NHS England recently awarded a contract for cancer scans to a company called Alliance Medical. This came despite a rival bid from a group of publicly-funded NHS hospitals being £7 million cheaper.

(EDIT  FEB 2016: The contract award was made in January 2015; it has recently been doing the rounds on social media again. The message of this article still stands, however it is a mistake to describe it as ‘recently’ as I originally did. The piece is edited to reflect that.)

The fact that senior Conservative MP Malcolm Rifkind sits on the board of Alliance Medical would clearly have nothing to do with this decision.

The deal was handled by the NHS Strategic Projects team. They helped secure the deal to privatise Hinchingbrooke Hospital. This deal spectacularly collapsed last year amongst damning inspection reports.

All fairly normal for the murky world of NHS private procurement. But unusually, I can actually add something to this news story. I happen to have some personal experience of Alliance Medical and their scanning work. Here it is.

Meeting Doris

During my 2-week placement on a neurology ward, I met a lady, who I’ll call Doris for the sake of this post. Doris had come to our ward after a fall. She  happened to have lost her balance, was a bit confused, and generally seemed ‘a bit off’. This was with good reason.

A CT scan revealed, she had two substantial extradural haematomas, one on the right and one on the left. These are bleeds into the space between the layers that cover the brain and the skull. They are not good news. Quite frankly, it was a miracle Doris was doing as well as she was.

 

Obvious Bleeding

A couple of hours after I’d seen Doris, and after she’d been sent to surgery, I was called into an office by the professor in charge of her care. He showed me a brain scan, not the one I’d seen earlier, and asked me what was wrong with it. Like Doris’ scan, it was an extradural haematoma and, happily for me, I noticed this.

That’s the thing about massive extradural haematomas (or any massive brain bleed/injury). They are a bit obvious.

To prove this to the non-medics reading this, see if you can see what’s wrong with this scan:

maxresdefault
A fairly obvious extradural haematoma.                                                                           Credit:MedPix

Even without the helpful arrows, I’d hope you can notice the massive white blob on the left side of the left picture. Even if you couldn’t say what it was, you’d probably say: ‘That doesn’t look like it should be there, I might tell somebody about it.’

Whoever worked for Alliance Medical and looked at the scan did not think that. They didn’t notify anyone about the massive extradural haematoma, and as a result, that patient went out into the world without being treated.

That patient was Doris. She’d had a CT scan a week before I’d seen her, for a reason I’ve now forgotten. I’m not sure it really matters. Whatever it was, doctors had not thought it serious enough to wait for the report of the CT scan.

That CT scan had been sent to Alliance Medical where three equally bad options await us.

  1. No one looked at the scan in the week leading up to me seeing Doris
  2. Someone looked at the scan and didn’t notice the massive bleed that was obvious enough for a 3rd year medical student to spot
  3. Someone looked at it, noticed what was wrong and didn’t tell either her GP, or the hospital who commissioned the scan, that their patient had a potentially fatal injury.

Actualy, we don’t have three options. It was the last one. The scan had been reported correctly, but no one at Alliance Medical thought it important to tell someone Doris was very, very ill indeed.

As a result, Doris spent a week with a bleed in her brain that could’ve killed her. She then fell and developed a second one.

Unneccessary Harm

Happily, Doris left hospital alive and well. However, it could’ve finished quite differently. She was exposed to a week of serious harm completely unnecessary.

She could’ve easily died if she hadn’t had the ‘luck’ to fall and be ill enough to require a second CT scan.

In this incident Alliance Medical, which  through incompetent management or lack of clinical judegemnt, failed Doris. They failed the NHS, which was required to pick up the pieces of the failure of private healthcare. They failed the British taxpayer who pay them handsomely to look at non-urgent scans so stretched NHS doctors don’t have to.

I imagine my experience is a one-off. I hope it is for the sake of patients like Doris and the NHS as a whole. Otherwise, it seems very unlikely that Alliance Medical will be able to provide a service that’s worth paying an extra £7 million for.

 

Advertisements

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s