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Trust took 10 years to deal with consultant whose competence was in question, report says

BMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f1446 (Published 04 March 2013) Cite this as: BMJ 2013;346:f1446
  1. Clare Dyer
  1. 1BMJ

A consultant obstetrician and gynaecologist went on practising despite more than a decade of questions about his competence because of inadequate communication within his employing trust and a “lack of clarity on roles and processes” to deal with such cases, an independent report has concluded.

Rob Jones was appointed as a consultant at Royal Cornwall Hospitals Trust in 1992 and was formally investigated eight times since 2000. The first reference to concerns about his practice appeared in a clinical director’s file note in 1997.

His career finally ended in May 2012 after the trust received the report of a review by the Royal College of Obstetricians and Gynaecologists. This concluded that retraining was not a realistic option “given the breadth of deficiencies and the length of time problems had been present.” It was agreed that he should retire, which he did in September 2010. He also voluntarily removed himself from the General Medical Council’s register.1

The independent report by Julie Acred, a former foundation trust chief executive, criticised the Cornwall trust’s “less than adequate” handling of the concerns over the years.2 The report was commissioned jointly by the Royal Cornwall Hospitals Trust and the primary care trust NHS Cornwall and Isles of Scilly and was published on Thursday 28 February.

Acred said that Jones, who delivered Florence, the baby of David and Samantha Cameron, in 2010 when the prime minister and his family were holidaying in Cornwall, could be “charming and disarming when challenged about his practice.” He would accept criticism and promise remedial action, but there was no evidence that this was carried out.

“Many of those involved in this case did not have relevant experience, did not receive the necessary training or briefing, and were not clear of their role,” she added. “Culture and attitudes within the specialty have contributed to the lack of escalation of issues. The opportunity for the board to challenge progress was missed because they were not made aware of the concerns raised.”

She said it was clear that the trust did respond to many of the issues raised about Jones’s practice but that the responses were “not always robust enough to deal with the issues raised or timely enough to prevent further harm to patients.”

Consultant colleagues and a nurse had raised concerns, but “the culture within the specialty has not supported open discussion at various points and there has been an element of acceptance of RJ’s practice.” Effective handover was lacking, as new people took up posts without any knowledge of the previous concerns.

The report was published along with a learning review for the primary care trust, a case note review by the Royal College of Obstetricians and Gynaecologists, a rapid response review to assess the safety and quality of the trust’s current obstetric and gynaecology services, and a Patients’ Association review of gynaecology patients’ experiences.

The review of patients treated by Jones from April 2010 to October 2012 found that 52 women had complications of surgery and that a further 57 were recalled for assessment.

The rapid response review of current services found “no compelling evidence” that the service was unsafe but highlighted staffing pressures and recruitment difficulties in the obstetric unit.

The trust’s board said that it accepted the findings and recommendations of the reviews and had asked the chief executive to present an action plan at a public meeting of the board on 28 March.

Lezli Boswell, the trust’s chief executive, said, “I want to thank patients and staff who did speak out and raise concerns about the practice of Mr Jones. I believe this is a significant moment for us and marks a challenge to change the culture of [the trust]. We will implement all of the recommendations from the independent reports and work tirelessly to rebuild trust and improve the services we provide.”

Notes

Cite this as: BMJ 2013;346:f1446

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