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NHS Resolution can help healthcare organisations deal with performance concerns

BMJ 2020; 368 doi: (Published 16 January 2020) Cite this as: BMJ 2020;368:m144

Rapid Response:

Re: NHS Resolution can help healthcare organisations deal with performance concerns

Dear Editor,

We read with interest the letter by Helen Vernon on the role of NHS Resolution helping healthcare organisations deal with performance concerns. She refers to the letter of Baroness Harding, 24 May 2019 ‘Learning lessons to improve our people practices’ (1).

Helen Vernon says that PPAS has been providing practical and impartial advice to health care organisations. She then invites practitioners to telephone PPAS for advice when needed.

In practice what happens is neither impartial nor independent of the organisations. It does not follow the ‘Just Culture’. The healthcare organisation’s Representative, often the Responsible Officer, telephones the PPAS advisor and gives a narrative with his/her decision. PPAS has no means of investigating the veracity of what is put to them. PPAS then writes to the Representative summarising their conversation, where the Practitioner is referred to with a number and no name. These communications are not normally shared with the Practitioner. The Representative is not obliged to disclose to the Practitioner about the referral or any conversation he/she has had with PPAS. They are not obliged to inform PPAS of any progress or any evidential material which later comes to their attention which may contradict their original narrative and decision.

To learn from lessons as Baroness Harding states in her letter, has PPAS carried out an audit of their practice and analysed the decisions they have wrongly supported? What mechanisms PPAS has in place for feedback to healthcare organisations and avoiding errors of judgement?

1.Harding D. Learning lessons to improve our people practices. NHSI/E May 2019. https:/

2. High Court Judgement

Competing interests: No competing interests

16 February 2020
Marjan Jahangiri
Professor of Cardiac Surgery (MJ), Consultant Cardiac Surgeon (JN)
Justin Nowell
St. George's Hospital
Dept of Cardiothoracic Surgery, St George's Hospital, London