Health trusts failing to make checks on locums, six years after being told to increase scrutiny
Some health trusts are still not carrying out pre-employment checks on locum doctors - more than six years after being told to increase scrutiny.
A new report says it is "deeply concerning" that a 2012 warning has not been acted on.
It comes days after a Northern Ireland coroner raised concerns about the way locum consultants are recruited and appointed.
An inquest heard Lurgan businessman Denis Doran suffered a fatal heart attack after being misdiagnosed with a hernia.
The locum consultant who made the error, Dr Mohammod Asaduzzeman, had not been formally interviewed. He had forwarded his CV to the Southern Health Trust, and no formal induction process was given.
Today's report by the Northern Ireland Audit Office says pre-employment checks need to be strengthened.
A locum is a qualified medical practitioner who temporarily covers for staff shortages or busy periods. Hospitals use locums for short-term shift cover or to fill vacant posts for staff on extended leave.
Today's report examines progress on the use of locums since a previous bulletin in 2011. It notes an "unsustainable" rise in health trusts' reliance on locums.
The report says: "The use of locum doctors is recognised as being both expensive and as having the potential to increase risks to patient safety."
One of the key findings is a continued lack of adequate pre-employment checks.
The Audit Office's previous bulletin, in July 2011, identified several instances where checks to ensure the competence of locums had not been undertaken or were not properly documented, and where trusts' arrangements with agencies supplying locums exposed them to risk.
The following year, in March 2012, a report by Stormont's Public Accounts Committee (PAC) said the Department of Health should "immediately" remind health trusts about complying fully with the relevant checks before appointing a locum doctor.
Today's review criticises the lack of progress since then.
It says: "Six years after the PAC reported, it is deeply concerning that there is evidence that some trusts are not completing the necessary pre-employment checks before making locum appointments.
"These checks provide vital assurance that doctors are suitably qualified and registered, and that no concerns exist over their fitness to work."
Internal audits indicate there is still non-compliance within some health trusts.
Today's report describes how auditors found proper checks were not carried out in at least three health trusts - the South Eastern; Southern and Western.
In the Southern Trust, which was criticised during Mr Doran's inquest, a sample review of 20 locums engaged from agencies in 2016/17 found the necessary pre-employment checks had not been completed six times.
In the Western Trust, in 10 of 40 agency locum appointments examined in 2016/17, no evidence existed that a check had been performed on the doctors' fitness for work.
And in the South Eastern Trust, no evidence existed that full pre-employment checks were made when 'non-contracted' agencies were used.
Further, of 23 trust employees engaged as locums, there was no evidence of Access NI checks (12 cases); occupational health checks (seven cases) and fitness to work in the UK checks (14 cases).
No audits had been completed on any of the 25 agencies used by the South Eastern Trust, to measure their compliance in carrying out pre-employment checks.
Today's report concludes: "Trusts need to take action to strengthen their internal monitoring to ensure that pre-employment checks on locum doctors are being undertaken.
"The department should also consider commencing central monitoring of this key area."
Last Friday a coroner raised concerns over the way locum consultants are recruited and appointed.
It followed an inquest after Mr Doran died following a heart attack in November 2016.
He had been seen around two months earlier by Dr Asaduzzeman, the locum consultant, who incorrectly diagnosed a hiatus hernia. It emerged Dr Asaduzzeman did not have an interview or induction after arriving for his first shift.
He told the inquest he was "not aware" of the existence of the Rapid Access Chest Pain Clinic in Craigavon Area Hospital when Mr Doran presented with chest pains "up to his throat".
"There was no formal orientation process because I was a locum - that's what happens," he said.
The coroner, Patrick McGurgan, concluded that if Mr Doran had received a proper diagnosis and treatment, his death could have been prevented.
The coroner is to ask the Southern Trust to review the cases of 13 other patients who died while on the waiting list.
The Southern Health Trust has pledged to review the coroner's findings.
British Medical Association NI chairman Dr Tom Black said the cost of locum doctors is "completely unacceptable".
"There needs to be proper, long-term workforce planning done in Northern Ireland, and these plans need to be implemented. Using locums to plug workforce gaps benefits neither patients or the health service," he said. "We are also concerned that using so many locums has a negative effect on training as younger doctors step out of the training programme to locum and this has a long-term impact on service provision.
"There are non-pay issues faced by doctors in training that need addressed to help make embarking on a long-term training attractive and rewarding.
"Our evidence shows that restrictions to annual leave, not knowing where you will be working and what your schedule will be, as well as not being able to take rest breaks, have a negative effect on junior doctors. The onus is on the department to ensure that the range of non-pay issues are addressed.
"In relation to patient safety issues raised in the report; all doctors want to make sure no patient comes to harm.
"We would welcome the introduction of an organisational statutory duty of candour and believe this may help create the conditions where staff feel they can raise concerns and importantly that the lessons are learnt to build patient and public trust in the healthcare system."