Cancer scandal just ‘tip of the iceberg’ at Aintree Hospital as bosses apologise

New cases have emerged of patients being diagnosed with advanced cancer after follow up appointments were missed, sometimes for years, at Aintree Hospital.

Managers are working to tackle the impact after it emerged more than 11,000 patients were overdue follow up appointments in the gastroenterology and hepatology departments of the hospital.

The group includes patients with serious chronic illnesses such as inflammatory bowel disease (IBD), Barrett’s Oesophagus and chronic liver disease, all of which carry high risks of developing into cancer and require regular surveillance.

Bosses at Liverpool University Hospitals NHS Foundation Trust have now apologised as it has emerged that there are multiple patients where the lack of follow-up cost the chance to catch their cancer early. 

The ECHO has seen internal trust documents detailing an increasing number of incidents linked to the scandal which have caused severe or permanent harm to patients – which a source described as “the tip of the iceberg”.

And it is understood there is disagreement between senior clinicians about the best way forward.

Correspondence seen by the ECHO showed a suggestion to redirect all new gastroenterology and hepatology referrals from Aintree to the Royal Liverpool Hospital for three months, despite an acknowledgment that this would cause referral to treatment (RTT) waiting lists to “deteriorate” at the city centre hospital.

The trust told the ECHO “a number of options” are being considered but no decisions have been made.

Severe and permanent harm

The details of the effects on patients make for bleak and upsetting reading.

One case, logged as a serious incident by the trust, involved a patient who had “abnormalities” identified in their thorax during a 2015 CT scan, and was told they should undergo another scan in three months.

However no scan was requested, and the incident was not picked up for two years. The patient now has stage four lung cancer.

Some of the most serious incidents surround patients with Barrett’s Oesophagus, a condition which involves normal cells in the gullet being replaced with abnormal cells at high risk of becoming cancerous, and regular surveillance using an endoscopy (a camera inserted down the throat) is considered absolutely essential.

In one example, a Barrett’s patient had an endoscopy in 2007, which revealed nothing suspicious, and another one was planned for two years later in 2009.

However the documents reveal this never happened and the patient was “lost from the Barrett’s surveillance process” for a further seven years.

The incident led to an “advancement of their disease” and the patient died in May 2018, although the documents do not state whether the death was directly related to the condition.

Another Barrett’s patient was referred for tests in 2019 after a change in their bowel habit and a new cough.

While they were being treated, it became clear they had not undergone an endoscopy procedure since 2014, and could not recall being sent an invite.

Ominously, the documents state the test revealed a “suspicious legion” within the section of their oesophagus known to be affected by Barrett’s.

Yet another case saw a patient who underwent an endoscopy in 2014 which detected “high grade dysplasia” (cell changes) and a possible carcinoma.

The results were “not acknowledged” until February 2019, when another hospital referred the patient back after worrying scan results.

Other types of patient have also experienced serious harm, including one who waited almost a year for a rectal polyp to be removed despite a request for it to be done within two weeks in December 2019.

The patient was eventually discovered to have an “advanced rectal tumour” in November 2020.

The ECHO has already reported issues with patients suffering chronic liver disease who have been “lost to follow up”.

One particularly disturbing example was a patient diagnosed with the condition Primary Sclerosing Cholangitis (PSC), which is known to have the potential to become cancerous.

According to the documents the patient was “placed in a hold file” in 2016 with no follow ups or scans planned in.

The patient turned up at A&E three years later with jaundice and a “probable malignant diagnosis.”

“I could already have cancer inside me”

One patient, Knowsley man Paul Cummins, has been left fearing he “may already have cancer” after not being seen since he was diagnosed with Barrett’s Oesophagus in 2018.

However the 42-year-old, was prescribed medication for the heartburn caused by the condition and did not hear anything again until the end of March this year, when he received a phone call and a letter saying he would receive a consultation in August.

Paul, who works in waste management, said a family member who did not wish to be named has the same condition and has since been diagnosed with cancer.

He said: “He got diagnosed with the same condition a year before me, and now he’s going through a really tough time.

“I have said to my partner, 12 months down the line is that going to be me? I would like to know do I already have cancer inside of me, am I going to go through it too?

“It is really worrying.”

The problem erupted into the spotlight during discussions over merging the departments with their equivalent at the Royal Liverpool Hospital, after the trusts running the two hospitals combined in a mega-merger in 2019.

The gastroenterology and hepatology consultant body at the Royal felt the situation was so serious they penned an explosive letter to the board of governors in March.

The letter, disclosed to the ECHO after a Freedom of Information request, said: “We have been advised it would be a dereliction of our duty as clinicians if we did not highlight our major concerns directly to you.

“We are concerned that without urgent and transparent action, which may include external independent investigation, that patient safety and actual harm will occur given the size and nature of the issues uncovered.”

The Trust has launched a review into the issue in recent months, and said it is auditing every patient file in included in the 11,000 group.https://get-latest.convrse.media/?url=https%3A%2F%2Fwww.liverpoolecho.co.uk%2Fnews%2Fliverpool-news%2Fpatients-diagnosed-advanced-cancer-after-20701231&cre=bottom&cip=56&view=web

It has also written to all affected patients and set up a “dedicated support line” for those with concerns.

A spokesman for Liverpool University Hospitals NHS Foundation Trust said: “We have apologised to the patients and families affected by these incidents and we are thankful to those who contributed to the incident reviews we conducted at the time.

“The Trust is committed to providing the highest standards of patient care and we take the opportunity to learn from all serious incident reviews in order to improve systems and processes for the benefit of patients.”

Healthcare watchdog the Care Quality Commission (CQC) has previously confirmed it is investigating the issue.

A spokesman said: “We have been made aware of concerns regarding waiting lists at Aintree University Hospital’s gastroenterology services and we are following these up with the trust.”

Source: Echo By Jonathan HumphriesPublic Interest Reporter