to staff salaries including the is obscene interim staff payments? To date we are told the deficit is £16M but that is increasing daily.
Question 2. How long is this new system going to take to instal? From past experience years and years - if ever! Look how long the outpatient system took to go live.
Question 3. Is this merely spin to assuage the public around the cancer plunder to restore confidence?
Go check out how complex it is to completely update an IT system in a hospital - it's not like buying a new tablet or iPad!
Not widely known but the author of the 'independent' review / Stephen Ramsden was actually the Chied Executive of the then Watford and Mount Vernon Hospitals NHS Trust prior to the merger pre 1999. Also the latest press release from the Trust last Friday regarding the £33M investment in the IT system is more spin. Question 1. Where is the money coming from when the Trust's finances fall even further into the red due to staff salaries including the is obscene interim staff payments? To date we are told the deficit is £16M but that is increasing daily. Question 2. How long is this new system going to take to instal? From past experience years and years - if ever! Look how long the outpatient system took to go live. Question 3. Is this merely spin to assuage the public around the cancer plunder to restore confidence? Go check out how complex it is to completely update an IT system in a hospital - it's not like buying a new tablet or iPad! Trust hotlines
  • Score: 1

4:02pm Sun 20 Jul 14

bishopofwatford says...

Trust hotlines wrote:
Not widely known but the author of the 'independent' review / Stephen Ramsden was actually the Chied Executive of the then Watford and Mount Vernon Hospitals NHS Trust prior to the merger pre 1999.
Also the latest press release from the Trust last Friday regarding the £33M investment in the IT system is more spin. Question 1. Where is the money coming from when the Trust's finances fall even further into the red due to staff salaries including the is obscene interim staff payments? To date we are told the deficit is £16M but that is increasing daily.
Question 2. How long is this new system going to take to instal? From past experience years and years - if ever! Look how long the outpatient system took to go live.
Question 3. Is this merely spin to assuage the public around the cancer plunder to restore confidence?
Go check out how complex it is to completely update an IT system in a hospital - it's not like buying a new tablet or iPad!
Yes and on a national level i believe even crony ridden central government realised that trying to get the whole of the gp network/patient record accessablity grand scheme was actually untenable. This was after spending god knows how many billions of nhs cash on the futile pipe dream. Why oh why do watford general think splashing the cash a anotherit system is going to make things better?
[quote][p][bold]Trust hotlines[/bold] wrote: Not widely known but the author of the 'independent' review / Stephen Ramsden was actually the Chied Executive of the then Watford and Mount Vernon Hospitals NHS Trust prior to the merger pre 1999. Also the latest press release from the Trust last Friday regarding the £33M investment in the IT system is more spin. Question 1. Where is the money coming from when the Trust's finances fall even further into the red due to staff salaries including the is obscene interim staff payments? To date we are told the deficit is £16M but that is increasing daily. Question 2. How long is this new system going to take to instal? From past experience years and years - if ever! Look how long the outpatient system took to go live. Question 3. Is this merely spin to assuage the public around the cancer plunder to restore confidence? Go check out how complex it is to completely update an IT system in a hospital - it's not like buying a new tablet or iPad![/p][/quote]Yes and on a national level i believe even crony ridden central government realised that trying to get the whole of the gp network/patient record accessablity grand scheme was actually untenable. This was after spending god knows how many billions of nhs cash on the futile pipe dream. Why oh why do watford general think splashing the cash a anotherit system is going to make things better? bishopofwatford
  • Score: 2
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