Will they ever learn? Transparency and accountability in the NHS

Within the NHS there are a plethora of different ways for mistakes in treatment to be learned from and patient safety improved:

• NHS Trusts conduct internal investigations;
• there is the Duty of Candour, which requires healthcare professionals to be open and honest with patients when something goes wrong;
• the Healthcare Safety Investigation Branch conducts independent investigations into NHS funded care;
• referrals can be made to the Coroner;
• the Medical Royal Colleges offer Invited Service Reviews; and,
• NHS Resolution have recently published guidance on how Trusts should learn from litigation.

Why is it then that recent investigations by the BBC and Independent newspaper highlight a culture of Invited Service Reviews by the Royal Colleges being kept from both the public and the regulator?

The Medical Royal Colleges offer Invited Service Reviews to help improve patient safety and care. Such reviews can be requested by any healthcare organisation and they offer independent and expert advice in a confidential report. Although these Reviews are confidential, since the 2015 Morecambe Bay maternity scandal, healthcare organisations should publish summaries of external reviews and share them with the regulator (the Care Quality Commission (CQC)); but there is no law to enforce this. Healthcare organisations are being relied upon to follow the guidance and publish but this is seemingly not happening.

A recent Freedom of Information Request by the BBC[1] demonstrated that the vast majority of Invited Service Reviews are not being disclosed to the CQC or made public. What is also surprising is that even if reports are disclosed to the CQC, the CQC does not have the legal power to compel NHS trusts to share Invited Service Reviews or force the implementation of the recommendations.

It seems to this clinical negligence solicitor that patients deserve better. Trusts need to tackle patient safety concerns head on and should be legally compelled to disclose these reports to both the public and the CQC. Furthermore, there should be independent monitoring to ensure that recommendations are acted upon. Ultimately, without true transparency there is no accountability and no guarantee that patient safety will improve.

[1] https://www.bbc.co.uk/news/health-57144923

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