NHS bodies split over County Durham breast review lookback

County Durham and Darlington NHS Foundation Trust will hold a public board meeting on September 24 to decide how far its breast-surgery review should go.

The Trust wants to move the review back one year at a time, checking each year’s findings before deciding whether to go further.

But the North East and North Cumbria Integrated Care Board wants the investigation extended straight back to 2015.

County Durham and Darlington NHS Trust (Image: NORTHERN ECHO)

The split is revealed in papers prepared for next week’s meeting.

The Trust says the decision has major implications for “patient safety, organisational accountability and public confidence”.

It says earlier reviews found “longstanding concerns regarding clinical practice, governance and oversight”, making a full review necessary.

Board members will consider four options.

The first would keep the existing review period, from January 2023 to February 2025.

The second would keep the same review period but leave the patient helpline open for two years after the planned reviews, allowing former patients to raise concerns about their care.

Trust leaders’ preferred option would complete the current reviews before moving back one year at a time towards 2015.

University Hospital of North Durham in Durham City (Image: Chris Booth)

Experts would review each year’s findings before deciding whether to investigate the previous year.

The paper calls it a “balanced, proportionate approach” guided by “emerging findings”.

But the paper admits the staged approach “may still be criticised as too slow or cautious” because some patients believe “everyone deserves to know”.

The fourth option would extend the review straight back to 2015, when the Trust says systemic failings first became evident.

That is the approach favoured by the ICB.

The Trust’s Collective Leadership Team considered the options in July, with 15 of its 16 members backing the phased approach.

The Trust’s Quality Committee subsequently backed the same option.

But the board paper says: “The North East and North Cumbria Integrated Care Board (ICB) formally wrote to the Trust on September 10, 2026 indicating a preference for option four.”

Despite the ICB’s position, the paper confirms that the Trust’s own governance process favours the staged option three.

The board’s choice could have major consequences.

The trust says extending the review to 2015 would “capture all potentially affected cohorts” and ensure “no patient groups are inadvertently excluded”.

The paper says the option would give regulators the “most robust assurance” while maximising “transparency and public trust”.

Darlington Memorial Hospital (Image: NORTHERN ECHO)

But the trust warns that reviewing the entire period would create an “extremely high operational burden”.

It also warns that “prolonged delays in patients receiving the outcome of their review” could cause further harm.

The widest options could require about 4,500 cases to be reviewed.

At the trust’s sustainable rate of about 80 reviews a month, the process would take roughly five years.

Independent clinical experts have questioned the medical benefit of going so far back.

The Clinical Reference Group says going further back is unlikely to find patients needing treatment or reveal major new clinical lessons.

But the group accepts that a records-only review may miss some affected patients and that older cases of harm could still emerge.

Under the heading “Missed harm”, the paper states: “The CRG has confirmed that there are likely more cases of harm and harm has already been identified in cases prior to 2023.”

Without an extension, it warns, those patients “will not be identified unless review is initiated by patients”.

That matters because the datasets and criteria used for the current review would have missed 283 patients already identified for review.

They were found through the patient helpline, complaints, incident reports from other NHS trusts and concerns raised by the current breast service.

Of the 240 cases reviewed by September 2, 19 met the threshold for the statutory duty of candour.

Patients and members of the public consulted by the trust urged the NHS to find those affected rather than wait for them to come forward.

The paper says the trust is expected to carry out “proactive, outbound patient engagement”.

It adds: “The trust must identify and contact affected individuals rather than relying on patients to come forward. Responsibility should not fall on patients.”

The paper also warns that “premature closure risks undermining trust”.

The debate follows mounting evidence about harm within the breast service.

Trust figures show that 315 of the 514 cases examined involved harm, including 77 involving significant harm.

At least 20 women underwent unnecessary mastectomies, and one patient is known to have died.

The Trust says the decision must balance “clinical proportionality, legal obligations, operational feasibility and the expectations of patients, regulators and the wider public”.

If approved, the phased approach would require a formal decision each year on whether to review the previous year.

The Trust admits it cannot set precise thresholds that would automatically trigger further investigation.

Instead, it would consider the number and severity of harm cases, emerging care patterns, concerns from patients and families and whether further reviews could identify people needing notification, support or follow-up.

Board members will make the final decision at the public meeting on September 24.