Safety and learning in the post-Paterson era26/02/20
The Paterson Inquiry report made safety and learning recommendations around multi-disciplinary working (in both the independent and wider healthcare sectors), complaints handling and patient recall (ongoing care and procedures generally). All three areas contain common themes around the need for hospital providers to review their policies and processes to ensure they are robust and where appropriate meet with national guidance. It is clear that challenges remain for providers to embed an effective safety and learning culture which is patient-centred and which has the duty of candour at its heart.
Multi-disciplinary teams (MDTs)
The Inquiry found that Paterson’s Spire patients did not have their treatment decisions discussed at ‘properly constituted’ MDT meetings. Some had their treatment discussed at NHS MDT meetings, but ‘the quality of those decisions varied’.
The Inquiry Report recommends that the CQC urgently considers whether all hospital providers are complying with the current national guidance on MDT meetings.
All hospital providers should review their procedures and guidelines to ensure that they are fully compliant with national guidance on MDT meetings and with the CQC’s ‘safe’ and ‘effective’ domains. Providers will also need to check that relevant procedures and guidelines are being consistently applied across the whole organisation. We may see a concentration of CQC inspection activity over the next few months, particularly in the independent sector. Those providers with ‘inadequate’ or ‘requires improvement’ ratings in the two domains should ensure that any deficiencies are addressed urgently.
Lack of patient satisfaction with responses to complaints, differences between NHS and independent sector processes and a lack of signposting to complaints resources were common themes from the evidence given to the Inquiry. In particular, many patients were unaware of the role of the Parliamentary Health Service Ombudsman (NHS) and the Independent Sector Complaints Adjudication Service (private sector).
The Inquiry Report recommends that the means to escalate a complaint to an independent body should be communicated more effectively in both sectors and that all private patients should have the right to ‘mandatory independent resolution’ of their complaint.
The right to mandatory independent complaints resolution for private patients is likely to require a statutory basis, but in the meantime providers in both sectors should review the effectiveness of their complaints process.
Complaints are one of the earliest warning signs that care is unsafe and they should be analysed regularly to spot trends to prevent future harm. It is essential that complaints are triangulated against claims to extract the maximum learning. Complaints should be checked to see if they indicate substandard professional practice. When responding, providers should be open and accountable, putting the patient at the heart of the investigation, keeping to deadlines and ensuring communication channels are always kept open. The response letter should avoid blame and contain an apology, detail actions taken to prevent harm and include the means to escalate the complaint. An apology should have been given at the time of the incident in compliance with the duty of candour. Read our in-depth Insight on how to get the duty of candour right.
Paterson is a stark example of weaknesses in the system for large-scale patient recall. However, the lessons learned could be applied to any size of recall in any specialty. The Inquiry report highlights deficiencies in national and local recall procedure and ongoing care.
Almost a third of patients who gave evidence said that they had received no information about recall or attended an appointment. Some in the private sector were critical of their ongoing treatment plans. Relatives of deceased patients said they had not been given information about the appropriateness of their care. Patients who had been recalled considered their recall to have been generally inadequate and lacking both patient-focus and transparency.
The Inquiry report recommends that hospitals handling recalls should check that all patients of Paterson have been recalled and communicate with anyone who has not been seen. All private patients should have an ongoing treatment plan as has been provided in the NHS. A cross-sector national framework / protocol, with guidance on recall is proposed
We will have to await formal proposals for the national framework, but hospital providers should be reviewing their recall procedures now. Policies should be robust and place the patient front and centre. They will need to contain the means to ensure all patients (current, former and deceased) are traced. Communication, transparency and candour will be the cornerstones. The recall process should be independent from those involved in the patient’s original care and centred on patient need, both physical and psychological.
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