Surgeons say they expressed safety concerns to hospital bosses before child’s deathBMJ 2017; 357 doi: https://doi.org/10.1136/bmj.j1779 (Published 07 April 2017) Cite this as: BMJ 2017;357:j1779
Surgeons at a leading UK children’s hospital have said that they were worried about the safety of surgery services some time before the death of a child whose urgent operation was repeatedly postponed and that they only decided to speak to the media after management failed to respond to their concerns.
Central Manchester University Hospitals NHS Trust has admitted failings in the case of Kayden Urmston-Bancroft, a 20 month old who died in April 2016 from cardiac failure after waiting several days for a hole in his diaphragm to be repaired at Royal Manchester Children’s Hospital, which is part of the trust.
Surgeons at the hospital told The BMJ that they had repeatedly raised concerns about shortages of staff, emergency operating theatres, and critical care beds at the hospital. Basem Khalil, secretary of the hospital’s medical staff committee, told The BMJ that he had given the trust formal notice that he was planning to give an interview to the BBC after attempts to secure improvements through other means had failed.
“We didn’t go to the media until we had exhausted all internal and regulatory means,” he said. “In January I informed the medical director that whistleblowing to the media was imminent. We have a duty of candour to bring this to the public or else we’ve learned nothing from Mid Staffs.” Khalil told the BBC’s News at 10, “We just worry how many more children must die before management is held to account and before the right changes are made.”
The diaphragmatic hernia was discovered when Urmston-Bancroft was admitted to Stepping Hill Hospital on Monday 11 April 2016 after a fall. Staff there requested a transfer to Royal Manchester Children’s Hospital for an operation to repair it.
He was transferred the next day to an ordinary ward, but the operation was repeatedly delayed because no intensive care bed was available. Khalil told the BBC that a locum surgeon suggested on 14 April that an elective surgery list be cancelled so that he could carry out the operation but “did not receive the support he needed.”
Late on 15 April Urmston-Bancroft went into cardiac arrest. He suffered a severe brain injury and died two days later. The trust has paid £25 000 (€29 000; $31 000) to settle a negligence claim by his mother.
Khalil told The BMJ, “Things are deteriorating very rapidly at the children’s hospital. This has been going on for years. The waiting list has been ballooning. At one point there were 1000 children who waited a year for surgery.”
In July 2016, three months after Urmston-Bancroft’s death, Ross Craigie, the clinical lead for paediatric surgery, wrote to managers, “The situation is such that currently we are unable to provide a safe service for our patients at all times.”
James Morecroft, a consultant paediatric surgeon who retired in February, told The BMJ, “We were horrendously understaffed. We were being pushed right, left, and centre to fill in gaps, to do extra on-calls.” He said that the department was heavily reliant on locum consultants, with only two locums covering three surgeons’ work.
The trust said that it could find no evidence that a locum surgeon asked to postpone an elective list in order to operate on Urmston-Bancroft. It denied that it had ever directed clinical staff to prioritise elective surgery and said that elective cases were regularly cancelled to accommodate emergency patients.
The trust’s own investigation found “significant problems with the organisation and delivery of [Urmston-Bancroft’s] care, which was not timely and resulted in his death.” It recommended that the hospital carry out an urgent review into “prioritising non-electives above elective cases.”
A year after Urmston-Bancroft’s death, Khalil said that staffing levels were worse than they were a year ago, particularly below the level of registrar. “There is a clear issue of leadership and weak processes that continue to contribute to harm to children. I am seriously worried that another death will happen, and many of my colleagues feel the same,” he said.