Select Committee on Health Written Evidence

Memorandum by Patient Concern (PS 06)



  1.  Patient Concern focuses on how:-

    —  patients and public can contribute to safer healthcare.

    —  healthcare professional can facilitate this.

  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 decisions—decline treatment. This challenges clinicians' raison d'etre—providing care—even though patients may only be exercising their right under the Mental Capacity Act. This conflict is one of medicine's insoluble problems.

  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 safety hazards.

Suggestion 1

  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 risks.

    —  Enable patients to decide what inherent risks they feel worth taking from those that are avoidable.

Suggestion 2

  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 them—that 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 science.

Suggestion 3

  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 practice.

  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 bought—our appalling level of hospital acquired infection or the rising re-admission rates following premature discharge?

Suggestion 4

  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"?)

Suggestion 5

  Fit CCTV cameras on all wards and in operating theatres.


    —  To identify and discipline persistent offenders, especially doctors who will not wash their hands between patients.

    —  To introduce the black box approach used in all aircraft and long overdue in hospitals.

Suggestion 6

  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:

    —  The Shipman Inquiry

    —  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.

Patient Concern

September 2008

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