Panorama asks whether female patients in Bradford missed out on vital radiotherapy
A year-long Panorama investigation reveals how Bradford Hospitals NHS Trust may have put around 150 women with breast cancer at risk by failing to give them the crucial second stage of their treatment - radiotherapy.
As a result they faced a greater risk of their cancer coming back and the disfigurement of losing a breast in a mastectomy operation - the very thing their treatment was intended to avoid.
The women affected were treated with breast conserving surgery for invasive cancer during the late 1980s and 1990s.
Doctors and managers at the hospital have known for over a decade that some patients in the 1980s and 1990s diagnosed with invasive breast cancer were receiving sub-optimal care - but the trust has never told the women what happened.
Analysis carried out for Panorama suggests the problem continued for longer than the trust has been publicly prepared to admit.
Three different doctors in the 1990s separately raised the alarm about the trust's failings in breast cancer care.
The first risked his job to warn managers and has since left the NHS, the second produced the statistical evidence without publicly naming the hospital and the third was branded a false whistleblower.
This is a story of how hard it can be for patients to find out the facts about the quality of medical treatment. In spite of the government's ambition for more openness across the NHS, the analysis of treatment methods and outcomes is currently one of the most controversial areas of medical research.
The public use of such performance data to reveal, for example, comparative survival times under the care of different medical teams is hotly contested by doctors and hospitals. Professional reputations are at stake.
Results not accepted
A number of eminent experts helped in the making of this film, including an epidemiologist who also advises the Department of Health and a lead statistician from the Shipman and Bristol babies inquiries.
Data for almost 30,000 women across a 22-year period was analysed for Panorama for the making of this film, but the results were not accepted by the NHS Trust at the centre of this special investigation nor by two experts they contacted.
It responded by threatening the professional reputation of a key medical expert who helped Panorama by saying they would refer him to the General Medical Council.
He believes the NHS is still capable of a bad news culture that "shoots the messenger" even when the message is about patient care.
New research published in the Lancet in December 2005 suggests a failure to give radiotherapy can affect the long term survival of patients as much as 15 years after their original treatment.
The hospital has made repeated attempts to persuade the BBC that the film is not in the public interest.
- Panorama has been engaged in extensive communication with the trust on the matters raised by our research both on and off camera over a period of more than nine months.
- We would welcome public debate about the issues of public policy and patients' rights raised by the programme. The trust have suggested that this should have taken place prior to broadcast. We believe this public debate will be informed following the transmission of Panorama's programme - The Hospital That Failed Women.
- Bradford Teaching Hospitals NHS Foundation Trust has been provided with the contents of the statistical research featured in the programme. The findings have been clearly put to the trust. We are more than satisfied that the hospital have all the information they need to be able to respond publicly to the film.
- We believe the primary responsibility for addressing concerns raised about the treatment of patients lies with Bradford Teaching Hospitals NHS Foundation Trust. Bradford have had possession of Prof Coleman's report and its findings since July 2005. The report was reviewed by Dr David Spiegelhalter - who conducted significant work in relation to the Shipman and Bristol inquiries. The hospital has had Dr David Spiegelhalter's final commentary since before Christmas. Following transmission we would be happy to discuss with the Healthcare Commission how we might help them pursue this matter.
The Lancet has today published a number of significant allegations about the Panorama programme, unaware of its actual contents and the considerable care that has gone into its production over many months.
With reference to the Lancet's press release we would make the following points:
- The programme reports that by the early 1990s there was international recognition that most women who had breast conserving surgery should receive radiotherapy. (We would refer you to the National Institute of Health Consensus Statement which was published in 1990.)
- Panorama focuses on the efforts of a medical team not one surgeon. The surgeon referred to in the Lancet was part of that team but Panorama makes clear what that surgeon - through his lawyers - says were and were not his responsibilities.
- Professor Coleman's report has been reviewed by Dr David Spiegelhalter who advised both the Shipman and Bristol Heart inquiries. Dr Spiegelhalter tells the programme that he does not regard Prof Coleman's report as "bad science" as the hospital and Sheldon contend. Dr Spiegalhalter who has since seen Sheldon's review has since told Panorama that he regards Prof Coleman's report as a good job on the data available and "comparable to the analysis carried out for the Bristol and Shipman inquiries". Dr David Spiegalhalter agreed that the hospital had low radiotherapy referral rates (as part of BCS) and was an "outlier" until the late 1990s.
- The programme reports that mortality data alone cannot be used to make definitive judgements about the quality of medical care but that it does provide leads to follow up. The programme draws no conclusion that excess mortality was caused by low radiotherapy rates. It is worth pointing out that the hospital have only ever provided Panorama with extracts of a letter from Professor Richard Lilford. Dr David Spiegalhalter said that there was evidence of excess mortality but it is this that he said needed to be treated cautiously.
Finally, we can all agree with the hospital's sentiment that the data we are now putting into the public domain should not be the "endpoint in investigating quality of care".
Panorama: The Hospital That Failed Women was on BBC One on Sunday 2 April 2006.