Salford Royal Hospital concludes review of spinal surgery patients

The Northern Care Alliance NHS Trust has concluded its investigation into cases where patients underwent surgery under the care of former spinal surgeon, John Bradley Williamson, between August 2009 and September 2014.

Its shocking findings have revealed a catalogue of clinical errors by Mr Williamson that tragically harmed several patients at the Salford Royal Hospital.

It also identifies themes of concerns raised by staff around the conduct, probity, and clinical standards of Mr Williamson from the start of his employment in 1991, until his dismissal in 2015, due to inappropriate behaviour towards a staff member.

Patient harm

The review, carried out by an investigation group drawing on expertise from several disciplines and including consultant spinal surgeons and an independent spinal expert, identified a number of Mr Williamson’s patients had been harmed or poorly treated. Concerns included poor surgical practice; misplaced spinal screws; failure to take properly informed consent issues; and excessive blood loss.

Whistleblowing

The Trust was first made aware of concerns regarding Mr Williamson in 2014 when it received a letter from an anonymous whistleblower raising issues regarding his behaviour, conduct, probity and capability. An investigation was opened and in 2015, the Trust asked the Royal College of Surgeons to carry out a clinical review of 10 selected cases, but that review did not highlight any particular concerns. In 2016, an internal request was made to review a further 17 cases, but it is unclear whether that ever proceeded, and it was not until 2021 that a multi-professional group set up by the Trust raised concerns about Mr Williamson, prompting the present review.

Findings

The report identifies significant areas of avoidable harm and death, as well as common themes surrounding patient safety, clinical incompetence, and professional concerns.

These include a lack of probity in documentation; poor surgical technique; non-compliance with informed consent processes; poor communication; dishonesty in discussions around risks relating to surgery; unacceptable conduct with patients and staff; and questions surrounding the appropriateness of surgery in particular instances.

The review also found that there was a poor culture of incident reporting within the spinal service between 2005 and 2014. Not all incidents had properly been reported through the Trust’s internal systems and some issues were not fully investigated to improve patient safety and implement future learning. It cast doubt on the findings of the earlier 2015 review, identifying “multiple significant contradictions” between the Royal College of Surgeons’ findings and the review’s own conclusions.

The Trust’s report is to be shared with the General Medical Council. The Royal Manchester Children’s Hospital and the Spire Hospital are conducting their own investigations into Mr Williamson's practice at their respective hospitals.

Recommendations and future learning

Centring Patient Voices

Whilst the Trust’s report is a welcome step in the right direction, it is crucial that patients are treated as individuals, and not just as statistics in a regulatory exercise. Their voices must be placed squarely at the centre of the process and there must be a high degree of transparency around all aspects of review into their care. Proper regard must be had for the concerns of bereaved or injured patients and families to ensure the right questions are being answered, and no patients remain at harm.

Full Recall and Independent Review of All Patients

Given the length of Mr Williamson’s employment from 1991 to 2015, the nature of his “serious and frequently occurring” conduct issues, and staff’s repeated complaints regarding his clinical competency, there is more to be done and other cases to be looked at: many patients experiencing long-term mobility issues, chronic pain and other complications may be unaware that their injuries are a result of substandard care. 

We therefore fully support calls for the Trust to conduct a full recall of all patients treated by Mr Williamson after he started work in Salford Royal in 1991, as well as across all hospitals in which he has operated. This must include a review of the patients who were lost to follow up after his dismissal in 2015, and patients must be properly informed about their care and any areas of learning identified.

Proper Identification of Issues

As the differences between the 2015 and 2023 findings reveal, there must be improvements in cultures of incident reporting. We would welcome collaboration with external stakeholders to ensure optimal governance practices for the appropriate identification of issues to allow proper investigations for improvements in patient safety and future learning.

Whistleblowing, Concerns and a Culture of Transparency

Senior clinicians’ attempts to bring this matter to light have been arduous and drawn out, with clear failures by the Trust to respond appropriately to their reports. Trusts must ensure a culture of accountability and transparency, and properly investigate all allegations of harm, particularly when relating to clinical care and conduct affecting patient safety. Attempts to avoid reputational harm must be eradicated in favour of a commitment to take whistleblowing reports seriously and eliminate patient harm.