Lindsey Condron, Chief Executive at King Edward VII’s Hospital, looks at how can clinicians and hospitals earn back the trust of patients in the wake of the Paterson Report.
The Paterson Inquiry has been a wake-up call for all hospital leaders both in the NHS and private sector. The Inquiry found that Ian Paterson’s victims were “let down time and time again” by the surgeon, then by the hospitals where he practised and finally by the regulators, who failed to act sufficiently to keep thousands of patients safe and free from harm.
The King’s Fund, back in 2012, recommended that the first line of defence “in the battle against serious quality failures in healthcare” was that frontline professionals, both clinical and managerial, who deal directly with patients, carers and the public are responsible for their own professional conduct and continued competence and for the quality of the care that they provide.
However, clearly there was a failure to do so in the case of Paterson, who remained free to practise for over 14 years despite concerns being raised by his colleagues early on.
So what have hospitals done to address the valid and ongoing concerns of the public? To win back trust that the system has learnt the lesson and that such huge failures of the system cannot happen again?
In October 2019, the IHPN released detailed guidance for all private hospitals in response to the Paterson Inquiry and report in the shape of the Medical Practitioners Assurance Framework (MPAF), which all private hospital providers are expected to follow.
An example of a private hospital which started to address the patient safety need even before the Paterson Report is King Edward VII’s Hospital in central London. As an independent, charitable private hospital located within the Harley Street medical district, the leadership team has been able to work closely with its consultant clinicians, nursing staff and allied healthcare professionals and to align around a number of key directives with patient safety as paramount:
- There is a ‘Ward to Board’ clinical governance structure with clear lines of accountability
- The Clinical Practising Privileges Policy has been signed up to by all the consultant clinicians and is reviewed by the executive team regularly. The Practising Privileges Policy has been redrafted to align with the most recent key recommendations and guidance within the MPAF
- Scope of Practice paperwork has been updated to ensure King Edward VII’s Hospital collects the required data annually, and an individual’s compliance with his/her stated scope of practice is reviewed biennially by the senior clinical and executive team
- Multi-disciplinary teams are in place for all surgical specialities treating cancer, with a constitution in line with national cancer standards overseen by the Medical Director and Medical Advisory Committee
- A clinical directorate structure has been established with the five clinical directors being key members of the Medical Advisory Committee. Agenda items include review of all clinical governance data by department and directorate
- Submission of data to all mandated national registries
- Transparent clinical governance framework that reviews medical performance, which is independently audited using third party clinical quality assurance platform (C2-Ai – CRAB Clinical Informatics) and development of quality improvement measures by the speciality Clinical Directors and Consultants specialists.
- Clinical outcomes performance data is published and updated quarterly for consultants and staff to read and interrogate on the Kind Edward VII’s Hospital intranet. Summary data is provided for patients on the Hospitals Website.
- Implementation of a ‘Freedom to Speak up Guardian’ since 2018
There is no doubt that hospitals like King Edward VII’s Hospital, as have others in the independent healthcare sector, sought to pre-empt the conclusions in the Medical Practitioners’ Assurance Framework. And it’s vital the framework continues to be fully implemented by all independent hospitals in the coming months and years to help earn back the trust of patients across the healthcare system.