Memorandum by the Patients Association
The Patients Association welcomes this opportunity
to submit evidence to the Health Select Committee's Inquiry into
This has been a central plank of our campaigns
and for over 40 years the Patients Association has been "listening
to patients and speaking up for change". We listen to patients
who call our Helpline, or email or write to us. We are available
to any patient calling from within the UK, and it is through these
contacts that we learn what is of most concern to them on a national
Risks to Patient Safety
Patients accept that clinical error will happen.
What they will not accept is if that clinical error was foreseen
by colleagues but not acted upon.
There is no reason why procedures similar to
airline pilots reporting near misses, and other airline reporting
systems should not be employed in all UK healthcare. The horror
stories coming before the GMC and NMC in recent years (Ledward,
Allitt etc) were not isolated human errors. There was a pattern
of suspicion by colleagues, who chose to keep silent. Only when
each of the patients concerned discovered they were not alone
and spoke up, was any action taken.
There is no justification for excluding management
from professional jurisdiction. Where NHS managers allow such
safety errors, there should be a disciplinary body, similar to
the GMC or NMC, with the power to remove from office and impose
penalties. This should be in addition to the corporate manslaughter
legislation now in operation. The public outrage following the
Maidstone C.difficile deaths was compounded by the failure
to impose any appropriate punishment on the Chief Executive involved.
There was posturing but no action.
Poor clinical judgement should be picked up
through the mechanisms currently existing, together with revalidation
processes. The biggest barrier to success is that patientsthe
customershave insufficient knowledge from which to formulate
a judgement about their care.
This imbalance perpetuates poor practice. Alongside
this imbalance, we believe patients have insufficient knowledge
about "risk" from which to form a view when presented
with media scare stories citing "risk". This should
be a basic element in general education at school.
The Patients Association has campaigned for
many years for proper patient safety, notably through the recent
reports listed below:
Hospital Acquired Infection and the Re-use of
Medical Devices"the Department of Health responded
with new policy and investment. (2000)
"The Decontamination of Surgical Instruments:
A Survey of Hospital Staff in the UK" designed to assess
the progress of Health Service Circular 2000/032. (2001)
"Infection Control and Medical Device Decontamination:
A Survey of Strategic Health Authorities." This work was
a collaboration with the Infection Control Nurses Association
(ICNA), the Institute of Sterile Services Management (ISSM) and
the Association for Perioperative Practice (AfPP). (2002)
"Infection Control and Medical Devices"
surveyed infection control staff, consultant microbiologists and
senior clinical nurses and found worrying levels of sterilisation
and decontamination hygiene. This report was the first time an
examination of patient involvement was included in the subject.
"Tracking Medical Devices and the Implications
for Patient Safetya survey of hospital practices and opinions"
was a collaboration with the Institute for Decontamination Sciences
(IDSc), Infection Control Nurses Association (ICNA) and the Association
for Perioperative Practice (AfPP) and revealed the lack of staff
confidence in the level of decontamination in their trust. (2005)
By 2005, the growing public concern and media
coverage about infection control convinced the Patients Association
of the need to expand the campaign. The first Clean Hospital Summit
was held, with delegates and speakers from government agencies,
clinical staff, NHS providers and of course patients. The Summit
also offered delegates solutions via an exhibition of more than
50 suppliers of all types of infection control equipment. The
Summit concluded with the 100 Day Challenge to which delegates
signed up and promised to report back within 100 days on improvements
made. A second event: Cleaner Hospitals, Safer Healthcare had
the addition of the first Patients Association Awards recognising
the best in healthcare practice, innovation and personal commitment
"Infection ControlIs it only Skin
Deep?" revealed a lack of training, budget cuts, ignorance
of best practice and the fact that more than 90% of staff spent
clinical time reassuring patients about the risk of acquiring
"Preventing Infection on the Frontlinea
survey of NHS staff" confirmed little improvement and in
some cases things were worse. Staff remained unaware of guidance,
despite new legal sanctions, resulting in another postcode lottery.
There were scathing comments about the role of Strategic Health
What is disturbing to the Patients Association,
and should also disturb the Committee, is that the NHS continues
to ignore best practice, advice from the Department of Health
and the Chief Medical Officer. This is best summed up in the comment
sent in to our 2008 ReportPreventing Infection on the Frontlinefrom
a frontline clinician: "There is a culture of ignoring best
practice". Two other constant themes running through all
this work since 2000 are the lack of priority for patient safety
by NHS trust boards and the failure to ensure that safety budgets,
in this instance healthcare acquired infection, are ring-fenced.
Our 2008 contribution to patient safetySafety
First: Top of your Board's Agenda?takes place on 7th October
in Harrogate and is directed at Trust boards and all patient safety
leads. To aid the Committee, the attached programme sets out the
speakers including Lord Darzi of Denham, Sir Liam Donaldson, Anna
Walker, Stephen Ramsden, and Martin Fletcher, as well as a USA
comparison from the Pittsburgh Regional Health Initiative.
All these healthcare acquired infection (HAI)
safety dangers for patients carry the additional burden of financial
waste to them as taxpayers. However because there is no direct
penalty attaching to HAIs, there is no proper oversight of that
waste. This should be scrutinised as part of the overview of NHS
patient safety. Until it is, it is impossible to be certain that
spending is either sufficient or cost effective.
The Patients Association has long criticised
the role that national targets have had on the HAI rate in hospitals.
We have also pointed out that, for example, targets lead to high
bed occupancy rates in turn leading to inadequate cleaning times
between patients and thus an increase in HAI rates. National targets,
however well intentioned, in our view have fatally undermined
Patient safety includes physical safety, and
thus should include examination of such contributing factors as
mixed sex wards. Insufficient staffing levels and clinical judgement
on placement has meant that patients who contact us about this
loathed aspect of their care have stories to tell which have no
place in any modern health service.
Similarly, lack of information for patients
not only compromises their safety but ultimately may mean that
there is no informed consent to treatment. Informed consent is
the basis of all patient care and underpins all patient safety.
Complaints are a crucial source of tracking
failures in patient safety. We have been concerned for some time
at the themes emerging from calls to our Helpline about complaints,
namely a perceived lack of transparency and honesty in dealing
with complaints and also a failure, common to many complaints,
of support for patients by their elected representatives. Our
snapshot Survey (September 08) "NHS Complaints: Who Cares?
Who Can Make it Better?" is attached for information. It
reveals that too many patients regard the complaints process as
pointless, which in itself is a danger to patient safety. These
findings reinforce those put to us during our MRSA Focus Group
in October 2007 when the participants had similar responses to
their complaints wherever they had been affected by NHS care.
We have great concern that the Care Quality
Commission will not be as robust as the Healthcare Commission
in reporting on safety. We believe the input of patients will
be weakened at worst and at best there will be a period of confusion
over new titles and remits. This has adversely affected patients
in previous reorganisations, and there are no signs that this
latest change will be any different. In turn this will put a greater
workload on charities and organisations such as the Patients Association
in signposting patients in need.
Patient safety may also be at risk in the prescribing
of medicines in two different regards. First, where patients are
not informed about changes to their medication and second, where
they may be in receipt of counterfeit medicines.
Next Steps for NHS regarding Patient Safety
Given, as stated above, the "culture of
ignoring best practice" we believe that ensuring best practice
is the crucial next step for the NHS. We believe that
All staff appraisals should include
safety of patients
Safety budgets must be ring-fenced
Each NHS Trust must make safety its
The role of Strategic Health Authorities
should be prominent in reducing any safety postcode lottery in
their area. This requires them to ensure NICE guidance on best
practice is not optional.
Patients must be able to rely on
support from their elected representatives in improving patient
safety. We are concerned that such elected representatives are
more supportive of their local NHS than their constituents using
it. This has become an increasing theme in calls to our Helpline
Patients should have access to information on
the outcomes of clinicians treating them. This too is becoming
a demand on the Patients Association. Patients now realise there
are different standards of every aspect of the NHS, confirmed
by the Choices website. However the Choices website stops short
of providing them with the final piece of information on which
to make a genuine informed treatment choice. Patients now realise
they need to know the difference between clinicians' outcomes.
Until this is available to them there will be no lasting accountability
of either clinician or manager in the Trusts they choose to use.
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