Netcare Orthopaedic Surgery

The SHA Report: a short summary

The Netcare contract

• The contract is described, “on the whole as successful”.
• The arrangements for the contract were “put in place hurriedly because of unusual local circumstances”: a reference to the loss of four orthopaedic surgeons consequent to their military deployment in Iraq.
• Timescales were “ambitious given the numbers involved and the mix of cases”.
• Concerns over clinical standards were raised during the contract after post-operative complications.
• Following investigation, the report found these concerns to relate to the activities of one surgeon.
• Issues of governance and clinical quality should be clarified in future contracts with overseas teams.

Recruitment procedures

• There were poor procedures to recruit doctors, who were described by Netcare as their “associates”, rather than their employees.
• Netcare considered itself to be an “introduction agency” and believed it to be Portsmouth Hospitals NHS Trust’s responsibility to satisfy itself that the Netcare surgeons were competent.
• Vetting procedures of Netcare’s surgical team are described as “weak” and references were “not always seen”.

Governance Arrangements

• Netcare’s audit procedures are described as “of a high quality” but they measure surgical outcomes until the patient is discharged rather than over the longer term.
• The risk to patients would have been reduced with the presence of a local senior clinical quality controller, as used in ‘Operation Joint Initiative’ in Southport.
• There needed to be “a strong and consistent standard of clinical governance understood and followed by all”, particularly where working arrangements were “unusual by normal UK standards”.

Hostility and Tensions

• Many of those interviewed by the review team referred to the hostility towards the Netcare staff by some local orthopaedic consultants.
• The review team found there were tensions surrounding the Netcare surgeons’ expectation of what equipment would be available to them.
• The orthopaedic workload at Haslar was considered by the review team to be large.

Dr Y

• The evidence of Dr Y’s previous lower-limb experience at the time of his recruitment “was not strong” and his clinical performance was judged to be “a source of concern, by comparison with normal specialist expectations”.
• Dr Y told the review team that he had previously confirmed to Netcare that he had severely limited experience of using the prostheses available at Haslar.
• However, the report also claims that given his previous position in an academic role, “he should be able to successfully implant an Exeter hip prosthesis, even if he has no previous experience of using one”.
• A minimum of five of Dr Y’s six hip replacements “raised concerns over his surgical technique”. He had not used an essential component and these operations “will probably fail within five years” according to independent analysis.
• They found that Dr Y had carried out 43 orthopaedic procedures over a two-week period whereas Netcare’s records show that Dr Y had carried out 39 operations.

Mrs X

The report describes a hip replacement operation performed by Netcare surgeon, Dr Y on Mrs X, a patient referred by Derriford Hospital in Plymouth. Mrs X is also a Michelmores’ client. She suffered a severe diathermy burn to her ankle as a result of the misapplication of surgical equipment. Dr Y had also failed to use an essential component and did not secure the joint with an adequate amount of surgical cement. He had been operating for more than 12 hours on the day of Mrs X’s operation.

Her hips subsequently dislocated but the joint could not be repaired immediately due to the threat of cross-contamination from her existing diathermy burn. An NHS consultant at Derriford Hospital in Plymouth concluded that her prosthesis had been implanted in a "totally substandard and probably negligent manner". Mrs X underwent a repeat hip operation at the Nuffield Hospital in Exeter funded by Netcare, without admission of their liability.

Mrs X was aggrieved at the attitude of Plymouth Hospitals NHS Trust who, in pointing to Netcare, would not accept responsibility for her failed hip operation.

Continued on page three: Michelmores' reaction to the SHA Report on behalf of its clients

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