Report and our action plan

RCS report and our action plan following invited review into General Surgery

In October 2024, we asked The Royal College of Surgeons of England (RCS) to review General Surgery.

Today we are publishing their report.

Alongside the report, here is our action plan in response to the findings of the review.

We offer our sincere and unreserved apologies to the patients affected. We will now work with patients and colleagues to deliver the changes needed.

Professor Lesley Dwyer, Group Chief Executive of NWUHG, said:

“We are deeply sorry for the lapses in care at the QEH identified in this report and for the governance failures that meant concerns were not identified sooner.

“Our apology to affected patients and their families is unreserved. We are in touch with each of them directly to offer our support.

“We acknowledge all the issues the report raises, however our top priority has been to ensure the safety and sustainability of this vitally important local service at the QEH for its patients, and be able to assure local people with confidence, that this is so.

“We can do so, because of the new mandated support arrangements from the NNUH now in place. They provide strong clinical leadership, increased support for QEH consultants, enhanced independent oversight and ensure a second opinion is sought and received for out of hours and emergency operations.

“The NNUH general surgery team are happy to be working alongside their QEH colleagues and support them in making the service as safe, supportive and robust as possible.

“We are committed to openness, accountability, and learning. The Group structure has allowed us to step in quickly with the expertise, leadership and oversight required. These decisive actions provide immediate assurance and lay the foundations for sustained improvement. Our focus now is on ensuring safe, high-quality care for every patient, every time.”

Chris Bown, Interim Executive Managing Director of The QEH, said:

“On behalf of the hospital, I apologise profusely for the fact that some general surgery patients did not receive the care they should have expected, and our staff want to give. We have acted to change that.

“We invited the Royal College to carry out a review proactively, because it is important that we are open to scrutiny, that we learn honestly, and take every opportunity to improve how we work together. Our patients must receive high quality care consistently across all our services.

“Some of the issues raised are deep seated and have been long lasting, predating the hospital’s current clinical and managerial leadership. I am extremely glad the RCS has been so thorough in bringing all these issues to light, so with our Group colleagues, we can act and put them right and critically, support our colleagues and this vitally important general surgery service.

“I am aware however, that day in day out many people have continued to receive safe, compassionate, and high-quality care from the range of services we provide, including other surgical specialities. It is very important that in learning the sharp lessons we have received from this report in respect of one area of our service, (now corrected), that we do not forget that, or fail to recognise the highly valued, caring contributions made by all our staff on behalf of the NHS, its patients and our communities.”

Foreword

On behalf of the Norfolk and Waveney University Hospitals Group and The Queen Elizabeth Hospital King’s Lynn (The QEH), we want to begin by offering our unreserved apology that there have been lapses in the care for some general surgery patients at The QEH.

We are also sorry that the governance and learning arrangements, highlighted so clearly in The Royal College of Surgeons of England (RCS) report, did not operate as they should, or that these issues were not identified sooner.

We also apologise unreservedly to those families and patients for whom care fell below the standards they should have received, and we want to deliver.t.

We commissioned this review (which took place between 30 April and 2 May 2025) through the national Invited Review Mechanism (IRM) after concerns were raised by colleagues working in the service and through whistleblowing.

We did so because patient safety must always come first and because it was essential to obtain an expert, independent assessment of whether the service was safe, what was working well and what needed to change.

The RCS reviewed 17 clinical cases, including planned operations and cases involving complications or return to theatre. These date between October 2022 and January 2025. Eight cases were judged to have involved care below the expected standard.

While the review did not identify evidence of widespread harm and mortality outcomes were within expected ranges, the findings are serious and unacceptable and require decisive and sustained action.

Some of the issues identified are deep-seated and long-standing. As leaders, we fully accept responsibility for ensuring they are addressed, that lessons are learned, and improvements are embedded. We are grateful to the RCS for a thorough and candid review that has brought these concerns into sharp focus and enabled us to act.

In response, the hospital enacted some improvements following reports of initial findings, and on receipt of the full report and its consideration, the Norfolk and Waveney University Hospitals Group moved swiftly to mandate new leadership, oversight and service arrangements for General Surgery at The QEH utilising resources from the Norfolk and Norwich University Hospital – also a member of the new Group.

As a consequence, from 12 December 2025, the service has been operating under the clinical leadership of the General Surgery team at Norfolk and Norwich University Hospitals and with their ongoing support. This includes alongside strengthened governance, senior oversight and on-site leadership and a strengthened pathway for emergency general surgery. These arrangements provide immediate assurance for patients and staff of the continued safety and availability of this critical service for local people and establishes a stronger foundation for sustainable improvement and preparation for a new shared service.

It is also important to recognise that many patients have continued to receive safe, compassionate and high-quality care across The QEH, including in other surgical specialties that were not part of this review.

As we address the specific findings relating to General Surgery, we remain committed to maintaining and strengthening standards across the whole organisation.

We are committed to openness, transparency and learning. We will publish the redacted RCS report and this action plan in full, redacted only to protect patient and staff confidentiality.

Most importantly, we will be judged not by words but by the changes we make and the consistency with which we deliver safe, high-quality care – every patient, every time.

Background

The Queen Elizabeth Hospital King’s Lynn (The QEH) commissioned an independent invited review by The Royal College of Surgeons of England (RCS) into its General Surgery service.

The review was commissioned through the national Invited Review Mechanism following concerns raised by staff, including through whistleblowing correspondence.

The purpose of the review was to provide an expert, independent assessment of the General Surgery service, including whether the service was safe, and to identify areas of good practice as well as areas requiring improvement.

The RCS review focused solely on General Surgery which covers a defined range of emergency and planned abdominal operations, such as emergency bowel surgery, gallbladder surgery, hernia repairs, appendicitis, and colorectal surgery for conditions like bowel cancer.

Other surgical specialties at The QEH were not within the scope of the review. These include:

• Breast Surgery
• Orthopaedics (bone and joint surgery)
• Gynaecology
• Ophthalmology (eyes)
• Urology
• ENT (Ear, nose and throat)
• Vascular Surgery

These surgical services continue to provide safe, high-quality care delivering excellent outcomes for patients.

As part of the General Surgery review, the RCS examined 17 clinical cases, comprising original operations and cases involving complications or return to theatre.

Eight cases were judged to have involved care below the expected standard.

Although the RCS found the service to be safe and did not identify evidence of widespread harm – noting that mortality outcomes were within expected ranges – the findings highlighted significant concerns regarding clinical decision-making, escalation, governance and team culture.

Support for patients involved in the RCS review

All patients and families whose cases were examined as part of the RCS Invited Review have been contacted directly throughout the review process, ensuring they are kept fully informed at every step.

They have received copies of the final report relating to their care and have been offered appropriate support.

We have also been careful to ensure that their privacy and any information that could compromise their identity has been redacted in line with our Duty of Candour.

Support for other concerned patients and relatives

For patients or families who are concerned about General Surgery care received at The QEH or about upcoming treatment we have established a dedicated helpline:

01553 613006
Monday to Friday, 10am to 4pm

The helpline offers a confidential route to:

• discuss concerns or questions
• receive information and reassurance
• arrange follow-up conversations where appropriate

For those who prefer not to call or call outside of these hours, a confidential online form is available to request a call back.

Actions taken in response to RCS recommendations and ongoing improvements

Following receipt of the RCS report in October 2025, the Norfolk and Waveney University Hospitals Group (NWUHG) implemented mandated support arrangements for General Surgery at The QEH, effective from 12 December 2025.

These arrangements were considered at the inaugural meeting of the NWUHG Board on 17 December 2025.

General Surgery at The QEH is now operating with enhanced clinical leadership, governance oversight and support from the General Surgery team at Norfolk and Norwich University Hospitals (NNUH).

Key immediate actions include:

• mandated enhanced clinical leadership
• strengthened clinical governance and assurance arrangements
• mandatory NNUH consultant support for emergency out-of-hours General Surgery
• alignment of clinical standards, pathways and expectations across The QEH and NNUH
• additional on-site leadership support to strengthen team culture and ways of working.

The RCS review report identified 20 recommendations and one recommendation for consideration.

Our action plan below explains how each of the recommendations in The RCS report have been tackled.

The QEH has established three programmes of work, each led by an Executive Director of the Trust. The Norfolk and Waveney University Hospitals Group Chief Executive and a Non-Executive Group Director have oversight of the actions taken and progress.

Taken together, the actions set out in the plan that follows result in better management and support for doctors, more effective clinical governance and a more open and collaborative medical culture.