Gosport deaths: lethal failures in care will happen againBMJ 2018; 362 doi: https://doi.org/10.1136/bmj.k2931 (Published 04 July 2018) Cite this as: BMJ 2018;362:k2931
All rapid responses
I am slowly reading the Gosport Report, and have currently reached page 103. Walshe's comments seem to me to be correct, but I find it revealing that so far I have yet to find a clear description within the report of the legal situation covering the prescription of drugs at the time: possibly because the legal situation was at the time 'somewhat unclear'. Now, however, the situation is much clearer: as I have pointed out in a comment (ref 1) about the Gosport Report, the justification for administration of drugs is now 'proper consent' [which amounts to compliance with the Mental Capacity Act (MCA)]. 'Clinical Indication' is merely the reason 'to offer' the intervention, not the justification for the subsequent administration.
It follows, from the framework described within the MCA, that logically some of the things criticised by the report, such as poor communication with families, and gaps in the record keeping relating to what I shall here describe as 'the 'consent aspect' of decision-making', would be addressed by not only involving non-clinicians in the processes, but by also involving those non-clinicians in record-creation. I have argued this in both relatively general terms (ref 2):
'Once, husbands 'owned their wives' - but no longer: and clinicians do not 'own their patients'. Until patient records contain within them the 'right' signatures (at the very least, the possibility of the right signatures being present: I accept that it might be difficult for patients and family members to sign such documents, but they should definitely not be prohibited from signing them) - signatures based on authority, responsibility and involvement, and not simply on whoever happens to be 'the senior clinician' - there will in my opinion never be satisfactory integration between the many people who are typically involved in supporting, and caring for, patients.'
and also more specifically in the context of the absence of non-clinical signatures on the main ReSPECT Form (ref 3).
The Clinical Establishment seems to be deeply resistant to this change - to the 'genuinely joint-ownership' of ''clinical*' records' - but, when only clinicians create the written record, then 'what actually happened, and who said what and did what?' can, as the Gosport Report makes obvious, be very difficult to establish 20 years after the events.
* I admit that 'clinical' is not the correct term there - it is the 'non-clinical' aspects which would correctly contain non-clinical signatures - but I think that whatever word I had chosen, would be 'imperfect' in a brief piece such as this one.
Competing interests: No competing interests