Colchester General: The key questions

Colchester General is subject to a police investigation

Inspectors have found evidence of cancer records at an Essex hospital being tampered with, potentially putting patients at risk.

A detailed report listing what was happening has been produced by the Care Quality Commission after inspectors went in at the end of August and start of September.

The case has now been passed on to the police to investigate and the trust - Colchester General - faces being put into special measures and further investigations by the authorities in the NHS.

In the weeks and months that come there are many questions that need to be answered.

How many people died or were harmed?

Inspectors looked at just over 60 cases and found the care of 22 may have been compromised.

All but two of these case were chosen at random. That suggests this practice could have been pretty widespread.

NHS England has set up a specialist team to look at the care given to patients since 2010.

The hospital sees about 6,000 cancer patients a year, although the tampering with records seems so far to be centred around the specialities that deal with cancers such as kidney, bladder, prostate and colon.

Why did bosses at the trust not put a stop to it last year?

Senior management of the trust was alerted to what was happening early last year.

An internal review was carried out by two members of the trust's executive team, but it did not result in the practice being stopped.

The trust now concedes the investigation was not carried out properly- and has apologised for that.

Colchester has yet to release details of that investigation or even said much about how it was carried out.

But senior bosses - including the current chief executive Dr Gordon Coutts who has been in post since September 2010 - will have to explain themselves soon.

The trust said a review of what went wrong with this investigation will be carried out.

Why was the trust not put into special measures earlier?

Colchester was one of 14 hospital trusts inspected as part of the Keogh Review into centres with high mortality rates.

Eleven were subsequently put into special measures, but Colchester was one of three that escaped the sanction.

A whistleblower alerted the Keogh team towards the end of the programme abut the tampering with records and this was passed on to the CQC for follow up.

Those involved in the Keogh process say there was not sufficient concerns about the leadership of the trust to warrant it being placed in special measures.

But the fact such a shocking practice was not dealt with by the Keogh inspection process - which has, after all, formed the basis of the new CQC hospital inspection regime that got under way in September - is a cause for concern.

Were there other missed opportunities to intervene?

One of the elements of the Stafford Hospital scandal was that there was evidence out there about the poor care that patients were receiving.

Patient surveys and complaints all pointed to the fact that something was not right.

The problem was that the people with the power to act either ignored the warning signs or missed them.

Did the same happen here?

It is too early to tell. But what we do know is that the trust had a much higher than expected number of complaints being made against it, according to the CQC.

Unions including Unison and the Royal College of Nursing also say they were trying to raise the alarm, but managers dismissed their concerns.

Was this practice going on anywhere else?

Prof Sir Mike Richards, the chief inspector of hospitals, says he has never before heard of anything like this happening anywhere else.

But what this case proves is that problems of this nature are very difficult to spot.

The CQC inspection team only found evidence of tampering after being told exactly where to look.

That raises the prospect that it could be going on undetected elsewhere.

However, as the new hospital inspection regime is rolled out - by the end of 2015 all hospital trusts will have been visited - inspectors are bound to be keeping an eye out for this sort of practice.