125. Evidence submitted by Nick Green
(PPI 77)
PATIENT SAFETY AND THE AUTONOMY OF LINks
REMIT AND
LEVEL OF
INDEPENDENCE—AND
ITS SUBVERSION
BY CPPIH
Independence
1. The autonomy of Patient Forums was embodied
in the Statutory Instruments (National Health Service Reform and
Health Care Professions Act 2002 Statutory Instrument 2003 No
2123 and 2124) but these were subverted by CPPIH.
2. No budgets have been allocated to any
Patient Forum[77].
A formal response from the Health Committee is required. CPPIH
withheld the money needed to do the job. A sum of at least £70
million has been improperly accounted. CPPIH has thus disqualified
itself from taking any part in determining the form of LINks and
this must be investigated.
3. In many parts of the country, particularly
London, Forum Support staff did not accept direction from members
as explicitly required by Statutory Instruments.
4. Contact details with other Forums were
deliberately withheld (again in violation of Statutory Instruments).
It is not the case that Data Protection legislation requires this
as CPPIH claimed.
5. CPPIH were aware of its non-compliance
with the law. This produced many complaints about members who
had criticised CPPIH[78].
Members had no remedy and many resigned. The complaints code of
practice was often breached by CPPIH itself. The contractual arrangements
with Support Organisations and past CPPIH accounts must be subject
to full forensic scrutiny so the mistakes of the past cannot be
repeated.
6. In view of paragraphs 1-5 a National
Body elected from Forums and LINks should be created with independent
support and legal staff. A budget of £60,000 per annum should
be sufficient per existing Forum as it is merged into LINks under
Local Authorities. An annual subscription should be paid to the
National body.
7. The existing Statutory Instruments were
adequate and simply require strengthening in view of the experience
outlined above of many, if not most, Patient Forums in the country.
Remit
8. The random unannounced Inspection visits
to NHS premises is the single most important function of Patient
Forums. In view of the difficulty of NHS staff complying with
hand washing and other patient risk minimisation procedures (eg
cleaning, control of nosocomial infection, patient nutrition,
accurate and timely delivery of appropriate treatment) inspection
procedures should be developed further.
9. A model adapted from the Home Office
funded Independent Custody Visiting Association, who visit custody
suites in Police Stations to ensure proper treatment of detainees,
could be applied.
10. No patient risk minimisation training
was given by CPPIH and this gross deficiency should be corrected
and enhanced for LINks with the right to inspect treatment records
when Patient consent is given.
11. Training should be given to enable scrutiny
of PCT expenditure and hospital accounts. This should be from
the perspective of reducing preventable accidents and promoting
error reduction in diagnosis and treatment.
12. Trusts should be able to give LINks
members clear statistical evidence of beneficial outcomes for
funded treatments.
13. This may be resisted because practitioners
do not routinely acknowledge the general error rates in medical
treatments.
14. 50% of Death Certificates are wrong
(Sington and Cottrell[79]).
Staff reported 840 lethal accidents to the National Patient Safety
Agency in its first report whereas Sir Brian Jarman at Imperial
College estimated 40,000 lethal accidents. [80]
15. The under reporting of accidents likely
has its origins in unfair disciplinary procedures within the Healthcare
professions that could also benefit from routine LINks scrutiny.
Membership and appointments
16. Existing arrangements from Statutory
Instruments are satisfactory but potential conflict of interest
by medical charity members and local authority Social Services
must be open to full scrutiny.
Funding and support
17. Guaranteed funding at the rate of £50,000
per year per existing unmerged Forum with a subscription of £10,000
to a National LINks Body who will enforce standards of recruiting,
reporting and training. LINks should report openly to anyone they
wished and have full access to legal advice. Initiation of legal
action against failing hospitals, contractors, practitioners etc
should be considered. LINks Funding should be inflation index
linked for next five years. Total costs are estimated at around
£30 million per annum as with CPPIH. Support staff contracts
should be subject to approval and monitoring by LINks.
Areas of focus
18. Patient safety concerns underlie every
complaint that patients make. Authorities frequently deny this
and the complainers are often labelled as malicious, litigious,
neurotic and trouble-makers as the recent report by Action against
Medical Accidents (AvMA) found. [81]
19. Unnecessary delay is also a major concern
of patients with chaotic use of existing facilities maintained
to feed the private sector and the waning status of the experts
involved. Delay circumvents intelligent questioning of agreements
to treat by patients. The negative and positive predictive value
of diagnostic tests, for example, is rarely made known to the
patient. Recent work at Arrow Park A&E Department on the "lean"
approach is very encouraging[82].
Zero length queues without increased expenditure appears to be
viable.
Statutory powers
20. Right to full inspection of all NHS
premises and premises where NHS work is contracted must be re-enforced.
Full access to all hospital records including financial, contractual
and patient records where patient consent is given. The commercial
confidence doctrine serves only to subvert Best Value and quality
constraints.
Relations with local health Trusts
21. Regional Liaison Committees of LINks
should be set up.
National coordination
22. A National Body to regulate and develop
activities should be elected from LINks members with a Board of
Trustees. The Health Committee may care to consult further on
this question.
HOW SHOULD
LINKS RELATE
TO AND
AVOID OVERLAP
WITH:
Local Authority structures including Overview
and Scrutiny Committees
23. Local concerns should be reported to
Overview and Scrutiny Committees but LINks should be free to report
to whomever they wish. All reports should be in the public domain
with anonymisation if appropriate and be accessible on a central
website- avoiding the appalling "Knowledge Management System"
model of CPPIH whose user interface was so bad special training
was required. A Wikipedia approach should be adopted.
Foundation Trust boards and Members Councils
24. LINks membership of boards and councils
should be considered but the essential independence of LINks must
not be compromised.
Inspectorates including the Healthcare Commission
25. The Inspectorates and Commission could
develop inspection procedures for LINks with eventual ratification
by the LINks National Board.
Formal and informal complaints procedures
26. Procedures should be monitored by LINks.
In what circumstances should wider public consultation
(including under Section 11 of the Health and Social Care Act
2001) be carried out and what form should this take?
27. As per legislation but LINks should
insist on clear presentation of performance indicators to justify
any intended reorganisation.
ABOUT ME
28. I am Chairman of the Real Time Study
Group, an academic and industry software design group set up in
1997 to examine the "Better Government" proposals.
29. As a past member of Camden and Islington
Mental Health Trust Patient and Public Involvement Forum I produced
the Patient Public Involvement Organisation website in 2003. We
focus on reducing error and delay in the NHS http://www.ppif.org.uk.
We are informally governed by a Discussion Forum of some 52 self
appointed patient and public users and take contributions from
both Forum members and ex-Forum members from around the country.
We publish Patient Safety oriented expert opinion from professional,
academic and government sources. We summarise local newspaper
reports of local Patient Forum activities. From our inception
we have advocated a National Patient Forum Organisation.
Nick Green
Patient and Public Involvement Forum Organisation
4 January 2007
77 On 24 July 2005 I received an unsatisfactory reply
from my MP Glenda Jackson and wrote:
"It seems to me the Minister's response is wrong
headed given the Statutory Instruments 2003 No 2124 (Functions)
and 2003 No 2123 (Membership and Procedure) adopted by Parliament.
Is there someone on the Health Select Committee and/or
the Public Accounts Committee that might be prepared to listen
seriously to Forum members about the issue of accountability for
money for Forums?"
I received no reply. From Treasury's "Productivity
in the UK" Stationery Office Limited 11/00 19585 we can estimated
waste in Public Expenditure at 52%. In this case the chain of
irresponsibility is established.Back
78
Michael English, chair of the London Region Patient Forum Executive,
will present the "Dirty Dossier" of Dr Janet Albu, chair
of University College Hospital Patient Forum, as part of his submission
to the committee. This documents the abuse of the complaints procedure
by CPPIH to silence its critics. Back
79
http://jcp.bmj.com/cgi/content/full/55/7/499 Back
80
http://www.ppif.org.uk/in126 Back
81
http://www.avma.org.uk/ Back
82
"Redesigning the broken processes in the Health Service"
http://www.ppif.org.uk/in244 Back
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