The Paterson Inquiry: three key themes

In his report, the Rt Revd Graham James describes the current system of healthcare as ‘dysfunctional’ at every level, observing how it has failed to keep patients safe from Paterson’s shocking malpractice.

It is harrowing to read and raises serious issues for regulators, service providers and professionals to all consider and act on. In this blog, we explore three issues and themes highlighted in the Inquiry’s report.

The sheer scale of how Paterson’s victims were failed time and time again by those who should have protected them is laid out in the 238 pages of the Inquiry’s report. He cites poor behaviour and a culture of avoidance and denial by those working in healthcare amongst other issues and makes a number of recommendations to Government.

Following numerous previous inquiries, it is not surprising to hear such strong terms from the Rt Rev Graham James. As the Inquiry heard, a lot has moved on since, and the report acknowledges ’there is no process, procedure or regulation which can prevent malpractice on its own’. However, as regulators we have a statutory duty to protect the public, and the Inquiry’s report brings this responsibility into sharp focus. Its recommendations cannot be ignored. 

Collaborating to keep service users safe

If, as regulators, we ever lose sight of the need to work together, and the purpose of regulation the findings and recommendations set out in the Paterson Inquiry should serve as a timely reminder.

In his report the Rt Rev James Graham, points to the scale of the regulatory system, and the layer upon layer of regulation which did not come together effectively to keep patients safe. He also highlights that many of Paterson’s patients found the regulatory system complex and difficult to navigate.

Sadly, this is the latest in a long line of scandals and inquiries where patients and their families have been repeatedly failed by the system which is there to protect them.

The sector has recognised this and is already taking steps.

The Chief Executives of all the professional health and care regulators are embarking on a combined programme of work. This includes, for example, exploring whether our standards of behaviour are coherent. It will also look at how we can become better at collecting, interpreting and sharing the data we have.

We have also made a significant commitment to share our data through the Emerging Concerns protocol. Signed by eight of the health and social care regulators, it is a mechanism for sharing information and intelligence that may indicate risks to patients and their families.  

It is a start and needs to have continued focus if we are to begin to address and make progress on the issues raised by the Independent Inquiry.

Importantly, awareness and understanding of regulation and its purpose also needs to be improved to help the public navigate the complexity; regulators, employers, professional bodies and professionals themselves working together can all help to educate and inform.

Changing culture

What the Rt Rev James Graham is also seeking is radical culture change in the sector to make open discussion of concerns and errors standard practice. Despite the protections in place for whistleblowers and the introduction of ‘Freedom to Speak Up Guardians’ across the NHS, this is perhaps proving harder to achieve than it should be.

Following the Francis Report in 2015, we strengthened our Standards of conduct, performance and ethics to include reporting concerns about safety and being open when things go wrong. These standards, which set out our expectations of registered professionals, are intended to provide a framework for everyday practise. We have also recently published information on our website about the protection for whistleblowers and guidance on reporting concerns. 

However, what the Inquiry is calling for is a culture shift, which goes beyond the expectations we set out in our Standards. This is not something that the regulators can fix on their own. Sector leaders, employers and registrants themselves also need to create environments where professionals can feel safe to reflect on their practise and be open, so that we can all learn from mistakes without fear of reprisal or being reported to their regulators.

Being able to reflect on experiences at work or considering feedback from service users is an important part of learning how to develop professionally and improve the quality of care - something we all want to achieve. 

What regulators can and should do, however, is work more closely with registrants and employers to address some of these concerns, and embed regulatory standards in everyday practise.

The work of the GMC’s regional liaison team is a good example, as is the NMC’s Employer Liaison Service. In addition to our programme of engagement with registrants, we are scoping the development of a professional liaison team that will work closely with both registrants and employers in the workplace to address some of the cultural issues and behaviours that may stop people from being open, or learning from their mistakes.

Reforming regulation

The Inquiry is not suggesting more regulatory bodies is the answer, but calls on Government to ensure that the current system of regulation, and the collaboration of the regulators, serves patient safety as the top priority. The reform of professional regulation could drive this change.

Regulatory reform has been long mooted, as anyone who was around for the Foster & Donaldson Review, and then the Law Commissions review can testify, so it is encouraging that the Government is actively working with the regulators to achieve it. 

Changing the fitness to practise process is the first priority; it will provide greater flexibility and ensure fair, efficient disposal of cases. When that happens, we will be able to free even more of our resources from the current reactive model so we can focus more on ‘upstream’ regulation; actively supporting professionals’ practise, and helping people not to end up in the fitness to practise process. This has to be in everyone’s best interests.  

So, we are ready to embrace the opportunities afforded by the Government’s reform agenda. We have already made a start, focusing initially on improving the flow of fitness to practise cases and the quality of decision making. This will reduce the time investigations take and the stress they cause.

However, to make real progress we need the necessary reform to our legislation, so we can fully embrace a more proactive, and less adversarial approach.  By doing so, we will make greater progress towards achieving some of things we have talked about in this blog, whilst still ensuring we fulfil our public protection role.