4 October 2022: Expert Group on Public Health and Administration - B

Upon return, the topic for consideration became that of involving patients and their representative organisations in developing healthcare policy. There had been a system of consultations and engagement, including health councils, for many years. (In the distant past this writer had a small role in that process and during the time was very impressed by the quality of material available within the NHS to achieve effective patient engagement and involvement; albeit many of those within the NHS did not know it was there and never used it.) More recently, the process of connecting with the public became part of the privatised conditions of a contract, and it is much less effective, and may be accused of being more like tokenism. There is a difference with asking people to express a view and them actually having influence on policy development. Also, as more aspects of healthcare become subject to standards and frameworks, there is less scope for people to contribute to a locally bespoke solution.

The discussion then concentrated on the involvement of patients and families in investigations when things go wrong. There are challenges for the individual if they are still traumatised by the matter being investigated. Involving people has to be done properly and fully, or not at all. Anything less is going to lead to a bad outcome. There is a very real issue around how traumatised people are involved in assessing the impact of a tragedy (for them) arising from a healthcare action. There are further issues, such as the breakdown of relationships since the clinician who might have been involved in creating the trauma may still be the active clinician involved with the patient or their family. This was clearly very pertinent to the Inquiry, and the EG person answering these particular questions was mindful of the difficulty of discussing these matters given the audience. The expert is one who had studied and written about the issues surrounding patients in situations when things go wrong in the NHS. The hierarchical nature of the NHS was considered still to be a problem. The duty of candour concept was seen as a positive shift. There is still “a muddle” about how to raise a concern. Basically, if a person is articulate and self-assured, then they will more likely find a way in, but many problems happen to people who are not so confident or knowledgeable about how to start (or even that they can raise concerns or complaints). The concept of “safety intelligence” was introduced, and reference was made to the Cumberlege report where it spoke about a Patient Safety Commissioner (who has recently been appointed, it seems). There used to be a National Patient Safety Agency, but it was abolished in 2012. There is now a National Patient Safety Team.

Counsel asked about the arrangement in Scotland, Wales, and Northern Ireland on these types of arrangements. The responses did not include any reference to what was happening outside England. The Air Accident Investigation Branch was included as an example as a specialist body that might carry out a role similar to an Inquiry. Counsel noted the significant differences between such investigative bodies and a Public Inquiry. The lack of discussion about the devolved nations arrangements was noted by Counsel. The Professional Standards Authority appears to be the body that regulates the regulators. “Safer Care for All” was cited as a report from the Health and Safety Authority. There is perhaps a role for a type of new Commissioner. The Professional Standards Authority has recently released a report highlighting the improvements in this area but noted the recurrence of failings and lack of learning, despite the aim to achieve “lessons learnt”. It recommended the creation of a Health and Social Care Commissioner for each of the four nations. The main responder from the Group on this topic could not comment, having not read the particular report, but he did see such a role as quite considerable. It was also mentioned how there are various people working within the professional Royal Colleges on standards and incidents of harm being caused in healthcare settings.

The communication of risk to the public or larger patient groups was the next sub-topic. It started with the matter of how risk is conveyed to individual patients. Research on the topic has highlighted how difficult it can be for patients to conceive risk. There were questions about how risk is presented, and to different people their various life stages. One practical example mentioned was to offer descriptions of “best case” and “worst case scenarios” as a starting point to discuss and explore risk and involve the patient in deciding what to do which is best for them in their present situations. It was noted that the expert on risk management was one of the EG who was not in attendance.

The ”hallmarks” of an effective campaign to raise awareness among the public were sought from the group, but these were seen as difficult to pin down. There has been a lot of research and published material covering a host of relevant factors to be considered when there is a need in a specific case to design and deliver a campaign of awareness-raising. It related to the principle of “openness” as contained in the Nolan Principles. Withholding the information was perhaps considered to be reasonable if the information was speculative or incomplete. CJD was mentioned as a useful case study. Some experts were predicting tens of thousands of deaths, others were suggesting virtually no deaths. Ministers had to deal with that. The example of the wearing of masks and testing in relation to Covid was also mentioned, since it was recognised how these were not at all settled matters. It was agreed that the full information can never be available until after the event. There are also factors such as the seriousness of an event happening balanced against the likelihood of it happening. Another element was related to who gives out the information, and particularly the degree of trust people may have in that person. (This writer feels to declare an interest in this sub-topic, having carried out work with academics and Government officials on responses to national emergencies. What has not been mentioned is the way the Government seeks to manage the behaviour of citizens in certain situations by involving experts, including from military intelligence, to design messaging and media opportunities which bring about a preferred public response. This can involve artificially creating situations to advance the preferred narrative and undermine any perspective which might call that official position into question. The setting for the work was a University Department of Psychology. The lead researcher for that programme latterly became part of the SAGE Group advising and responding to the Covid pandemic.)