Kirkup clinical lead standards would be ‘struggle’ to implement

The investigation chaired by Bill Kirkup into care failings at University Hospitals of Morecambe Bay Foundation Trust, which was published earlier this month, recommended that “clear national standards” should be drawn up “setting out the professional duties and expectations of clinical leads at all levels”.

Speaking to HSJ, Corinne Slingo, a partner at the law firm DAC Beachcroft, said it would be “a struggle” to create a common standard because of the variation in roles across the health care system.

According to the Kirkup report the standards would apply to clinical directors, clinical leads, heads of service, medical directors and nurse directors.

Ms Slingo said: “The reason I find that challenging is that A: how do you ever police it? And B: how do you ever get to the point where you agree [on standards] across a really complex healthcare system, in different organisations where being a clinical lead will mean something different?

“I think that’s going to be a struggle actually.”

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She also questioned whether another Kirkup recommendation, that a duty should be placed on trust boards to openly report the findings of external investigations, was necessary in light of the existing duty of candour.

The duty of candour had “already started to change” attitudes and most boards were in “the state of mind” where if they were conducting a services review they would do it with the expectation it would be published, she said.

“Do we need something as obvious as a specific duty on NHS boards… or in fact do we need to let duty of candour run because that will be the natural consequence in any event?”  

The view that some of the Kirkup recommendations were already implied by the duty of candour was shared by Neil Grant, partner at Ridouts Solicitors.

The inquiry recommended that the duty should be extended to include the involvement of patients and relatives in the investigation of serious incidents, but Mr Grant said “you would hope that that would happen anyway”.

The government has said it will examine the inquiry’s 44 recommendations “in detail” before providing a full response.

However it has already announced a number of measures in relation to the inquiry, such as a review of the feasibility of creating an independent patient safety investigation unit similar to the Air Accidents Investigations Branch of the Department for Transport.

Mr Grant said that if such a body was established it would be important for there to be clarity about its role because patient safety was already a “very busy landscape”.

“The [Kirkup] report… criticises the fact that it’s a complete muddle out there; nobody seems to take lead responsibility.

“The danger is that if you add another organisation into the mix it becomes even more complex,” he said.

Ms Slingo said the “sheer volume” of incidents in health would mean the unit would probably only be able to deal with the highest severity incidents.  

However this could result in there being a “gold standard” for the worst incidents while the learning from a larger number of less serious incidents would be missed.

“Quite often the learning is from the less serious incidents,” she added.

“So it’s the numerous, smaller [and] medium things that happen, that if you got right would save lives ultimately, and would improve services.”