Since 2003, Peter Walsh has been chief executive of Action against Medical Accidents (AvMA), which works “for patient safety and justice”. Ahead of Patient Safety Learning’s second annual conference on 2 October, he outlines the role of patients in a patient safety system and some of the changes that are needed to make it effective.
The patient role in patient safety begins right at the start of their treatment journey. It is best practice for patients to be fully involved in their care and decisions about that care; and that includes discussions of the benefits and risks of treatment and alternative courses of action.
Moving forward, patients should be encouraged to be proactive in identifying risks in their own care, because often there is nobody better to judge whether something feels right or wrong.
A really good example of how patients can be proactive is the campaign to get patients to ask clinicians to wash their hands. That worked because people were encouraged to speak up.
When things go wrong
The next thing is that patients should remain engaged if something goes wrong. Patients need to be fully informed about what has happened and involved in any investigation into an incident. This is where the duty of candour comes in, both for institutions and for individual clinicians.
There is an absolute requirement to give patients a full explanation of what has gone wrong; but we know, in practice, that this can be something of a ‘tick box’ exercise. The duty of candour needs to be embraced and applied in a way that is meaningful.
Also, we know that, in practice, patients can find it hard to play a full role in an investigation. After all, they are not experts in writing terms or commenting on legal findings. This is why we need to create funding for specialist independent advice and advocacy for patients, to give them the help and support they need.
Involving patients in safety systems
Moving on to system issues: there are some really good examples of patients being involved in patient safety committees and governance committees and patient safety projects. But that involvement is not consistent across the NHS and it is often not resourced.
The recent NHS Patient Safety Strategy, issued by NHS Improvement, talks about creating a new role, patient safety partner, to support strategy, service and pathway design, and some aspects of governance.
We fully support the vision, but we think the patient safety partner idea needs to be replicated at all levels of the system, and we think it will require a national strategy to be properly planned and resourced.
We also think there should be a national network, so that somebody in Newcastle can confer with somebody in Bournemouth about a problem. And we think that should be a central resource, with dedicated staff. With the right engagement and resources, that could be a powerful, social movement for change.
Learning from what works
None of this is without precedent. The National Patient Safety Agency, which was set up in 2001, was very strong on patient engagement and worked with AvMA to launch a patients for patient safety project. Unfortunately, the funding was lost a decade later when the NPSA’s functions were transferred to the NHS commissioning board and then to NHS Improvement.
It would be good to see those resources brought back together and to learn from the positive aspects of that work. Patient Safety Learning could play a role in advocating for that, as part of its mission to promote learning for patient safety and disseminating examples of good practice.
Patients involved at every level
Overall, then, there is a role for patient engagement at every level of care. Patients can help to keep themselves safe, remain engaged if something does go wrong, and contribute their knowledge to patient safety initiatives across the system.
What we need is to make sure patients are empowered to speak up, that they get the help and support they need to be involved in investigations, and that their role in patient safety initiatives is planned and funded, so the NHS’ ambitions in these areas are realised - and not just good intentions.
Patient Safety Learning’s second annual conference is on 2 October 2019, at The King’s Fund, 11-13 Cavendish Square, W1G 0AN, from 9.30am to 6pm. The conference builds on the foundations of patient safety described in A Blueprint for Action, which details the key actions needed for a patient-safe future and to reduce the 11,000 avoidable deaths each year (1). The winners of the 2019 Annual Patient Safety Learning Awards will also be announced. For more information on the conference and to book a ticket, please click here.
(1) Hogan et al, in NHS Improvement (July 2019) The NHS Patient Safety Strategy: Safer culture, safer systems, safer patients (p.3)