Chelsea and Westminster Hospital NHS Foundation Trust says it is safe despite serious incidents increase

BY OWEN SHEPPARD
Local Democracy Reporter
yann@slpmedia.co.uk

The number of top category Serious Incident investigations carried out at Chelsea and Westminster Hospital has risen in the past year – but the Trust insists it is one of the “safest” hospitals in London.

A report by Chelsea and Westminster Hospital NHS Foundation Trust shows that from October 2018 to September 2019 there were 99 Serious Incidents declared.

The Trust’s report said most of the Serious Incidents related to “maternal” care, as well as fetal or neonatal care, patient falls, operations/procedures and diagnosis or observations.

Twelve of these cases took place in the labour ward, six in A&E and six in the hospital’s eye clinic.

Another six happened in the acute assessment unit, where “rapid assessment, diagnosis and treatment of patients with urgent medical and surgical conditions” takes place.

A Trust spokesman said the hospital had the second lowest stillbirth rate of any maternity unit in England.

Most but not all of the 99 cases at the hospital in Fulham Road involved harm caused to patients. In one case, a patient died.

The report said that in 38 of the 99 cases, patients suffered “moderate harm”, or non-permanent harm. In eight of the cases, patients suffered “severe harm”.

The Serious Incidents are also put into two categories of investigation, internal or external.

External cases have been raised at a national level with NHS England, as the investigation may pose questions about the safety of treatments, medicines or techniques.

The Trust’s report, entitled Learning from Serious Incidents, said 55 of the serious incidents were classed as internal, while 44 were external.

The Trust has only recently started publishing data about internal reports it carries out.

But past reports, which are discussed every three months by the hospital’s board members, show the number of external Serious Incidents carried out at Chelsea and Westminster Hospital was 41, 42 and 34 respectively between the financial years 2016/17 to 2018/19.

The report said: “Serious Incident investigation provides clinical teams with a structured approach to care and service delivery evaluation, and supports the identification of learning opportunities designed to reduce the risk of harm to patients, staff and the public.”

Some of the reasons why these incidents can occur include a failure to stick to Trust policies and procedures, a lack of risk assessment, complications of treatment and a lack of clinical expertise or technical ability.

A spokesman for the Trust said: “The Trust is committed to safe and effective care. For example, we have the second lowest stillbirth rate in the country. We are one of the safest Trusts in London.

“We know we do not always get it right. Where something is not right, our first priority is the patient and their carers.

Our commitment to a safety culture means carefully examining every case where something went wrong to ensure we learn from it. That is why we take care to investigate and report on significant incidents which are below the threshold for external

reporting. Patients should understand that a willingness to investigate clinically and report is a positive thing for safety.”

The Trust also manages West Middlesex University Hospital in Isleworth, where 92 internal and external Serious Investigations took place between October 2018 to September 2019.

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