Everything you need to stay up to date on patient safety and workforce, plus my take on the most important under-the-radar stories. From patient safety correspondent Shaun Lintern
Why medical examiners matter; the relentless push for nursing associates at the expense of evidence based workforce planning; a public inquiry into historical complaints; and how bad is the NHS bullying problem?
Want me to investigate something? Contact me in confidence here.
Shaun Lintern, patient safety correspondent
A big advance for patient safety
One of the many sobering lessons from the horror of what happened at Stafford Hospital was the inability of those in the NHS system to listen to the real concerns that were raised over many years. From nurses and doctors on the wards to government ministers and advisers in Number 10, no one wanted to see what was happening.
A new report for the Department of Health by the national medical examiner Peter Furness has made the bold claim that, had an independent medical examiner service been operating at the time, the poor care would have been detected sooner. Why? Because medical examiners – which are being introduced in April 2018 – will be required by law to consult with relatives and crucially to consider any concerns they have about the treatment of the deceased. They will examine every death that isn’t investigated by a coroner, and will be at the heart of the process, not pushed to the sidelines.
It is bizarre that the current archaic coronial system often makes families feel excluded, and we know from Mid Staffs, Morecambe Bay and many other cases that inquests are not the place to explore patient care and get answers for relatives. Medical examiners will provide an invaluable service for those relatives who want to speak up about poor care. And, the medical examiner will have the ability to refer cases to the coroner as well as highlighting issues to trusts and other authorities.
Crucially the pilot sites for medical examiners have also shown the service can boost care for the living. They have identified trends and patient safety concerns on hospital wards and care homes that were missed by existing governance structures. This initiative will be a considerable advance for patient safety and is to be applauded. The report of the national medical examiner is here.
Evidence based policy
It is almost exactly 12 months since HSJ broke the story that the government and NHS England were going to suspend NICE’s work on safe nurse staffing guidance – arguably the most important recommendations by Sir Robert Francis QC in his 2013 public inquiry report.
At the time NHS England agreed with ministers it would take over this work – but silence swiftly followed. Stung by the reaction to the news, Jeremy Hunt intervened and said the new regulator NHS Improvement would deliver this important guidance by the end of 2015.
We are still waiting.
In the intervening period we have seen the dawn of the nursing associate role, with HEE proudly claiming overwhelming support (actually 54 per cent approval) for its proposal in a recent consultation. Since when has 54 per cent been overwhelming?
Meanwhile Lord Carter’s “regression to the mean” review – where average performance is the sole important factor, regardless of local nuance and needs – and specifically his proposals for a care hours per patient day metric, have only added to the pressure on registered nurse staffing levels.
When quizzing those in authority at national bodies about the risks to the registered nursing workforce and the evidence that supports improving ratios, the response is often that there isn’t enough evidence or that it isn’t any good.
Well, thanks to the University of Pennsylvania School of Nursing here is a document listing 60 peer-reviewed journal articles on the link between nursing numbers and patient safety.
If NHS England, NHS Improvement or the Department of Health can show us a similar body of evidence for the nursing associate, the care hours metric and the vague strategy of multidisciplinary team staffing guidance I will shut up right now.
They haven’t done so far.
Reopening old wounds
A public inquiry into historic patient safety complaints and concerns should be established, according to MPs on the House of Commons Public Administration and Constitutional Affairs Committee, to help provide closure to families left grieving by the NHS.
This was one of their conclusions in a report last week which also criticised the government’s failure to make the new Healthcare Safety Investigation Branch truly independent.
What a sad state of affairs that the failure of all the many systems and structures in the NHS to tackle patients’ and relatives’ concerns have failed to such an extent that this recommendation has been made.
The government is said to be considering the proposal. It must do so with the utmost care.
If such an inquiry were begun, it is hard to see how common conclusions could be drawn from historical cases, or how any process would not be overwhelmed by thousands of people hoping for fresh consideration of their complaints. I have no doubt there would be many that merit a closer look, and doing so could well produce real learning for the system.
But for many other families, this risks reopening old wounds. And, with the likelihood of a clear resolution to most cases being low, the inquiry could perversely add fresh pain to those still hurting if they feel they have been denied justice all over again.
Opening the floodgates with a public inquiry on this scale could prove hugely damaging and distracting for the NHS. And the amount of time it would take would likely make the delays around the Chilcot report look minor by comparison.
- Academy of Medical Royal Colleges
- Board Talk/governance/assurance
- British Medical Association (BMA)
- Care Quality Commission (CQC)
- Department of Health and Social Care (DHSC)
- Health Education England
- National Institute for Health and Care Excellence (NICE)
- NHS England (Commissioning Board)
- NHS Improvement
- Patient safety
- Quality and performance
- Seven day working
- Simon Stevens