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7 October 2015, 14:00
Arrangements for managing acutely-ill patients at a major cancer centre have created an "unacceptable risk" to the quality of care, a report has found.
Healthcare Improvement Scotland (HIS) investigated concerns raised by medics at the Beatson West of Scotland Cancer Centre in Glasgow.
In May, 86 staff members signed a letter to the General Medical Council warning of potentially serious risks to patient safety as a result of the reorganisation of acute services in the city.
HIS has called for NHS Greater Glasgow and Clyde to take immediate action to improve patient care after visiting the centre in July to meet staff.
A report said: "The enquiry team concluded that ... the current arrangements for managing acutely unwell patients at the Beatson pose an unacceptable risk to the quality of care for patients.''
HIS found there had been a "serious and detrimental breakdown'' in relations between management and oncologists at the Beatson, with evidence of "deep mistrust, poor communications and an adversarial relationship''.
"Consultants informed us that senior managers would resort to what they described as 'emotional blackmail' to coerce them into accepting planned changes,'' the report said.
The health board has been told to take urgent action to rebuild relations between consultants and management.
Medics had warned the lack of a high dependency unit (HDU) at the Beatson was affecting the ability to deliver high dependency care and raised concerns about anaesthetic and out-of-hours cover.
High dependency care services previously available at Gartnavel General Hospital on the same site have been moved to the new Queen Elizabeth University Hospital, about three miles away.
HIS found that a new high acuity care unit at the centre was a "positive and welcome" development but added: "Having no HDU facilities at Gartnavel General Hospital poses a significant concern for consultants we spoke with.''
The team concluded the current 24/7 anaesthetic cover at the centre ``is not economically sustainable in the long-term'' and there were "delays and confusion'' as a result of ambiguity over who is responsible for patients.
The report said: "While NHS Greater Glasgow and Clyde management team has put measures in place, these are viewed by the Beatson consultant body as provisional measures and insufficient to offer a sustainable answer to the concerns they have raised.''
The health board has been asked to urgently agree a model of care for the management of acutely unwell and critically-ill oncology patients, and ensure that its effectiveness is regularly monitored.
Robbie Pearson, HIS director of scrutiny and assurance, said: "The redesign of Glasgow's acute services is amongst the most substantial and complex in any hospital service within Europe.
"There is work to be done to make this an even more effective service that provides the best quality of care for patients.
"We are confident that our recommendations will be used by the NHS board to provide guidance and support for those working in the Beatson to help them deliver the necessary improvements.''
Medical director Dr Jennifer Armstrong said the health board accepted the recommendations and would work with management and clinicians to make improvements.
She said: "We are pleased that the enquiry has found that the high acuity unit is effective and a positive and welcome development which has improved the treatment of acutely unwell patients and also those whose condition is deteriorating.
"All those involved - our oncology doctors and nurses, our critical care doctors and nurses and the Beatson management team - reported to the enquiry that the unit is working well and providing a high quality of service to patients. Patient feedback has also been very positive.
"We do accept, however, that while our arrangements are safe and patient care has not been compromised, we can do more to mitigate any risks of introducing this new way of working.''