Executive summary

The panel would like to thank the trust for facilitating a successful and well-attended visit.

The NHS England North West Deanery brought a large panel of experts to undertake a Learner/Educator Review at Whiston Hospital on 2 July 2024, following on from – and picking up on the medical service issues identified in – related visits in 2023.

We met doctors in postgraduate training across lower, middle and higher grades and in a wide range of medical specialties and also surgery foundation, speaking to them in three groups in one-hour sessions over the course of the morning. In the afternoon we spoke with their educators and supervisors, and others with a role in medical and surgical education.

The key finding from this intervention is the delay in patient care after being admitted through the emergency department route. We had identified an unusually high number of free text comments in the National Training Survey which pointed to issues with the post take ward round at Whiston, and this was clearly corroborated by every individual group we spoke to. We learned that delays of several days were not uncommon, and we were told of this posing a risk to patient safety and given examples of specific patients that came to harm as a result of it. We determined to retain this risk on our Intensive Support Framework at level 2, meaning that it is of significant concern.

Other findings include an improvement in foundation doctors’ access to foundation teaching (while recognising that there are still some improvements to be made), lack of capacity for workplace based assessments and feedback overall, the better experience in foundation surgery, the positive culture and friendliness described by many individuals, and the risk of foundation doctors working at times outside their competency.

After our six sessions with learners and educators, we briefly met with representatives with senior leadership and/or medical education roles to feedback on our headline findings for the day. The most pressing of these was the patient safety concern related to the delays in the post take ward round, and we committed to sending a letter to the trust immediately following the visit to provide enough details to investigate and plan mitigations to this risk without delay.

The senior team were able to share with us their line of sight to the issues we raised, including substantial new policy changes and additional resources (notably an approved business case for three new consultants) who will support the post take ward round, the use of criteria-based discharges in the trust which answers some of the questions raised by foundation doctors about discharging patients, and mitigating external factors to some issues such as delayed information about doctors rotating onto placements from the lead employer.

We also fielded some challenges in return, including well-considered analysis of the distribution of placements in gastroenterology training which the trust argue leave them less able to deliver the service than other units which have a disproportionately higher number of doctors in training. We have taken this point away to follow up the consideration of redistribution of training posts (and were clear with the trust about the complexity of doing so) and the allocation of new training posts as they arise.

We will return to the trust for a Senior Leadership Engagement event on 25 September 2024.

Review overview

Background to the review

We last visited Whiston Hospital as part of our review of the legacy trust St Helen’s and Knowsley in 2023, with a Learner/Educator Review in April 2023 and Senior Leadership Engagement in August 2023. During these interventions, we spoke to several groups including doctors in geriatric training. We discovered that on the whole they were satisfied with their time in specialty training and on wards in the Department of Medicine for Older People, but they were strongly dissatisfied with their time on the acute medical take.

We have returned in 2024 to interview doctors in medical training across a wide range of grades and specialties to further explore the underlying causes of concern and dissatisfaction with training and service provision elements of medical care at the new, combined trust of Mersey and West Lancashire.

As well as exploring the acute medical pathway, we had specific lines of enquiry about cardiology and foundation surgery – both due to poor results on the National Training Survey in this year and in previous years. We are grateful to the trust for ensuring that there was a cohort of surgery foundation doctors in the foundation session we ran, doctors in cardiology training posts in sessions at all grades of training, and supported the cardiology consultant body to attend a focused session with the panel.

Who we met with

Learners

• 20 × foundation doctors, including year one and year two doctors across medical and surgical placements
• 10 × doctors in postgraduate medical training at middle grades including those in internal medicine training and GP specialty training
• 7 × doctors in higher specialty medical training

Educators

• 7 × consultants in cardiology
• 16 × consultants in medical specialties including respiratory, acute medical, endocrinology, emergency medicine, gastroenterology and haematology
• 5 × consultants in surgical specialties

Education team

• Medical Director
• Director of Medical Education
• Associate Medical Director
• Foundation Programme Director
• Divisional Medical Director (Medicine)
• Head of Clinical Education

Review Panel

• Nadeem Khwaja, Deputy Dean for Cheshire and Merseyside
• Paul Baker, Deputy Dean for Foundation
• Simon Carley, Associate Dean for Quality
• Alistair Thomson, Associate Dean for the trust
• Zander Zambas, Quality Support Manager
• Leanne Moore, Quality Coordinator
• Shelley Cunliffe, Quality Coordinator
• Lyndsey Dodd, GMC
• Laura Curtis, GMC
• Sue Barker, lay member

Review findings

Foundation

A large cohort of foundation doctors were made available to come and speak with us. Twenty doctors including representation from both foundation years one and two, from a range of posts. We had specific concerns raised regarding foundation surgery, and so included them in this group despite the medical focus of the day overall.

Starting on a positive note, we heard some positive experiences of working in a range of posts. Work and the variety of the caseload was described as enjoyable. The main drawback which qualified this positivity was the “sheer volume of work”. Shifts on call were described as particularly problematic, where there “can be bleeps every five minutes”. One doctor told us of being bleeped three times during the care of a sick patient in just the last few days. Their impression was that “everyone has the F1 [foundation year one] bleep” and there is lots of overuse with no triage system in place. It was said to be a problem overnight, evenings, weekends. A foundation doctor claimed to have been through a 12-hour night shift without stopping, and described this experience as not safe for patients. Another doctor shared an idea from another trust, where the bleep was triaged by an advanced nurse practitioner – an idea that was met with broad approval from their foundation colleagues.

The busyness of these shifts was compounded, we were told, by a change in the rota which now puts a year one medical foundation doctor on 17 night shifts in a four month rota, working one in every second or third weekend: “a really rough work-life balance” [Editorial note: the rota was reviewed by the medical education team after the visit and this working pattern of such regular weekends was deemed to be possible only if the doctor in training swapped into these shifts]. A different story was told on the surgical side, where an additional F1 was added since last year which has helped.

We explored the impact of what we were hearing on their learning. We discovered that it was different from post to post: respiratory was said to be a good training post, but some specialties “are entirely service provision”. This was the case for surgery, for example, where we were told there had been no teaching so far, three months into the surgical placement. A doctor observed that consultants appeared to make time when there were medical students, but not for foundation doctors. There were also many shared experiences of educationally unproductive tasks. Again in a surgery post we were told of nurses refusing to take paediatric bloods leaving the F1s to do so.

We asked a series of questions about tasks or experiences which doctors felt was outside their competence. Though these were thought to be rare experiences, we heard several concerning stories from doctors feeling they were put in a position to act outside of their scope of practice in some way. For example, an F1 was asked to hold a registrar’s bleep while the more senior doctor was in theatre and told simply “not to accept referrals” – which referring consultants did not abide by – leaving the F1 doctor feeling exposed. Another believed they were asked to consent a patient for an endoscopy, which they refused but felt uncomfortable about doing so. Unfortunately, we heard a few examples of uncomfortable pressure, even “extreme” pressure, for foundation doctors to discharge patients in a way that they felt was unsafe. A portion of this pressure came from Discharge Coordinators. In terms of patient safety, one doctor felt that there were “near misses” in surgery but there were “no unsafe discharges, but you have to push back really hard and resist pressure”. Another doctor said that there were “probably unsafe discharges at the start of F1” as that pressure is applied to “young and malleable doctors”.

Support for the foundation doctors from senior doctors appeared to depend on specialty. The Department of Medicine for Older People was said to be difficult to get support in, whereas in respiratory posts, general surgery and stroke there was usually support available, for example.

We then landed on the topics which appeared to be the most emotive and stressful for the doctors we spoke to: the acute medical pathway, handover from the emergency department to medical specialties and delays in the post take ward round. One specific issue was the online referral process, which we were told used two separate clinical systems – Medway for the emergency department and CareFlow for the patient’s onward medical journey. We heard that patients could fall between the gaps due to this arrangement of “needing two referrals”, for example if a patient is not accepted by the medical team then they are not picked up again by the emergency department. We also heard about delays to the post take ward round. One doctor shared with us the experience of clerking a patient and then, when returning for another shift three days later, finding the patient still awaiting consultant review. The expectation of long delays was unfortunately corroborated by others. Several doctors arrived at the estimate that there are at times 40-45 patients awaiting the medical take on a given day. They viewed the resources of their colleagues as stretched, recognising that the “consultants cannot keep up” and the emergency department nurses are “rushed off their feet”.

We were compelled to ask whether these issues had led directly or indirectly to patient harm in their view and we received a few examples where that might be the case. It was believed that these had been raised as incidents, either through guardians or through Datix courtesy of the nurses on the ward.

Foundation doctors in surgery assured us that the general surgical pathway works well and does not face the same problems as medical pathways described above. We then heard directly from these same doctors the issue raised through the free text comments of the National Training Survey, namely that two F1s are on nights and now the day shift feels overstretched.

While the conversation did cover many topics which were sources of stress and worry for these doctors, they were able to wrap up the conversation by articulating some of the positive aspects of working in their respective posts. The hospital overall was said to have a nice feel about it, with staff here being the “nicest to work with”, and we heard good comments about specific departments such as the acute medical unit.

Central doctors/middle-grade doctors

Ten doctors joined us in this session from GP specialty training and Internal Medicine Training programmes, and currently based on a range of posts including the Acute Medical Unit, the gastroenterology department, haematology and the Department of Medicine for Older People. We started with small group work to identify the most pressing issue these doctors wanted to talk to us about, and immediately we picked up the thread from the previous conversation with the foundation doctors of exploring the acute take.

One doctor shared the thread and theme of their main concern being the lack of support they felt that they had. Others built on this to recognise the pressure on the acute take registrar, saying they are “overburdened” and “trying to manage it all”, while also noting the impact that has on more junior staff. They also made clear how these pressures translate into patient care.

Every morning there is a whiteboard handover with consultants present, we are told. While the foundation doctors gave us the figure of 40-45 patients awaiting review on a given day, these central doctors said there are “rarely less than 30 patients” and “sometimes up to 65”. In the opinion of this cohort, it is this volume of work that determines the pressure on staff and also the patient delays, who are “sometimes left for days”.

Another perceived example of patient harm was shared in this context. The lower grades in this group had no experience of incident reporting, saying incidents are usually raised by a senior member of the team. However, all of the middle-grade doctors felt that the incident reporting process was well supported, with morbidity meetings, feedback in bulletins and a feedback system in a junior doctor forum. The panel was informed at this point that the Freedom to Speak Up Guardian is the Medical Director, and concern about potential conflict of interest was expressed.

We broadened the conversation to other elements of their work and training opportunities, and the next difficulty shared with us was about balance in the rota. The rota was characterised as very intense with on call shifts. The unanimous feeling was that the rota team or coordinators “consider numbers” for the rota and there is no tailoring to individual requirements – even that they “do not care about our requirements”. Some of the doctors present were happy with their clinic arrangement, but several suggested that they would not have met their clinic requirements were it not for classifying time on SDEC (Same day emergency care) as a clinic. Doctors had to arrange shift swaps to attend teaching, even for mandatory teaching; it was described as “a real mission to get to teaching”. The rota was said to have changed recently, becoming “more intense”, the “hours made longer and harder” such as weekends that were 9am-5pm becoming 9am-9.30pm, and the “burden becoming greater”.

At these middle grades, doctors felt that there was no feedback, no teaching shifts. Workplace based assessments were supported through the college tutor’s ACAT (Acute Care Assessment Tool) clinics, in which doctors could go through past cases retrospectively with the college tutor to meet their workplace based assessment criteria. This was described as a “fabulous educational opportunity” and all who were able to use the clinic spoke very highly of it (GP specialty trainees told us they had to go through their educational and clinical supervisors instead).

While the doctors in this group echoed similar positive sentiments to the foundation doctors about the friendly and supportive culture at the trust, where staff relations are good and people are pleasant to work with, ultimately almost all of the doctors said they could not recommend this post as a place to work, citing the lack of senior cover around the acute take and the post take ward round as the key issue.

Higher specialty training

Our next cohort was this group of seven doctors in higher specialty training, from medical specialties including acute medicine, geriatrics, cardiology and respiratory.

Without much preamble we launched straight into a discussion with these doctors about the acute take. They volunteered the same issue about feedback that we had heard from previous groups, that getting feedback and review from consultants doesn’t happen, especially on nights. They would like and appreciate informal, timely feedback as they sometimes feel they are “left to their own devices” with “no idea of whether [they] are doing a good job on medical”. We heard the same praise for the college tutor and her ACAT clinics in plugging this gap, suggesting even that the ACAT clinics were oversubscribed. Most were getting regular educational supervision, “every couple of months or so”.

We also spoke with these doctors about the post take ward round, which one described as “wildly unsafe at times”. While they agreed with previous cohorts that there could be over 40 patients waiting for the post take, they themselves had these patients in addition to the remaining medical patients meaning they quite regularly had over 100 patients in their care. They recapitulated that quite often 20 or more post take patients are not seen on a given shift, that it’s not unusual to have no post take patients seen in a shift (and they are just handed back to the day registrar), that it’s not uncommon for patients to wait three days after clerking, and that the volume of patients passed from one shift to another means that one “can’t handover all patients…just unwell patients and [outstanding] procedures”. One summed up this challenge comparing it to something out of one’s scope of practice or competency level, adding “to be responsible for all A&E patients feels beyond possibility”.

In addition to the issues driven by volume and capacity/demand, there were some specific process-driven issues in the post take. One doctor expressed concern about the Physician of the Day system, as it was not always clear who that was on any given day and the perception was that they were not on site or accessible. Another risk was flagged following the process that the list of patients is ranked and prioritised based on admission (which we understood to be admission time), amongst other things. We were told that when patients are moved, the list is updated and their “admission time” is overwritten with when they last moved. In practice this leads to people waiting longer; the example was given of a patient who had been seen by one of these doctors and then moved every day for three days, each time being put back to the bottom of the list. The patient was reported to have not been seen/reviewed during this time.

We asked about the resources put towards looking after these patients. A respiratory doctor told us that respiratory medicine has specific in reach, and though cardiology had “no job plans to be in A&E” we did hear about a quality improvement project which saw consultants on the acute medical ward with ongoing work to “improve cover on A&E”. We were pleased to hear that these medics broadly had good relations with the emergency department team, whom they called a “functional and good team” with a “good, friendly culture”.

There were clearly significant concerns around the care of patients coming through the emergency department route into medicine, and we asked if and how these concerns had been raised. We were told of complaints along these lines being raised in the regular forums for registrars, about the volume of patients getting bigger and care becoming less safe. We also heard that Datix incident reporting processes were perceived to be time-consuming and did not result in written or verbal feedback.

When asked about training opportunities, we were enthusiastically told that respiratory training is “fantastic”, that in that specialty one is able to achieve ACATs and that it has the “best rota for training in terms of specialty vs service provision”. We heard that cardiologists are very happy, with requests for training or experience usually accepted. Unfortunately, cardiologists were struggling to get their GIM (general internal medicine) competencies signed off, and ACATs and clinic quotas were not so straightforward to achieve. Local teaching was universally praised at the trust, and simulation sessions were well-received. We heard that it was acceptable to get off the wards for training, though not when on call, and that the on call shifts were “well balanced”.

Overall, we built a picture of different specialties at higher specialty level with their own strengths and challenges, but a unified view from the doctors of the dangers of the gaps in the post take ward round and the discharging and handing over of patients from the emergency department.

Cardiology educators

Ahead of the visit we had heard that the cardiology educators could not initially make it to our scheduled session. At the last minute it was confirmed that we would be joined by several consultants, and we were very pleased to be able to have a short but enriching conversation with six highly engaged cardiology consultants with educational responsibilities.

Our concerns for the cardiology service have been on our risk register since 2017, when feedback of the service and its provision of training was poor. Since then, the National Training Survey has had a mixed picture of results, never quite recovering. The survey results in 2019 were particularly bad with six negative outliers and again in 2023, which was the latest data we had when preparing this visit, with seven negative outliers. We were unable to share the results of the 2024 survey with the trust at the time of this visit, but the new year’s results show a noticeable improvement on the previous year despite its five outliers.

With this background and history, we were especially keen to talk to longstanding members of the team to take a longitudinal view of education quality in the department over the last seven or more years. The main issues cited to us were recruitment, curriculum changes, rota management and some circumstances of the hospital which impacted survey results.

Recruitment was said to have been “the main concern” and caused a number of acute periods of workforce shortage and stress over the years. Clearly the slack was picked up by those in post, and it was observed that “the more consultants are overworked, the less time for training”.

The cardiology curriculum changes have presented challenges to many cardiology departments, and Whiston is no different. We were told there were only a few trainers competent in general internal medicine for those newer aspects of the curriculum.

We were told that doctors in cardiology training had “no say in the rota”, and the increased frequency and minimum set of on call shifts had impacted on their experience. The supervisors agreed that doctors in training love to come to catheter labs and take part in echocardiogram clinics, but these experiences were hard to come by. Indeed, there was even said to be a downward trend in the number of ward rounds doctors in training could join.

The hospital circumstances which were put forward was described as a “paradox” in which most doctors in higher specialty cardiology training want to subspecialise in one of several branches of cardiology, but there are more jobs in district general hospitals [DGH] which require generalist cardiology skills. The nature of Whiston’s caseload made it “harder for trainees to concentrate in specialty” and the educators agreed that regardless of the interests of doctors in training, in fact sometimes in spite of their subspecialty interests, they “need to have lots of experience in DGH before specialising”. This is stipulated by the curriculum as well, which requires lots of general cardiology competencies.

We accepted much of this explanation for the inconsistent results in the National Training Survey in recent years, including poor results for several of those years, and probed to find out more about what measures were being taken to resolve this. We were glad to learn that the team had reviewed the poor results from the 2023 survey, and this had galvanised the department’s commitment to training and education, resulting in a number of restorative actions. It was agreed with the rota team to make some changes, including setting a minimum of three (but preferably four) doctors on wards every day and a session was created just for access to clinics. We were told of a consultant looking at the rota and stepping in directly to “balance the workload”, and we agree that senior clinical oversight of a rota brings numerous benefits to the doctors on that rota.

While clearly many improvements had been made, the team were also looking ahead to further changes that could positively impact on the training experience. They told us of their plans to scope out with the foundation programme director(s) whether more foundation doctors could join cardiology, and wider creative ideas around clinical fellows, international medical graduates, and trust-appointed local doctors to build up the middle grades.

In summary, it was clear to us that the consultant body was keenly aware of the problems and gaps in the provision of medical education and was driven to seek short- and long-term solutions.

Although we could not share the 2024 National Training Survey results for cardiology at Whiston with the cardiologists we met with, we were fortunate to have representatives from the GMC with us who were able to verbally share the improving picture of results. We hope that this supported the view that – though there was still some way to go – the quality of education and training provision was trending in an upwards direction.

Medical educators

Bringing together educators from such a diverse group of medical specialties brought a welcome diversity of perspectives.

We started by enquiring about the consultants’ capacity to support and supervise doctors in training. Job planning varied from specialty to specialty. Some consultants had the 0.25 sessions of allocated Supporting Professional Activity (SPA) time per supervised doctor in training. Others appeared to have a standard 2.5 sessions of SPA time for all non-clinical activity. Supervisors often had four, five and up to six doctors under their supervision at any time.

How the various departments elicited, collated and acted upon feedback from doctors in training was also a key line of enquiry in this session. Consultants appeared confident that they were getting regular feedback from those they supervised, through supervision sessions and feedback mid-post and after onward rotation. There was an anonymous survey available for doctors in specialty training, and one out of every four “trainee meetings” was turned into an open session for feedback. We also learned of specialty-specific feedback within departments and numerous examples of changes made in response to such feedback, such as the endocrinology team with a survey specific for diabetes specialty training having run every four months for the last two years, and a “mid-post” anonymous survey in the emergency department.

Raising our main patient safety concern, we asked the medical educators about the post take ward round. The views of those present were that the delay to the post take ward round is a “big issue”, and with respect to the challenges faced by other emergency departments in the region one consultant ventured that the ward round issue was the “worst locally”. There were actions taken to improve the situation, we were told, though the “easy option” was to employ more people but they also shared the view that this option was not deemed possible by the trust and decision makers had “not accepted the business case” for additional staff. However, there was evidence of a strongly engaged team thinking deeply about how to deploy the minimal funds and resources available.

We continued a wide-ranging debate on the post take systems of different hospitals, the change in patient demand over time, the reasons for the historical setup of the current systems, the competing interests of the emergency department and the medical wards the patients are moved on to, and much more. Ultimately, the room could agree that there was a problem with potentially serious consequences for patients and a shared resolution that some solution needed to be found. In general terms, all agreed that there was a need to front load the senior post take clinical assessment to improve patient flow. The Acute Medical Unit, for example, was proud of its “award-winning” service being a “beacon” of good practice and argued that it would leave their service and ward “short” in order to meet the patient demand coming from the emergency department, for example starting the ward round in the emergency department itself, as one colleague suggested. Other medical areas were more open to the idea of better in-reach to the emergency department, though we came away without a clear view of solid plans for implementing this

We had heard earlier in the day from the doctors in medical training about how much they valued the ACAT clinics, so we were very grateful to hear from the college tutor in this session. We fed back the positive comments we had received and learned more about the context of these clinics. They were understood to be initially funded by Covid recovery money and this funding was due to expire in November 2024 with the future of these clinics uncertain after this point. An interesting related observation was that some supervisors were struggling to find and use assessment space, as more and more space was encroached upon with additional beds to increase bed capacity.

Last year we had a visit with foundation doctors and investigated the provision of teaching sessions for foundation doctors and their access to the teaching sessions. We discovered that the trust had opened the foundation teaching sessions to foundation doctors and to junior clinical fellows, and that doctors sometimes did not attend teaching as they felt they could not get away from the ward. In the aftermath of that visit, we were informed that the trust had separated the provision of foundation teaching, ensuring that doctors in postgraduate training programmes under the deanery would be prioritised for access to these teaching sessions, and the cohort of junior clinical fellows who previously had parity of access would only be able to attend if workplace pressures allowed. In this session today, we had an update on this programme of work in relation to the junior clinical fellows. We were pleased to learn that new provision had been put in place as an induction of sorts for the junior clinical fellows, in which they start with three weeks of training. Although the focus of our quality intervention was of course on the deanery doctors, it is reassuring to hear that the trust is supporting locally employed doctors in this way.

Finally, we learned that the educators had organised a meeting with a number of the more senior doctors in training to feedback on some of the changes. Though they recognised that “not much had changed” by the time of that meeting, we encourage supervisors and the medical education team to keep actively communicating progress and plans to doctors in training as well as being open to their feedback.

Surgery educators

Foundation surgery was the reason for our focus on surgery today, in particular with the poor National Training Survey results for foundation year one in 2023 and then speaking with doctors in foundation surgery in our first session of the visit today.

We had also received a free text comment through the National Training Survey about staffing levels on day vs. night shifts from a doctor in foundation surgery. We had previously shared this comment with the trust and received a thorough explanation and a robust response in writing, and we were able to re-examine the issue in person with the college tutor for surgery.

In the morning of this visit we had heard a regular theme of concerns from the foundation doctors around supervision (both in and out of hours) and induction, which the department had clearly been aware of and taken steps to improve. While rota issues were said to be ongoing, an additional foundation year one doctor had been added to help with the rota and it was planned that a new rota master or administrative rota coordinator would imminently start to help manage the “tricky balance” of covering the shifts. We were told of a history of service areas taking “little ownership” of the local induction, but after a recent focus on the local induction this was said to have now changed with a much-improved induction experience at the local departmental level.

We learned of the team of ward-based advanced nurse practitioners who are able to offer lots of support to foundation doctors. We were told that they introduce themselves at inductions, that they are present on twilight shifts and on weekends, and that a planned staffing change (from August) would ensure cross-cover working and reduce the number of ward rounds foundation doctors have to do, at the same time as ensuring the presence of a senior clinician, either a consultant or a doctor in higher surgical training. This was also expected to facilitate the ward round experience becoming a consistently more effective opportunity for teaching and learning.

Rotas are complex in many ways, and we probed specifically into how less than full time doctors were accommodated in the rota. The consultants informed us of the “Less Than Full Time Champion” and their role, as well as additional support for doctors returning to training. They also noted the experience of the rota coordinators who are “very good at integrating [less than full time doctors] into the rota”.

Over the course of the conversation, we built a picture of a team of educators who were actively seeking feedback from the doctors in their training programme. As well as being responsive to the data and the free text comments from the National Training Survey, there were regular feedback sessions in the form of a college tutor forum, a “trainee forum” for resident doctors, a departmental journal club, and a space for trust specialty training leads to regularly meet as a group. We learned that some of the recent changes and plans for changes were driven by feedback picked up from these forums. Educators noted that sitting on Annual Review of Competency Progression panels was also a useful source of intelligence, and remarked that outcomes were generally adequate to good.

While multiple channels for feedback are likely to have a positive impact on the responsiveness of the responsible educators, we did ask further about specific quality-focused initiatives. We were told of a consultant-led safety and quality meeting held on Fridays, to which “all are invited”. This was said to have an element of quality and also acts as a useful “place to vent frustrations”.

The doctors in surgical training had talked about their experience of using and interacting with the incident reporting systems at the trust, and we fed that back to the consultants. We were told that, as a rule, outcomes from Datix investigations are sent on to a doctor if they raised it, and if the department is indicated it goes to the college tutor to follow up with the involved doctors and consider including an assessment for their portfolio.

The consultant body were clearly very proud of the service they were responsible for. We had heard positive things about the simulation training. It was unfortunate to hear that this had been put on hold due to a long-term sickness absence of a key member of staff. The department was rightly proud that they consistently score very highly on patient satisfaction scores.

Areas for improvement

Immediate mandatory requirements

Mandatory requirements

Recommendations

Report approval

Report completed by: Zander Zambas, Quality Support Manager
Review lead: Nadeem Khwaja, Deputy Dean for Cheshire and Merseyside
Date approved by review lead: 11 November 2024

NHS England authorised signature:  
Date authorised: 4 December 2024

Final report submitted to organisation: 4 December 2024