Editorial

The purpose of this editorial is to explain to readers and authors how we select papers for publication from the much larger number that are submitted to us.


AVMA Medical & Legal Journal
Looking at it from the patient's point of view, the way in which the NHS investigates adverse events tends to damage people's confidence in the system rather than improve it. In my view, there is little in the Chief Medical Officer's recommendations for the reform of the way in which clinical negligence is handled in the NHS to restore that confidence. Take for example the recommendation to exempt health professionals from disciplinary action if they report incidents which impact on patient safety, and the recommendation that reports made about adverse incidents should not be disclosed to the court investigating a clinical negligence claim. How many health professionals feel that it will do anything to improve public confidence in their profession if they are seen as needing exemption from normal professional accountability? How can withholding information about what actually happened to bring about a medical accident square with commitments to more openness, honesty, fairness and 'putting the patient at the centre'?
Even as things stand at the moment, all too often the injured patient is treated as if they should be a passive recipient of the findings of 'investigations' carried out by the system that prevailed over their injury. Adverse event investigations, including the commendable 'root cause analysis' approach, often takes place in a vacuum. At best, the patient may provide a statement. However, the investigation itself proceeds with the input of staff, and the patient has the findings explained to them at the end of the process. As with complaints investigations, the patient is put in the position of having to counter erroneous or misleading accounts of what actually happened after the eventwithout the opportunity to play an equal part, let alone a leading one, during the course of the investigation. Of course, to do this, or even to challenge findings after the event, requires a degree of knowledge or independent support. It must be of great concern that as set out so far, the Chief Medical Officer's plans for an NHS Redress Scheme envisages a process where even access to independent legal and clinical advice is denied.
Most people would agree that human nature being what it is, it is sensible that the National Patient Safety Agency (NPSA) should be able to receive reports anonymously, if that is what people chose to do. Some information is better than none. However, it is wrong to give the impression that the withholding of information from a patient about what actually happened to them is in any way acceptable. Health professionals are already subject to potential disciplinary action if they fail to uphold this basic professional and moral duty. The proposed 'duty of candour' (a posh way of saying dishonesty should stop?) has positive potential, especially as it would extend to management. However, it will be perceived as 'spin' unless there are sanctions taken when the duty is not honoured. The carrot of exemption from any possible disciplinary action in exchange for what is in any case moral duty as well as an existing professional responsibility, would surely end up doing more harm than good?
Peter Walsh

Editorial
The AVMA Medical & Legal Journal Volume 9, Number 6, November 2003