Select Committee on Health Written Evidence

Memorandum by the Patients Association (PS 50)


  The Patients Association welcomes this opportunity to submit evidence to the Health Select Committee's Inquiry into Patient Safety.

  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 basis.

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 patients—the customers—have 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.

Current effectiveness

  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. (2004)

  "Tracking Medical Devices and the Implications for Patient Safety—a 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 to patients.

  "Infection Control—Is 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 infection.(2006)

  "Preventing Infection on the Frontline—a 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 Authorities. (2008)

  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 Report—Preventing Infection on the Frontline—from 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 safety—Safety 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.[288]

  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.

  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 top priority

    —  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.

September 2008

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