A scrapped review of breast cancer services in Tayside called for urgent psychological support for staff left “distressed” following revelations patients were given lower than standard chemotherapy doses.
The Royal College of Physicians (RCP) London found there was need for “significant improvement” in governance arrangements for breast oncology at NHS Tayside and was critical of the health board’s handling of concerns raised by a whistleblower.
The full review has been scrapped after a potential conflict of interest was identified but RCP said it stands by the initial feedback issued as part of the process in June.
Around 200 women were given the lower dose between December 2016 and April 2019 in a bid to reduce harmful side effects. A Scottish Government-commissioned report later stated this resulted in an increased risk of their cancer recurring.
The RCP feedback, seen in full by The Courier, outlines how the Tayside oncology team and their clinical lead presented a dossier of information that “disagreed or aimed to refute” the findings of previous reports.
RCP said the broad outcomes of the reports should be “acknowledged rather than contested”, particularly in relation to drug treatments, but said it had received “many letters of support” for the consultants.
The investigating panel noted they had met “a significant number of tearful and distressed staff” and highlighted the additional pressure on doctors and patients.
The report states: “The handling of the whistleblower and the raising of concerns has clearly been a very stressful time for all parties and we feel this could have been handled more efficiently and effectively by the Board for both patients and the staff involved.”
The panel said NHS Tayside should have a major incident response to the revelations, including “rapid resolution of outstanding grievances, bullying and harassment claims and the issue of the immediate employment future of the whistleblower”.
It found the consultants to be “cohesive, conscientious, caring and hard working but said longer, more comprehensive consultations, including conversations around consent, “is the way forward”.
The panel said this was especially important “when treatments are offered locally that are not in line with what is regarded as best practise”.
The preliminary views, which RCP said “focus on any areas of concern to patient safety”, include a recommendation oncologists should continue to offer the higher chemotherapy dose as a baseline but reduce when appropriate for individual needs.
It states there should be “urgent resolution of all issues relating to the whistleblowing investigation in its widest sense and appropriate support urgently given”.
RCP has offered to re-run the review with a new team immediately or return in 12 to 18 months to see how initial feedback has been implemented.
NHS Tayside expressed disappointment at the review being scrapped but said it had accepted and acted on RCP’s immediate recommendations.
A spokeswoman said: “NHS Tayside is in discussion with the Royal College of Physicians about next steps following the college’s decision not to proceed with the commissioned review.”