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Tayside reduced to a single breast cancer consultant amid warning ‘decimated’ service will cost lives

Headlines about the NHS Tayside treatment scandal. Image: Supplied

Tayside health chiefs have been warned the “decimation” of breast cancer services in the region will cost lives after another senior doctor announced he is leaving the beleaguered department.

Dr Douglas Adamson has notified bosses he will retire in January, despite being only 57 years old, meaning the service will be reduced to a single consultant who was recruited in August.

Dr Adamson is the last remaining member of the oncology team who accused management of throwing them “under the bus” amid a long-running scandal about lower-than-standard chemotherapy doses.

Dr Douglas Adamson, second from right.

We can exclusively reveal investigations by the General Medical Council have effectively cleared individual team members over use of the doses and found the clinicians involved behaved appropriately despite not telling patients about the practice.

The explosive findings raise further questions about the working culture within NHS Tayside, which was forced to ask other boards for help after its chief executive said he was unable to guarantee the future of the service in the wake of several resignations.

A service in turmoil

The oncology department was thrown into turmoil in early 2019 following the revelation that around 200 patients were given lower-than-standard doses of chemotherapy drugs in a bid to reduce harmful side effects.

The doctors lowered the dose after an internal audit in 2015 found significant toxicity and the need for a reduction in half of their patients.

The decimation of this vital service is a long and sorry story of management failings and an inept SNP Government.”

Michael Marra

A Scottish Government-commissioned review said the treatment resulted in a 1-2% increased risk of their cancer recurring but a series of investigations by us revealed one of the experts behind the claim later privately admitted it was “flawed, probably, but the best that could be done, really”.

Doctors in Tayside claimed the review was “deeply flawed”, reported being physically threatened following its publication and hit out at bosses for accepting the findings despite their concerns.

What did the GMC investigation find?

We can reveal a GMC investigation into the consultants at the heart of the controversy notes that while the majority of cancer centres use a higher dose, “there are other accepted regimens using other doses”.

It states the outcomes of using lower doses “have largely not been compared in clinical trials and therefore cannot be said to offer proven inferior outcomes”.

Several government-ordered reviews – many of which have been disputed – concluded the doctors believed they were acting in the best interest of their patients by reducing the dose but there was a lack of fully-informed consent around the practice.

However, the GMC said it “would not be normal practice for an individual consultant to discuss with a given patient the differences in chemotherapy doses recommended or the other possible regimens available either in their centre or at another centre”.

It stated that even if a doctor was aware of the alternative regimens available at other centres, “it would not be normal practice to discuss with patients the availability of these treatments unless it was considered these treatments were superior and therefore in the patient’s best interests”.

NHS Tayside said it would not comment on the report, as it is a “confidential matter between the individual doctor, their regulatory body and the individual who made the referral” to the GMC.

Patients and families affected by the 2019 dosing scandal have repeatedly called on health secretaries and Nicola Sturgeon to meet them as part of their ongoing search for answers but to date not a single meeting has been arranged.

‘Time to get a grip of the chaos’

Ms Sturgeon said earlier this year it would not be “acceptable or appropriate for women in Tayside to have to travel long distances for essential breast cancer support and care”.

North East MSP Michael Marra urged the Scottish Government to step in “to finally get a grip of the chaos they have caused”.

He said: “We cannot allow this to be a fatal blow to Dundee’s breast cancer service and to local women.

“The decimation of this vital service is a long and sorry story of management failings and an inept SNP Government.

Michael Marra.

“It is women in Tayside and their families that will suffer the consequences.

“The time for action at the very highest level arrived long ago, but if it does not happen immediately then lives will certainly be lost.

“It is now nine months since Nicola Sturgeon said she would look into the issue, and the situation has only deteriorated further and faster.”

‘We know the harm this will cause’

Mr Marra said he had been told by local staff that the situation could mean women being forced to travel further for the treatment they need.

“Some women, particularly from the most deprived backgrounds, don’t and won’t travel.

“We know the harm this will cause,” Mr Marra added.

An NHS Tayside spokeswoman said the health board “currently offers a full breast oncology service with all patients seen here in Tayside”.

“A new consultant breast oncologist started in August this year and recruitment is ongoing for clinical and medical oncologists,” she said.

“Our priority remains that we continue to deliver a service for patients in Tayside.”

Timeline: How we investigated the NHS Tayside breast cancer treatment scandal