Safety through regulation – how the independent sector is playing its role in improving patient safety and quality

Read IHPN’s Director of Regulation, Dawn Hodgkins reflections on IHPN’s recent “Safety through regulation conference” 

With the covid pandemic unfortunately leading IHPN to delay our annual “Safety through regulation” conference in summer 2020, it was great to finally hold the event this year and share our experiences on how the independent healthcare sector can continuously improve patient safety and quality across the healthcare system.

The event, attended by over 100 independent healthcare representatives, began with Prof Ted Baker, Chief Inspector of Hospitals at the CQC, who gave the key note address and started by saying a huge “thank you” to all staff in the independent health sector and paid tribute to their important role in supporting the NHS during the pandemic.

In keeping with the theme of the day, Prof Baker emphasised that “even the best services can improve”, with continuous improvement being a key part of an “outstanding” healthcare provider’s culture. And in terms of the independent healthcare sector, he very much acknowledged that acute providers had “taken on the challenge” in responding to the CQC’s 2018 report into the sector – particularly highlighting the work done to strengthen clinician oversight and ensure concerns are acted on (with specific mention of the important role IHPN’s Medical Practitioners Assurance Framework (MPAF) has played in pushing forward this agenda).

With continued challenges posed by Covid-19 and the publication of their new strategy, Prof Baker made clear his ambition for the regulator to be more nimble and “not wait for things to go wrong”. We can, he said, expect to see “a more flexible and responsive regulator” who will listen more closely to patients and respond swiftly.  Whilst acknowledging CQC are not ‘an improvement’ agency’ they will look at how they can support an improvement in safety through accelerating quality improvement activities.

Key to this will be greater engagement with patients with more rigorous use of data and his ultimate message to the independent sector was a very welcome “we want to work in partnership with you” – something that IHPN are playing a key role in facilitating.

Next up we had a number of breakout sessions looking at an array of issues around safety and quality improvement including “Strengthening medical governance and assurance”, “Talking duty of candour” and “Building on audit and outcomes”.

In the “Strengthening medical governance and assurance” session there were some really practical examples from IHPN members including Living Care and Ramsay Healthcare about how the MPAF had helped them improve governance and oversight of clinicians with a strong message on the importance of setting out clear cultures and expectations for practitioners “from the get go”. It was also great to hear from Catherine Picton, who led IHPN’s work on the MPAF and the recent impact review, and the enthusiasm there is in the sector for refreshing the framework and extending its use into Wales and Scotland.

In our session on “Talking duty of candour”, our event supporters Bevan Brittan gave an insightful overview of the current rules and regulations on this issue, with the MDU sharing their experience from the doctor perspective on both professional and statutory duty of candour. The CQC also supported the conversation and the challenges between the two different definitions and have agreed to a round table to discuss this issue further. And while it is clear that the current regulatory framework around this can be “clunky” at times, the key message was simply to forget that candour is about being open and offering an apology – something providers must not lose sight of.

And finally, the “Building on audit and outcomes” session, featuring IHPN members Andrew Cuff from Connect Health and Cleveland Clinic London’s James Gutierrez, really highlighted the growing numbers of audits and registries in healthcare and the changing attitudes that these are a real vehicle for quality and safety improvement rather than simply an administrative/bureaucratic task. However, the need to benchmark and accurately evaluate performance against the NHS remains a key challenge in this area.

Next up at the event we had an absolutely fascinating session with Nick Woodier from the Healthcare Safety Investigation Branch (HSIB) on what the healthcare system can learn from other sectors – whether that’s airlines or the nuclear industry – about continuously improving safety. This includes the importance of developing “Safety Management Systems” which provide a systematic and proactive approach to managing safety risks which is often lacking in healthcare. Although just a short introduction to some of the tools and techniques available, it helped to explain the distinction between different tools and techniques and how they can support the move away from a blame culture.

And to close the event, our plenary session of the day was a wide ranging discussion on “Improving patient safety and quality within a complex and changing system”. Much of the conversation focussed on the forthcoming legislative change and move towards Integrated Care Systems, and, reflecting on the key findings from both the Paterson and Cumberlege reports, the real need to ensure that meaningful patient partnerships are put in place in these new systems. For HSIB in particular, the new Health and Care Bill currently going through parliament gives them significant new powers, including to investigate incidents relating to privately funded care, and their Deputy Medical Director rightly emphasised how the patient safety landscape can very often be confusing for patients with the need for much greater clarity and transparency for the public so they don’t have to “fight their way through” the system when things go wrong.

All in all, a busy day for IHPN, focussing on a huge range of safety and quality improvement issues. While covid has of course dominated the last year, it’s clear that the sector’s commitment to continuous improvement in these areas remains stronger than ever. Independent providers have a huge amount to be proud of with almost 85% of providers rated good or outstanding, up from 70% just a few years ago. But as Prof Ted Baker made clear, “even the best services can improve” and as demonstrated today, this is a mantra which is very much alive and well in the independent health sector.