HCSA investigation exposes 'serious flaws' in exception reporting process

A new HCSA investigation has exposed serious flaws in the exception reporting process introduced as part of the controversial 2016 Junior Doctor contract to monitor potentially unsafe rota breaches.

Doctors in training are encouraged to file a report each time they encounter issues around working or rest hours, unplanned variation in their work pattern or missed educational or learning opportunities.

However, the HCSA probe has revealed that just a handful of the thousands of exception reports being lodged have resulted in service or rostering changes, leading to a breakdown of “faith” in the system among junior doctors.

HCSA President Dr Claudia Paoloni warned that hospitals are opting to pay fines rather than act to tackle the root causes of service issues amid a national shortage of medical staff, branding the reports the “canary in the mine” for hospital safety.

NHS Employers guidance states that a work schedule review, which can consider whether to make changes to services or rotas, should be undertaken where exceptions become more regular or frequent. 

But according to data obtained through the Freedom of Information Act just 852 (2.55%) of 33,406 exception reports led to service or rostering changes. Dozens of Trusts reported they had implemented no changes whatsoever despite thousands of exception reports being submitted by junior doctors.

FoI requests revealed:

  • 33,406 exception reports were submitted between September 2017 and September 2018, but only 852 (2.55%) led to service or rostering changes.  
  • Over half of all service changes (457) were made in just three Trusts. 
  • 59 Trusts made no changes to services or rostering despite receiving 11,862 exception reports.

HCSA President Dr Claudia Paoloni said: 

“Our research exposes significant flaws in the current exception reporting regime, with dozens of Trusts unable or unwilling to do anything at a system level to correct repeated rota breaches. 

“Three Trusts appear to account for half of all system or rota changes, which suggests either a significant variation in the way reports are processed and recorded or a fundamental difference in the level of concern and priority these breaches attract. 

“We suspect that the acute shortage of doctors is the underlying cause of the apparent failure to tackle repeated breaches. 

“We know that many overstretched Junior Doctors are already losing faith in exception reporting, and these figures will do little to raise confidence. While it is essential for doctors to continue to exception report, this lack of faith is understandable. 

“If hospital managers prefer or have no choice but to pay fines, rather than sort out their staffing issues, then clearly the current approach is failing badly. 

“Exception reporting can be made to work and has the potential to be an effective canary in the mine on safety, but it needs reform that goes beyond refining or streamlining reporting mechanisms. 

“We need a fundamental review which drives action on the acute lack of junior doctors - and that means going beyond a revised box-ticking exercise.”