Patients 'at grave risk' from poorly trained doctors

Confidential documents reveal 'inadequately skilled temporary staff left to treat patients'

Nina Lakhani
Sunday 19 September 2010 00:00 BST

One of Britain's largest NHS trusts is at the centre of "grave" safety concerns after confidential documents revealed inadequately skilled temporary doctors were being left to treat critically ill patients.

The London Deanery, which oversees the training of qualified doctors, is threatening to withdraw all trainee anaesthetists from Queen Elizabeth Hospital (QEH) because of "major patient-safety concerns".

The threat follows a confidential report which revealed that junior and locum (temporary) doctors are routinely left to deal with patients unsupervised, at times working 36-hour stretches because of a shortage of consultants. The damning report, seen by The Independent on Sunday, says junior doctors felt pressured into undertaking activities "beyond their competence" and were not being properly trained. Complaints of bullying were also common.

Threatening to withdraw trainee doctors is a rare and drastic measure as it would leave the QEH unable to function properly. Anaesthetists are essential for a wide variety of operations and procedures and withdrawal could lead to hundreds of operations being cancelled and delayed.

The London Deanery report, following complaints from trainees, found overseas locum doctors unfamiliar with NHS anaesthetic equipment and procedures being employed without any induction or vetting.

"There appeared to be no individual vetting for locums; some were clearly out of their depth clinically and were completely unsuited to the demands of the post they were covering," the report said. The Deanery is demanding South London NHS Healthcare Trust make extensive improvements by the end of October.

Doctors insist the trust management was "fully aware" of problems for more than a year but took no action.

The latest revelation comes after the trust was referred to the regulator by the local MP, Home Office minister James Brokenshire. Mr Brokenshire said a number of consultants came to him in confidence to report widespread equipment shortages and failing safety standards. As a result investigators from the Care Quality Commission (CQC) watchdog are now believed to be investigating. The CQC refused to comment.

Katherine Murphy, of the Patients Association, warned yesterday the situation had "Dr Ubani written all over it" – a reference to Dr Daniel Ubani, a German out-of-hours locum doctor who killed a British patient in 2008 by prescribing a fatal dose of painkillers during his first NHS shift. She urged the CQC to take a more hands-on approach to patient safety and hold managers to account. Morale among staff is reported to be "very low" as the trust tries to reduce a £35m deficit by downgrading nursing posts, closing wards and cutting back on equipment.

An internal review of another of the trust's hospitals, Queen Mary's in Sidcup, is under way amid fears that it is not fit to cope with the imminent winter pressures. Plans to close its A&E and maternity department have been put on hold after the Secretary of State for Health, Andrew Lansley, ordered the review.

Dr Roger Smith, the trust's medical director, said: "The trust is fully aware of the issues around training junior doctors. We have already taken significant steps to improve the situation, started a round of consultant recruitment and have moved experienced consultants to help."

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