I am afraid that although Klein (BMJ 23/05/09) is correct and that
ultimately the protection of standards in the NHS and elsewhere comes down
to professionals speaking out where necessary, he is too vague about how
this can be facilitated. The position of the individual whistleblower in
an organisation is invidious and failing to address this aspect when
discussing the situation does not take us much further forward.
Pre-MMC reforms, there was an excellent conduit through which
individuals could raise their concerns without fear of reprisal. This was
the specialty advisory committee (SAC) system of the Royal Colleges and
specialty associations. Visiting teams, comprising experienced clinicians
in the specialty, carried out regular and triggered visits and became
expert at ‘turning over stones’ and looking carefully underneath for poor
practice and standards. Their main focus was upon training issues but
poor practice inevitably impinged upon training and where such was found
to be the case the ensuing SAC reports made uncomfortable reading for
those concerned. In my experience they were usually effective in
producing change. Chief Executives understandably objected to the number
of visits being made but only at the point where the government started to
ramp up inspections by other quangos. Probably in the interests of
economy, these depended much more upon submitted data rather than in depth
site visits by professionals and interviews. How sad that the Royal
Colleges allowed this major plank in the supporting structure of standards
to be removed almost without demur in favour of the much diluted approach
imposed when PMETB was introduced.
If the Colleges are serious about their role as guardians of the
standards of care then in my view and I suspect that of many others, they
should seriously consider re-introducing independent site visits and
inspections by their emissaries. I am sure that many would consider
taking this on as a professional duty and in their own time if the NHS
would not offer support. Endorsement of standards by a Royal College is
still the best kite mark of quality and provides the professional voice
espoused by Professor Klein,
Rapid Response:
Safeguarding NHS Standards
Dear Sir,
I am afraid that although Klein (BMJ 23/05/09) is correct and that
ultimately the protection of standards in the NHS and elsewhere comes down
to professionals speaking out where necessary, he is too vague about how
this can be facilitated. The position of the individual whistleblower in
an organisation is invidious and failing to address this aspect when
discussing the situation does not take us much further forward.
Pre-MMC reforms, there was an excellent conduit through which
individuals could raise their concerns without fear of reprisal. This was
the specialty advisory committee (SAC) system of the Royal Colleges and
specialty associations. Visiting teams, comprising experienced clinicians
in the specialty, carried out regular and triggered visits and became
expert at ‘turning over stones’ and looking carefully underneath for poor
practice and standards. Their main focus was upon training issues but
poor practice inevitably impinged upon training and where such was found
to be the case the ensuing SAC reports made uncomfortable reading for
those concerned. In my experience they were usually effective in
producing change. Chief Executives understandably objected to the number
of visits being made but only at the point where the government started to
ramp up inspections by other quangos. Probably in the interests of
economy, these depended much more upon submitted data rather than in depth
site visits by professionals and interviews. How sad that the Royal
Colleges allowed this major plank in the supporting structure of standards
to be removed almost without demur in favour of the much diluted approach
imposed when PMETB was introduced.
If the Colleges are serious about their role as guardians of the
standards of care then in my view and I suspect that of many others, they
should seriously consider re-introducing independent site visits and
inspections by their emissaries. I am sure that many would consider
taking this on as a professional duty and in their own time if the NHS
would not offer support. Endorsement of standards by a Royal College is
still the best kite mark of quality and provides the professional voice
espoused by Professor Klein,
Yours faithfully,
Denis Wilkins
Hon. Consultant Surgeon, Derriford Hospital, Plymouth
Past Chairman SAC in General Surgery
Competing interests:
None declared
Competing interests: No competing interests