Patients 'let down' by Royal Cornwall Hospital bosses

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By Western Morning News | Saturday, November 10, 2012, 06:30

A damning report has revealed how hospital chiefs in Cornwall missed an opportunity five years ago to tackle a consultant obstetrician now at the centre of an inquiry over care.

The report, following a review into consultant obstetrician Kenneth Jones by the Royal College of Obstetricians and Gynaecologists (RCOG), lifts the lid on how The Royal Cornwall Hospital at Treliske, Truro (RCHT) "disappointingly" failed to deal with mounting concerns about him.

Worries had been spiralling from both staff and patients since 2007 and yet RCHT only acted last year by asking the RCOG to review the situation.

The report stated: "We are disappointed with how the trust has managed this situation.

"There was a clear opportunity in 2007 to deal with a number of the issues and consider referral to NCAS or retraining."

NCAS is the National Clinical Assessment Service that aims to improve patient safety by helping to resolve concerns about the practice of doctors, dentists and pharmacists in the UK.

The RCOG found RCHT's own audit into the matter had not been adequately used to identify – or exclude – a problem with Mr Jones.

Some 1,574 women the medic treated over the last two-and-half years have now been contacted by RCHT.

Mr Jones took up his post in 1992 and was clinical director from 1997-2001.

From 2007-11 he chaired the guidelines group.

The review was to later find he did not closely follow guidelines laid down for colposcopy and obstetrics.

Mr Jones stopped operating in November last year and left the hospital in May – he is now retired.

When RCOG officials went into RCHT in January this year, they spent four days wading through medical records and interviewing staff.

They found Mr Jones made "bizarre" decisions, was difficult to challenge and there were major concerns about his colposcopy practice over some years, leading to him stopping doing the procedure in 2011 – had also not followed guidelines surrounding the practice.

Concerns over possible bullying were raised and Mr Jones was found to carry out poor documentation and communicate poorly.

There was also little, if any, documentation of risk recorded on consent forms patients signed prior to surgery.

The RCOG said it gained an "impression of increased surgical complications" following surgical procedures.

"Appalling" relations with some staff was found – two of whom were consultants who both ended up in tears.

It was also revealed Mr Jones would be accompanied and "managed" by midwives on his ward rounds to make sure "an optimal outcome" was achieved, with registrars asking to "do one thing in the knowledge that he will choose the opposite".

Staff also said while he could make good decisions he was not always consistent.

The report found there was an initial investigation in March 2007 by the hospital of seven women with high-grade cervical cytological abnormalities.

The review read: "It is difficult to ascertain what the outcome of the review was, but it is suggested that [Mr Jones] was not following national guidelines with regard to treatment and recall for these young women."

However, inspectors found Mr Jones was described "almost unanimously as a very nice person" who had been very supportive of his staff and was said by some members of staff to be "the social cement of the department" and was "very sensitive and looks out for people".

When asked about his strengths, members of staff said Mr Jones always read the notes before seeing a patient, they had learned a lot from him and had enjoyed working with him.

In a statement Lezli Boswell, chief executive at RCHT, said: "We acknowledge the RCOG report identifies some concerns about the trust's historic management of the case.

"This is exactly why we have commissioned the external review to learn any lessons for the organisation, and possibly the wider NHS. We expect the independent external review to be completed by the end of this calendar year."



  • Profile image for John1000

    Initial media management by the Hospital is all about blaming Mr Jones for his poor practice rather than the management of the Trust that has allowed him to continue to harm women in Cornwall for so long.

    True leadership would not have spun this line but would have put their hands up and accepted this responsibility. So much for openness and transparency and the longer this story runs the more apparent this becomes. Why has the leadership of the hospital not apologised to the women of Cornwall for letting this happen. Who do you blame when an organisation fails, the person who failed or the organisation that allowed the failure to occur ?

    Looking on the hospital website I can see that Mr Jones was specialty lead – how so if there had been all these reviews and concerns since 2000.

    What does the boss say in the press statement?

    "As the new Chief Executive I am very clear, I will not tolerate poor clinical practice at RCHT. Patients in Cornwall and the Isles of Scilly deserve the very best care and we the Trust Board are committed to ensure that any lessons are learned".

    Should there be an even greater focus and lack of tolerance in a leadership that allowed this to occur. In my view this is as much a leadership and system failure as an individual doctor failure, but still no appology from the leadship. Shame on you.

    By John1000 at 11:31 on 10/11/12

  • Profile image for Whistle9339

    This appears to be endemic within RCHT and, even today, the problems remain despite Mrs Boswells protestations that she is steering the ship. As an eloquent University Lecturer I have offered my services to work with Lezli Boswell as I know from my own experience this year that nothing has changed. There is still appalling treatment, still a culture of cover up and still poor communication at RCHT by a few staff. I know that Mrs Boswell supports my view but that she can't be seen to being 'disloyal' to the RCHT staff. There is still the culture that that those at the bottom believe they can dictate what and when they will do things and that they will obstruct all change at all costs. It is time that the tail stop wagging the dog!!

    Lezli, I fully support your ethos but you now need someone who can take the bull by the horns and sort this mess out so that you are not making similar statements about other staff inm another five years time.

    By Whistle9339 at 11:07 on 10/11/12

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