News on complaints
At last we have the plan for the new complaints system, though implementation is still over a year away. In future, complaints not resolved at local level will go to CHAI, the new Commission for Healthcare and Inspection (the future incarnation of the Commission for Health Improvement). They will decide what steps need to be taken.
As CHI, with its mandate for regular inspections, has so far been the most effective body for change, this may be a good move, providing that patients are still at the centre of any investigation. As yet we have no assurances about that – in fact, we have no idea how the new process will actually work..
If the new system is to have any credibility, complainants must be kept informed at every stage. They must know what action is taken following a successful complaint and whether it results in disciplinary action, retraining, new protocols or other measures.
There is no mention of this in the DoH report, which says only that each organisation must have a member at Board level to see that lessons are learned. If that still means that the follow-up to a complaint is handled ‘in house’ and in confidence, patients will remain disgusted and dissatisfied.
What we already know is that England loses it valuable Community Health Councils (Wales has shown more sense, in keeping and strengthening theirs) at the end of August. This is before the planned replacement, the Independent Complaints Advocacy Service, is properly established. We can only hope this is not an example of the way in which the rest of the new proposals will operate.
No more secrecy
We have been members of the Health Records and Data Protection Review Group since it began work in May 2002. The group, where patient organisations are outnumbered three to one by medics, is considering, among other things, charges for access to records and the requirement for doctors to review notes before patients can see them.
At the outset we were told that all its discussions were confidential, which worried us. These are issues that need an open debate, not a secret group making recommendations, followed by a DoH announcement of what they intend to do.
Luckily the Campaign for Freedom of Information got into the act, asking for minutes of meetings and copies of papers. The first reaction of the DoH was a firm refusal but the Campaign pressed hard with the public interest argument. When the Group was consulted they decided that as much as possible should be made public.
You can now see all the details on the web site at www.doh.gov.uk. Patient Concern’s first paper is in the September meeting section numbered HRDG 19/2002.
Healthcare proxies – time for action
Back in 1999 the government promised legislation to allow people to appoint a healthcare power of attorney (or proxy) who could make medical decisions on their behalf if they are no longer able to do so for themselves.This has still not happened.
Patient Concern has campaigned for healthcare proxies since its formation three and a half years ago and is a founder member of the Making Decisions Alliance, which launched its own campaign to push for legislation on February 19.
You can see full details of the Making Decisions Alliance, its aims and its membership on www.making decisions.org.uk
When the National Patient Safety Agency was preparing its launch, we were asked to endorse their targets. At the time we had to say no.
Though the idea of establishing a national register of medical mishaps was worthy of support from all patient organisations, they mentioned among their aims a ‘blame-free culture’ for the NHS.
We all want to make sure that there are no scapegoats in the NHS, that one person at the end of the line is not blamed for the failures of a whole system. But when professionals are careless or negligent patients want them to be answerable for their actions. We believe that a ‘blame-free culture’ would remove personal responsibility and accountability.
We made strong representations and we are delighted to see that their published targets now simply mention ‘a fair and just culture’. This is an aim we can all support.
We also had a lot to say when the Royal College of Surgeons put out the consultation draft of their ‘Good Surgical Practice’ with no mention of Living Wills.
The result is that the final version asks surgeons to ‘carefully consider any advance statement (living will) that the patient may have written’.
This is better than nothing but it falls far short of recognising the current legal position. Cases heard in the courts have made it clear that a properly made out Living Will is legally binding. Unfortunately many doctors still refuse to recognise this.
Good News on Consent
Patient Concern worked hard with the Department of Health to produce a patient-friendly consent procedure. Most (but not all!) of the points we consider important show up in the final documents. We also supplied the small list of patient organisations listed for further advice in the information leaflets on consent.
New consent forms introduced from 1 April 2002 now provide for documenting risks and benefits of treatment, additional procedures that might be necessary during an operation (e.g.blood transfusion) and leave space for patients to refuse any procedure they do not want. There is a box to record if you have a Living Will and you should be given a copy of the consent form. You can see the new consent form on www.doh.gov.uk
Every hospital should now be using this form. But some surgeons still claim that it is unworkable and continue to use their own. Patient Concern believes that the process for obtaining consent should be the same whether it’s in Brighton, Blackpool or Birmingham.
LET US KNOW if your hospital is not following good practice and using the new consent form. We will notify the DoH of every report we receive.