Memorandum by Patient Concern (PS 06)
1. Patient Concern focuses on how:-
patients and public can contribute
to safer healthcare.
healthcare professional can facilitate
2. For these reasons we offer some ideas,
based on daily contact with patients, their family and carers,
who have suffered from sloppy safety standards. We are less qualified
to respond to your specific questions which seem targeted towards
service providers. We hope this is helpful.
3. Three kinds of conflicting issues bedevil
efforts to reduce the widespread harm done by medical care.
Risks inherent in all treatment versus
risks avoidable via good safety procedures.
Individuals' clinical autonomy versus
standardising best practices.
Maximising throughput of patients
versus maximising safety.
4. Any test or treatment is inherently risky
and therefore unsafe. It may do temporary, permanent or fatal
harm. Healthcare professionals know this. Patients often don't.
5. If patients are told too much about inherent
risks, they may make misguided or medically irrational decisionsdecline
treatment. This challenges clinicians' raison d'etreproviding
careeven though patients may only be exercising their right
under the Mental Capacity Act. This conflict is one of medicine's
6. It is also true that every test/treatment
is a controlled experiment based on a risk/benefit judgement reflecting
statistical evidence, individuals' skill, experience and values.
Safety risks therefore go with the territory.
7. These realities can have the unfortunate
effect of making providers inclined to accept the unacceptable
as far as safety procedures are concerned. It is too much trouble,
too expensive or just too time consuming to enforce best practice
safety rules. With luck, patients will never know if equipment
is sterilised effectively, if single use items are used only once
or if cheaper or experimental devices are used, all creating avoidable
Have appropriate experts explore the feasibility
of defining the potential benefits and risks of all common treatments
and ensure that this information is automatically available to
all patients offered those treatments via GP surgeries, hospitals
and on the internet.
To separate the inherent from avoidable
Enable patients to decide what inherent
risks they feel worth taking from those that are avoidable.
Delete "significant" from an obligation
in the draft NHS Constitution to disclose risks.
To enable patients to be the judge of what is
significant to themthat is their expertise and their right.
8. Medicine is a judgement based service.
Clinicians guard their autonomy (power) fiercely. Standardisation,
like prescription, is a dirty word widely perceived as reducing
professionals to technicians.
9. But diagnosing what is wrong with patients,
choosing the most suitable treatment options and deciding how
to provide them calls for both judgement and the application of
standard procedures for which the evidence suggests the best potential
outcomes. The process is a combination of art and evidence-based
Make it mandatory to provide all common treatments
throughout the NHS using best practice procedures with deviations
only permitted for defined and recorded reasons.
To maximise the chance of good outcomes.
Encourage clinicians to realise that
appropriate standardisation complements, rather than conflicts
with good judgement.
10. Reducing waiting lists when supply falls
short of need, let alone demand, inevitably conflicts with safe
11. A faster service is an obvious vote
winner and a good thing per se. But do patients and public recognise
the cost at which it is boughtour appalling level of hospital
acquired infection or the rising re-admission rates following
Set and enforce standard cleansing procedures
and elapsed time between patients using beds.
12. Lack of staff often becomes the excuse
for acceptance of the unacceptable. (Do airlines treat that as
a reasonable or inevitable explanation for "adverse incidents"?)
Fit CCTV cameras on all wards and in operating
To identify and discipline persistent
offenders, especially doctors who will not wash their hands between
To introduce the black box approach
used in all aircraft and long overdue in hospitals.
Ask every ward visitor to express their view
anonymously on specified safety measures and pass this information
to the risk (reduction) manager.
To get continuous feedback on what
is happening from people with neither health nor jobs at risk.
(Exhorting patients to do likewise has limited value. Many are
too ill or too frightened to risk reprisals).
Ensure the risk manager has continuous
information on the application of safety standards in order to
enable rapid action as necessary.
13. Patient Concern gave oral evidence to:
Joint Select Committee of the Lords
and Commons on the Mental Capacity Act 2005
Welsh National Assembly Committee
on presumed consent to organ donation
Health Select Committee of the Commons
on electronic patient records
14. When we gave oral evidence to you on
electronic patient records, a member said: "I should like
to congratulate our clerk for gathering together our witnesses.
This is what an evidence session should be about. There is real
tension here. I shall do my best to see if we can make it rowdier."
15. Patient Concern would be pleased to
attend an oral session on safety if required.