Radiology debacle shows good-quality healthcare costs, but poor care costs more
On the same day that news broke of three separate reviews of radiology services in three small regional hospitals, the Irish Independent can reveal that a number of patients have had a cancer diagnosis following their recall after an initial colonoscopy test in Wexford General Hospital. And hundreds more patients from Wexford hospital are being recalled for a retest.
At the end of February, it emerged that 271 patients who had originally had their colonoscopy in Wexford hospital during 2013 and 2014 were recalled after concerns were raised about the quality of the procedures. These were all people who had been picked up through the Bowelscreen services.
The initial recall occurred after two patients in Wexford were identified as having interval cancers - these are cancers diagnosed between screening examinations.
Reviews of scans triggered concern that in some cases the very end of the bowel had not been examined. At the time, the HSE said it was just a precautionary measure to have a repeat procedure and the risk to patients was low.
The Irish Independent is aware of one particular patient who had his colonoscopy in March 2013 and was given the all-clear. He presented as an emergency to Wexford hospital in February of this year and was later discharged home. He went back to his GP and the same week he received a recall for a second colonoscopy.
The HSE then offered him the colonoscopy in St Vincent's Hospital in Dublin, paying him €200 to attend. After this, the man was told he has bowel cancer, which has also spread to his lungs. He is now undergoing treatment for this cancer.
This week the man and his family met with a senior clinician from Wexford, who said they could not tell if the cancer could have been detected two years ago. The HSE would not comment on this case but confirmed that some people have been diagnosed with cancer as a result of the colonoscopy recall.
The Irish Independent has also learnt that hundreds of other patients who initially had their colonoscopy in Wexford have been recalled for another colonoscopy. These patients have not yet had their procedures.
Meanwhile, as a result of the radiology reviews in Bantry, Kerry and Cavan Monaghan, hundreds of patients were recalled and just one delayed cancer diagnosis has been confirmed.
The HSE is adamant that there is no connection between the three different radiology reviews. In Bantry, all CTs, ultrasound scans and X-rays for a five-month period in summer 2013 were reviewed. In Kerry hospital, all of these tests for one month in August 2013 were reviewed, while all tests carried out over a three-month period in Cavan Monaghan last year were reviewed.
All the reviews are completed. However, there is now a "preliminary audit" of cases reported on by these doctors in Drogheda, Blanchardstown, Wexford and Roscommon, as the consultants involved in Bantry, Kerry and Cavan/Monaghan went on to work in those hospitals.
These reviews occurred after clinicians working in those hospitals raised concerns about the quality of specific radiology reading.
Increasingly these tests are available through the NIMIS - the National Integrated Medical Imaging System - which provides filmless imaging data. This allows images to be shared easily across teams and even across locations. The availability of NIMIS and the fact that these were picked up by colleagues, possibly through multi-disciplinary teams meetings, is a positive development.
But can the public be sure that there are not other radiology reviews to come? The HSE says yes and the locums have been referred to the Medical Council.
The HSE also confirmed that none of these doctors are currently working in the system. Yet there is no HSE central system which tracks locums across the different hospitals, no one person who had the detail and oversight of the different radiology reviews.
Common to all three radiology reviews is that they were all locum radiologist in three small hospitals. Such locums tend to do a short time in a hospital and move on. The HSE said there were no other radiology reviews or concerns over other radiologists.
The HSE was unable to provide the most recent figures on locum or agency consultants although recent figures released to TD Caoimhghín Ó Caoláin and Senator Colm Burke for December 2014 show that out of a total of 2,314 consultant posts, 182 were filled by locum or agency staff, while 143 posts remained vacant.
The HSE was unable to say whether locum numbers had gone up or down in the last year. However, the most recent HSE Performance Report for January 2015 says €27m was spent on locum agency staff. This is up from €19m spent on agency and locum staff in January 2013.
The dependency on agency and locum staff is a direct result of staffing and budget cuts over six years of austerity.
There have been increasing difficulties of recruiting and retaining consultants. Some of that is related to the pay cuts introduced under James Reilly when he was Health Minster.
He cut the pay of new-entry consultants by 30pc. This pay cut has now been undone.
But difficulties in recruiting and retaining good-quality staff are also directly related to the broader working environment where staff are under continuous pressure, under supported and under resourced. This over reliance on locum staff is costly in terms of expense but it is also costly in terms of quality of care.
As HSE Director General Tony O'Brien said recently, "although care costs, poor quality care costs more".
For anyone with any concerns, the HSE Information Line Callsave (1850) 241850 is open from 8am to 8pm, Monday to Friday, 9.30am to 4.30pm on Saturday.