04/02/2020

The Independent Inquiry into the issues raised by Paterson chaired by the Reverend Graham James, Bishop of Norwich has today reported its findings and recommendations following its review of medical governance in the light of the issues surrounding Ian Paterson’s malpractice. In acknowledging the report, Nadine Dorries MP Under Secretary of State for Health and Social Care said that the report identified a “failure of the entire healthcare system to protect patients”.

Although the Inquiry has made 15 formal recommendations, it does not demand multiple new regulatory and assurance processes.  Instead it reinforces the need to “get the basics right and implement existing systems” across both the NHS and independent healthcare sector particularly with regard to;

  • Visibility and accessibility of boards to front line clinicians and patients;
  • the need for clinical leadership at board level;
  • the freedom to speak up agenda;
  • the duty of candour;
  • appropriate MDT working and
  • appropriate consenting processes.

In the light of this, it is likely that both the independent sector and NHS will face increased scrutiny from the CQC regarding these issues in the coming months.

On many of the wider system issues, the Inquiry has recommended that Government provide guidance, in particular in relation to:

  • Developing a national framework or protocol for managing patient recall procedures, to ensure these are more focused around patients' needs
  • Insurance – reforming the regulation of indemnity products for healthcare professionals and introducing a nationwide “safety net” to ensure that patients are not left on compensated.
  • Regulation: securing greater collaboration between CQC and professional regulators (e.g. GMC and NMC) to close ‘regulatory gaps’ and ensure that patient safety is given top priority.

The detail of how the Government will respond to the recommendations is awaited.  However, Nadine Dorries’ statement in Parliament indicated that the recommendations are a “route map” for Government and it will provide a full response in a few months.

Other specific recommendations in the report include:

Enhanced Information:

  • A single repository of consultant data in England detailing their practising privileges and other critical consultant performance data including volume of procedures undertaken to be made available to the public and mandated for use by managers and healthcare professionals in both the NHS and independent sector.
  • Patient Focussed Correspondence – with consultants letters to be addressed to patients in terms that they can understand and copied to the patient’s GP, rather the vice versa.
  • Explanations to Patients being treated in the independent sector (even if NHS funded) – of how consultants are engaged at the hospital and the arrangements the hospital has for emergency provision and intensive care.

Patient Safety:

  • Consenting procedures – there should be a short period introduced into the consenting process for surgical procedures, to allow patients time to reflect on their diagnosis and treatment options. This should be monitored by the GMC.
  • Multi Disciplinary Team (MDT) working - The CQC should assure itself that all hospital providers are complying effectively with up-to-date national guidance on MDT meetings.

Response to Adverse Incidents:

  • Investigations of healthcare professionals – the Inquiry states that the healthcare professional should be suspended and any concerns about them should be communicated to any other provider with whom they work when there is “any perceived risk to patient safety”.
  • Escalation of Complaints - Information about the means to escalate a complaint to an independent body should be communicated more effectively in both the NHS and independent sector. All private patients should have the right to mandatory independent resolution of their complaint.
  • Openness: when things go wrong boards should apologise at the earliest stage of investigation.

The Independent Health Providers Network has already taken steps to address some of these areas through its Medical Practitioners Assurance Framework to improve consistency around effective clinical governance for medical practitioners across the independent sector, and this will no doubt be subject to ongoing review.

As the response to the Inquiry evolves, Bevan Brittan will be working with clients and providing further insights looking at the implications of this landmark report in terms of:

  • Patient Safety;
  • Workforce;
  • Models of engagement with consultants;
  • Information sharing;
  • Competition; and,
  • Insurance   

If you have any queries about what the implications of the Inquiry may be for you, please get in touch.