Gloucestershire Health and Care- NHS Trust logo
with you, for you
Responses > 293-2024

Freedom of Information request 293-2024

Response published: 16 January 2025
Media | Serious Incidents

FOI Request

1. Since January 1, 2020, how many incidents have been reported to your Trust involving a wrong implant or prosthesis? Please note that this is any incident falling under the following definition: “Placement of an implant/prosthesis different from that specified in the procedural plan, either before or during the procedure. The incident is detected any time after the implant/prosthesis is placed in the patient.” For each incident, please provide the month, year and the implant or prosthesis involved in the procedure. In addition, please confirm the total number of cases reported between January 1, 2020 and December 31, 2024.
2. How many incidents fell under the definition of a serious incident, in line with the Patient Safety Incident Response Framework (or, prior to that, the Serious Incident Framework)? Please state which cases met this definition.
3. How many incidents fell under the definition of a Never Event? Please state which cases met this definition.
4. How many incidents led to serious, moderate, or slight harm to the patient?
5. What were the causes of implant/prosthesis incidents?

FOI Response

Freedom of Information Request – Ref: 293-2024

Thank you for your recent Freedom of Information request. Please find our response below.

You asked:

  1. Since January 1, 2020, how many incidents have been reported to your Trust involving a wrong implant or prosthesis?  For each incident, please provide the month, year and the implant or prosthesis involved in the procedure. In addition, please confirm the total number of cases reported between January 1, 2020 and December 31, 2024.
  2. How many incidents fell under the definition of a serious incident, in line with the Patient Safety Incident Response Framework (or, prior to that, the Serious Incident Framework)? Please state which cases met this definition.
  3. How many incidents fell under the definition of a Never Event? Please state which cases met this definition.
  4. How many incidents led to serious, moderate, or slight harm to the patient?
  5. What were the causes of implant/prosthesis incidents?

Our response:

There have been no incidents relating to implant surgery within this timeframe.

Gloucestershire Health and care NHS Foundation Care do not provide prostheses surgeries therefore cannot provide a response to these questions.

Next steps:

Should you have any queries in relation to our response, please do not hesitate to contact us. If you are unhappy with the response you have received in relation to your request and wish to ask us to review our response, you should write to:

Louise Moss
Head of Legal Services / Associate Director of Corporate Governance
c/o Gloucestershire Health and Care NHS Foundation Trust
Edward Jenner Court
1010 Pioneer Avenue
Gloucester Business Park
Brockworth, GL3 4AW
E-mail: louise.moss@ghc.nhs.uk

If you are not content with the outcome of any review, you may apply directly to the Information Commissioner’s Office (ICO) for further advice/guidance. Generally, the ICO will not consider your case unless you have exhausted your enquiries with the Trust which should include considering the use of the Trust’s formal complaints procedure. The ICO can be contacted at: The Information Commissioner’s Office, Wycliffe House, Water Lane, Wilmslow, Cheshire SK9 5AF.