“Big personalities”, “ego problems” and a “toxic culture”. These are all issues which have led to a shocking review of the surgery team at Lynn’s hospital.

The damning report has found serious lapses in care for patients during surgery at the QEH, resulting in at least one person dying.

This death could have been avoided, according to several members of staff interviewed as part of the Royal College of Surgeons (RCS) report.

The RCS reviewed 17 clinical cases – eight original operations and nine complication or return-to-theatre cases – and eight were judged to have involved care below the expected standard.

The findings are so serious that all general surgery at the QEH is now operating under supervision from surgeons from the Norfolk and Norwich University Hospitals, as part of a new mandated service. This arrangement began last Friday.

Here are some of the key takeaways from the damaging RCS report…

‘AN AVOIDABLE DEATH’

Patient safety concerns were raised in two whistleblowing letters, in September 2023 and August 2024, as well as by hospital staff.

Staff have said they believe that at least one surgery patient’s death could have been prevented.

One case reviewed by the RCS had originally been resented as an “unavoidable death”’. However, the review team was informed that “almost every colleague felt this was an avoidable death”.

An anonymous letter submitted in August last year raised concerns about a patient who had died, as well as seven other people treated.

Some of the cases raised in the letter had been reviewed through local governance processes. Other cases had not been reviewed as they were not reported or had not met the threshold for investigation.

The review also states that there was no mortality lead employed at the time of the investigation.

SURGEONS’ COMPETENCY

Of the eight cases deemed to be below standard, three of them resulted in the review team querying surgeons’ competency to perform operations.

Concerns were raised about one surgeon’s ability to carry out a colorectal endoscopy, a surgical procedure commonly used to detect bowel cancer.

Within three cases, the review team queried whether the operating surgeons “had sufficient competencies to perform the surgeries undertaken”.

“In these cases, the standard of surgical care was considered to have been unacceptable,” the report states.

Four of the inadequate cases reviewed showed there was a delay in surgeons’ recognising post-operation complications in patients.

“The delays in the recognition of post-operative complications in cases likely resulted in delays in these patients being returned to theatre,” the review states.

“However, one of the surgeons in question described a lack of support and mentorship on joining the service, by which the review team were concerned.”

This is something that borough councillor and founder of the Save the QEH group, Jo Rust, has raised concerns about.

“A failure to provide support and mentoring is a fundamental flaw in employment practices, and it must be addressed as a priority if we want to retain staff and nurture their development and skills,” she told the Lynn New.

VACANCIES NOT BEING FILLED

The review stated that general surgery staff reported having an extra workload due to vacancies not being filled.

Interviewees further reported that there was no policy surrounding the care of consultants’ patients while they were on annual leave.

The review reads: “The ad-hoc approach of cover had become more difficult to manage when the service had struggled with low consultant staffing levels.

“The service should strongly consider implementing a robust policy that defines what the patient handover process entails, which should be followed when consultants take periods of leave.”

A recent FOI request carried out by the Lynn News can reveal that four speciality doctors and three general consultants in the general surgery department are earning more than £100,000 a year.

An increase in staff sickness also added to the shortages among the team.

‘TOXIC CULTURE’

Findings revealed that there is a “toxic workplace culture” in the general surgery department.

The report states that there are “poor working relationships and culture” among consultants within the service.

Colleagues said that “it can be pretty toxic between the surgeons” with certain individuals “making each other’s lives difficult”.

Accusations were made that two colleagues had not spoken to each other in years.

“Ego problems” have resulted in surgeons not getting a second opinion from others when caring for patients.

Cllr Rust said the toxic workplace culture would put trainee doctors off coming back to the hospital in a full-time capacity.

“I have raised the issue of the toxic culture at the trust, and this message was a thread throughout the report,” Cllr Rust said.

“Particularly among senior staff, with one senior consultant being referred to as having become bitter and resentful because he didn’t feel his seniority was well enough recognised.

“Again, why would resident doctors undertaking their training at the QEH want to come back and become a permanent member of staff if they had suffered under this toxic culture?

“So it makes recruitment to the trust incredibly difficult. High staff turnover at a senior level was also referred to.”

Several interviewees said the distribution of work within the team was “not fair”, especially around the disparity in cancer work.

It was heard that two surgeons were primarily operating on cancer patients, and that patients were being “cherry-picked”.

The review team was informed that differences between surgeons and their attitudes to surgery had “led to some tension within the team”.

A minority opinion expressed was that there was “an overuse of laparoscopic surgery” within the general surgery service.

THE ROBOT

At the end of last year, the QEH celebrated a historic milestone, performing its first robotic-assisted surgery using a £1million “cutting-edge” system.

The acquisition of the CMR Versius Surgical Robotic System, known as “the robot”, was supposed to improve outcomes for patients.

However, the review has said that this piece of equipment is underused and is now at risk of being moved to another hospital.

A widely held view queried the trust’s ability to use the robot “to its fullest”.

“Interviewees reflected that the robotic surgery was taking a long time,” the report stated.

“The theatres in which this surgery was taking place were described as pitch black, silent, no lights, people are requested not to talk. This can be draining on people’s well-being for very long procedures.”

‘NARCISSISTIC’ LEADERSHIP FROM DIVISIONAL DIRECTOR

The review team was informed that there had been a general surgery divisional director in place until a few weeks before the RCS review was conducted.

It was said that this director had struggled to make time for their service managerial responsibilities.

Some interviewees said the divisional director had a “temper”, was “potentially not very keen to ask for help” and had a “narcissistic leadership style”.

An anecdotal allegation was also shared, saying the divisional director was “bullying theatre staff, a colleague and middle-grade doctors”.

POOR TRAINING EXPERIENCES

Trainees in the general surgery department did not receive the help required, the review found.

The review team heard that there was very little “locally arranged training” for resident doctors, but they could use study leave to attend courses.

A small number of interviewees described a type of laparoscopic training, held by the clinical director, in which individuals could “practice in a simulation”, but no further examples of localised training were provided.

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