County Durham and Darlington NHS Foundation Trust's Board has today agreed to extend its breast services look-back into earlier years.
The Trust will complete the reviews already underway covering care between January 2023 and February 2025. It will then look back one year at a time, starting with patients treated in 2022 and working backwards towards 2015.
After each year has been reviewed, the findings will be carefully considered before a decision is made about the next steps.
The decision was made at an extraordinary public meeting of the Trust Board on Thursday 24 September, after hearing from women affected and considering patient and public views, independent clinical advice and the different options available.
If you have previously received breast care from the Trust, today's decision does not mean there was a problem with your care.
You do not need to contact us simply because you were treated by the breast service during this period.
As the look-back moves into each earlier year, we will identify the patients whose care needs to be reviewed. We will contact you directly if we need to review your care and will explain what happens next.
If a review finds concerns about your care, we will speak to you directly about what has been found and arrange any clinical follow-up or other support you may need.
Patients will also be able to choose not to have their care reviewed if they do not want to take part.
However, if you are worried about your previous breast care, you do not have to wait to hear from us. Our dedicated patient support team remains available:
Telephone: 0191 333 2126
Email: cddft.
This support will remain open throughout the look-back.
We have previously acknowledged serious and long-standing failings in our breast services. We remain deeply sorry to the women and families who were harmed and let down.
There were times when, as a Trust, we should have listened more carefully, asked more questions and acted sooner.
The look-back has already identified harm in some patients whose care would not necessarily have been picked up through the original review.
We have also heard clearly from women and patient representatives that the responsibility for identifying people who may have been affected should not rest with patients themselves. The Board paper reflects a strong expectation that the Trust takes a proactive approach.
Independent clinical experts have advised that looking further back is unlikely to identify significant numbers of patients who now need further treatment or reveal significant new clinical learning.
However, they also recognise that reviewing medical records alone may not identify everyone affected and that further cases of harm may still be found.
The approach agreed today means we can continue looking further back, while carefully considering what we find at each stage.
We will complete each year's reviews before considering whether to move into the next earlier year.
That decision will not be based on a single number. We will look at the overall picture, including:
- the number and seriousness of any concerns or harm identified
- whether any cases meet the threshold for Duty of Candour
- whether we are seeing recurring themes or patterns
- what patients and families are telling us
- whether looking further back is likely to identify more people who need information, support or clinical follow-up
- advice from independent breast specialists
The independent specialists on our Clinical Reference Group will help assess the findings. Patient and family experiences will also continue to inform the work. Recommendations about moving into another year will then be considered through the Trust's formal decision-making arrangements.
We will continue to make decisions about the look-back openly and in public through our Trust Board.
Supporting women and families
Chief Executive Steve Russell said: “We have heard again today about the profound and lasting impact that failings in our breast services have had on women and their families. We remain deeply sorry for the harm and distress caused, and for the times when we should have listened more carefully and acted sooner.
“This has been a difficult decision. Throughout this work, we have said that we want to do the right thing for the women and families affected. The Board has carefully considered the different views we have heard, alongside the clinical evidence and advice available to us, before reaching its decision today.
“We have heard from women who want us to look further back and who understandably want reassurance that others who may have been affected will be identified.
"Likewise, some women and families have told us they would not have wanted concerns about their care brought back to them many years later, and that receiving this information has itself been very distressing for them and their families.
"We have listened carefully to those different experiences and views, and to the importance of doing this work thoroughly and making sure the right support is available throughout.
“Today's decision means we will look further back, one year at a time. We will carefully consider what we find at each stage and use that to decide what happens next. We will continue to listen to women and families and be open about what we find.
“We know the look-back itself can bring further worry and distress. Our support will remain open and available throughout. Where we identify concerns about someone's care, we will contact them directly and make sure they receive the information and support they need.
“We cannot change what happened, but we can continue to listen, support those affected and do everything we can to get this next stage right.”
We will complete the reviews already underway covering January 2023 to February 2025.
The look-back will then move into 2022.
Each patient's care will be considered individually by independent specialist clinicians. Some cases need input from more than one specialist.
Records from before October 2022 can also take longer to review because they were created before the Trust's current electronic patient record was introduced.
Many older records were originally held on paper and have since been scanned, meaning clinicians may need to work through large amounts of information to understand an individual's care.
We know women will want answers as quickly as possible. We will continue to look at how we can increase capacity, while making sure every review is carried out properly and consistently.
Breast services today
We also understand that patients receiving breast care now may be concerned by what they have heard about the failings in the previous service.
The breast service patients receive today is very different from the service described in the historic reviews.
Changes have included new specialist breast surgeons, stronger clinical leadership and oversight, greater independent expertise, changes to multidisciplinary working, improvements to diagnostics and radiology, and changes to how decisions about patients' treatment are made.
We are seeing measurable improvements in patient care, including reductions in mastectomy and repeat operation rates, increased immediate breast reconstruction and more patients being able to have their surgery as a day case.
We know, however, that rebuilding trust takes more than saying the service has changed. We will continue to monitor patient outcomes, listen to patients and report openly on both the service today and what we find through the look-back.
Patients will be contacted directly to explain what has been found and make sure appropriate clinical follow-up and support are available.
However, anyone who is worried about previous breast care at any point in time can continue to contact our dedicated support team:
Telephone: 0191 333 2126
Email: cddft.