Examination of Witnesses (Questions 40-59)
DEPARTMENT OF
HEALTH AND
NATIONAL PATIENT
SAFETY AGENCY
16 JANUARY 2006
Q40 Jon Trickett: The NPSA, does
your remit run into the independent sector hospitals?
Ms Williams: Our remit extends
to wherever NHS care is funded and, therefore, clearly the independent
sector is a vast area and—
Q41 Jon Trickett: Are you collecting
information from, say, BUPA hospitals?
Ms Williams: Not at the moment.
We are concentrating on getting all the NHS trusts reporting.
Q42 Jon Trickett: Now we are committed,
are we not, to 15% of all operations going into the independent
sector?
Sir Nigel Crisp: No, we are not
actually. That is a quotation from Mr Reid which was up to 15%.
Q43 Jon Trickett: We are committed
to a number of NHS operations being commissioned in the independent
sector, whatever the figure is. We have no idea at all how many
accidents have taken place in the various hospitals which are
being offered by the GPs, is that correct?
Sir Nigel Crisp: We do not have
the same system in place yet in terms of direct reporting.
Q44 Jon Trickett: Would it not be
a good idea for the local health authorities to find out how many
accidents take place in independent sector hospitals before they
are offered to patients as one of the four choices?
Sir Nigel Crisp: In the contracts
with the independent sector agencies we do have requirements about
what we call clinical governance, which is about reporting and
how they manage patient incidents. It is not the same mechanism.
Q45 Jon Trickett: You have no idea
how many accidents are taking place at Methley Park, which is
the local BUPA hospital in my patch?
Sir Nigel Crisp: I think that
is true. I do not know whether either of my colleagues know.
Q46 Jon Trickett: You do not have
any idea at all? On the ISTCs, the independent sector treatment
centres, are we monitoring those?
Sir Nigel Crisp: Not through the
same system. As I was saying, we have contracts with the individual
organisations which have certain requirements about clinical governance
in them and about the reporting of incidents, how they are managed
and who is overseeing them and so on. That is something we have
got under review.
Q47 Jon Trickett: Let me ask you
another question because I have just come from a meeting with
my local chief executive who tells me he is about to hand a lot
of staff over to the PFI partner for the local hospital. They
will be working in an NHS hospital but it is a PFI hospital. Those
porters, electricians, joiners, domestic cleaners and all those
kinds of staff are not going to be employed by the NHS. Do they
come under the reporting mechanisms which you have been talking
about this afternoon?
Sir Nigel Crisp: Yes, I think
they do.
Ms Williams: There are a number
of PFI hospitals which are reporting through to us. If I may add
that the larger private sector, independent sector hospitals very
often do have their own reporting systems and we are in discussion
with them about how they might link through to the National Reporting
and Learning System.
Q48 Jon Trickett: You have given
me two answers. Let me just deal with the second one and come
back to the first. In terms of those staff who are employed by
the PFI partner, are they obliged to report accidents in exactly
the same way as NHS staff are?
Sir Nigel Crisp: In an NHS hospital.
Q49 Jon Trickett: Yes they are?
Ms Williams: Yes.
Q50 Jon Trickett: You then went back
to the debate about the ISTCs. My understanding at the moment
is that the ISTCs are not required to provide information. Whether
or not they are doing, they are not required to, is that right?
Ms Williams: That is right.
Q51 Jon Trickett: Does your remit
allow you to go into those hospitals at some point, it is just
that you have not got round to it yet?
Ms Williams: We would like to
develop an arrangement so that the independent sector, whether
it is ISTCs or the larger hospitals, BUPA et cetera, can
report incidents so that there is learning that can affect all
patients.
Q52 Jon Trickett: So it is an aspiration,
"we would like"?
Ms Williams: Yes.
Q53 Jon Trickett: I think that is
profoundly unsatisfactory from the point of view of the patient,
Sir Nigel. What do you think?
Sir Nigel Crisp: I understand
the point, but that is why we have got the contracts with people
and we have got what I have described as clinical governance arrangements
to make sure that there is reporting to us of incidents so that
we can investigate them, and why we have used our clinical governance
team to go in and look at where we have had incidents reported.
Q54 Jon Trickett: Basically it is
a lack of an even playing field between the NHS and the rest of
the medical health sector, is it not? Can I just draw attention
to table six on page 25 which shows this remarkable curve in terms
of the number of incidents in each acute trust. The problem is
it is not comparable to table five, which is the number of incidents
per thousand staff. It is a very crude figure indeed, is it not?
I might ask the NAO to produce it on the same basis. I will put
that to Sir John.[3]
The curve would be probably less since the smaller number of accidents
might be taking place with only half a dozen staff or something.
Sir John Bourn: Right.
Q55 Jon Trickett: All these curves
are all the same. Have you formed a view as to what correlation
there is between the ones who have so few incidents and any sort
of external factors which might govern a particular trust, or
is it simply that self-reporting is not working, as I suspect?
Sir Nigel Crisp: You are quite
right on the last point. These are reports of incidents rather
than actual incidents, so there is some spread in what people
are reporting. Very definitely we pick up on patterns but we need
to pick up on patterns firstly at the local level and then nationally.
Ms Williams: In a sense this is
not unexpected given where we are in relation to the cultural
issues that we were talking about earlier. Over time we would
expect to see an increase in reporting rate across all of the
NHS.
Q56 Jon Trickett: You would expect
the curve to flatten out, would you not, and it is not over the
two year period that we are looking at. Have you not asked the
question of yourself in a way that you can report to us why there
should be some trusts which are reporting almost no accidents
at all?
Ms Williams: They have now but
some trusts during this period did not have a centralised reporting
system. What we found when we were developing the scheme, particularly
in primary care and in the ambulance services, was there were
some parts of the country where they were very reliant on the
paper system and things were at a very early stage. There is nervousness
amongst staff groups about reporting. Our role is to try to promote
a culture where we see a year-on-year increase in reporting from
all trusts.
Q57 Jon Trickett: My time is up but
I wonder if I could ask the NAO to produce those figures I asked
for and also whether there is a correlation between the number
of stars which each trust has so we can see the curve for no star,
one star, two star and three star trusts.
Sir John Bourn: I will produce
that information.[4]
Q58 Mr Bacon: On page 34, paragraph 2.31,
Sir Nigel, there is a reference to the fact that: "Healthcare
organisations in other countries, having compared the merits of
anonymous and confidential reporting, have generally opted for
confidential reporting." This system opted for anonymous.
Why do you think that was? Do you see yourselves moving towards
a more open system?
Sir Nigel Crisp: I think this
was the same point Sir Liam responded to a moment ago. I think
we have got it confidential at a local level and anonymous at
a national level. That is felt to be the right balance so that
confidentiality can be handled and learned about at the local
level whereas anonymous is the right level for us to be looking
at the big patterns. Is there anything you want to add to that?
Professor Sir Liam Donaldson:
I have already responded to part of that.
Ms Williams: We went for that
de-identifier so that we do not carry names of clinicians or patients
at a national level in the database. That is because what we are
looking for is themes and trends, types of incidents, where we
might be able to develop a system-wide intervention to prevent
harm recurring to those particular groups of patients, therefore
we do not need the identifying details about individual people
at a national level.
Q59 Mr Bacon: I appreciate that you
want to have as open reporting as you can about the facts and
the themes and the trends and why people behave in certain ways,
but you still want to be able to take corrective and, if necessary,
disciplinary action, do you not?
Ms Williams: Yes, and that will
take place at the local level.
3 Report, p 9, Figure 2. Back
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