Health Service Focus

Sharing concerns

Sally Taber, director of Independent Healthcare Advisory Services (IHAS) and Nyla Cooper, programme lead at NHS Employers, explain the need for new guidance on how to share information about healthcare workers.

Regulating health workers across both the NHS and the independent healthcare sector has been held back in the past by a reluctance to openly communicate about safety issues.

New guidance has been produced to combat this, helping organisations share information about healthcare workers, promoting transparency and patient protection.

Developed by NHS Employers, in partnership with the Independent Healthcare Advisory Services (IHAS), the guidance aims to bring together a variety of existing measures, providing clarity for both sectors to clearly communicate any issues relating to individuals whose fi tness to practise has been called into question.

NHE spoke to Sally Taber, director of IHAS, and Nyla Cooper, programme lead at NHS Employers, about the need for the guidance, and the impact it could have throughout the health service.

No more regulations

The Government paper, ‘Enabling Excellence’, which set out the strategy for reforming and simplifying the system for regulating healthcare workers in the UK, stated that no more regulation would be introduced unless it was absolutely essential. This prompted IHAS and NHS Employers to look for different ways of improving information sharing when developing the guidance.

Taber said: “We looked at a memorandum of understanding after the regulations and took legal advice and it really didn’t work. So we sought a set of guiding principles and looked at ways in which we could build them into the HR procedures that the independent sectors have and the same with the NHS.”

“The original intention was to make sure we had legislative levers to ensure the safety of patients by sharing appropriate information,” Cooper added.

“It’s not the investigation progress, although there will be certain triggers through legislative leaders that are currently in place that would allow that to happen in certain circumstances.

“It was about ensuring consistency, ensuring that organisations felt comfortable to [share] when there was an absolute need to do so. There is a risk of safety – that was what we wanted to focus on essentially and that’s where the Government has supported us in driving this forward.”

A raft of different levers

The new guidance builds on legislation from Responsible Offi cer (RO) regulations and revalidation for doctors, as well as various HR practices that are currently in place.

Cooper said: “So we’re not just looking at doctors, but other professions and clinicians where there isn’t that sort of process in place.”

“It’s essential for us, particularly with the revalidation agenda, to be able to share information,” Taber added: “The importance of that can’t be emphasised enough.”

Cooper highlighted a “whole raft of different levers” already in the NHS for sharing employee information, which the guidance seeks to consolidate and link together for the first time.

These include empowering patients to report criticisms of their care, as well as the NHS Constitution, to create a “culture of openness”.

Previously, some organisations have “not been willing to share”, Taber explained, and pointed out that failing to do so was not to anybody’s advantage, regardless of the sector they worked in. Cooper said she hoped the publication will make the whole process of information sharing more inclusive, covering all the grey areas that currently allow staff to move organisations and transferring the risk.

The culture has got to change

Taber offered the example of a member of staff in the independent sector who had a number of complaints, but this information wasn’t shared beyond the organisation his poor practice occurred within.

She said that had communication been clearer then, such an “unacceptable” situation could have been avoided. “That was a long time ago and the culture has changed and has got to change. We can’t let this carry on.”

The guidance will help healthcare providers ensure information and alerts are shared through a set route, with precise direction for what information can be enclosed and who they should be liaising with at any given point.

Taber continued: “It should be built into HR contracts, our practising privileges, into all of the work that we do. It’s a constant reminder that if there are some practitioners there is some concern about, that information is shared. They don’t just go to another organisation and do the same thing there.

“I think we’ve got to get more used to not letting practitioners move from place to place when their performance is below par.”

Public and private

The bumpy relationship between private and public within the NHS may have been an obstacle to such transparency in the past, Taber said.

“I’m hoping that now the independent sector is accepted as part of the landscape – I know there are still concerns from organisations like the BMA, like Unison – but the NHS can’t cover the agenda by themselves.

“It’s important that we do respect each other and can then share [information] if there is a problem.”

Cooper commented: “It’s certainly getting more complex – which is why we need this kind of consistency.”

The information around practitioners will affect patients “wherever they’re cared for”, Taber said, making reluctance to share concerns a risk. The guidance offers a templated inclusive contract with private or third party providers to ensure everyone is following the same principles.

Fighting the fear

The growing awareness of the need to communicate clearly about staff issues is mainly down to culture change, and is part of a wider move to improve efficiency.

In terms of staff engagement, Cooper acknowledged that “there’s always going to be a fear about information being shared, data protection issues. It’s something that people don’t feel comfortable with”.

Taber added: “I’m really keen on being open and transparent and ensuring that staff are addressed if there’s a problem, because if they suddenly leave and go to another organisation, then the same thing can happen there and patients can suffer which is just wrong.”

Stigma against whistleblowers working in the health sector remains an issue, although Taber suggested the recognition that patients can choose not to return to a provider means they have to “make sure the service is right the first time.”

“If a practitioner delivers a poor service then that’s got to be addressed and if they are perhaps working between the NHS and independent sector then it’s got to be shared to see whether the NHS is experiencing the same.”

But moving from discussion around transparency to the real thing will take signifi cant focus. Cooper suggested that the Francis report (still to be published when NHE went to press) would help in these efforts, changing culture around quality and safety throughout the health service.

“Having an open transparent environment where staff can raise issues can prompt early intervention rather than waiting for whistleblowing for instance,” she said.

There was significant engagement in this goal, which Cooper said was “encouraging”, although she admitted “it’s not something that can change overnight, it is going to take a period of time.”

Safety or cost?

Financial implications of limiting staff activity must be taken in consideration with patient safety, Taber said. “I wouldn’t dream of thinking them as separate because they are not. Most of the time, providing a quality service doesn’t cost you any more, it’s just a change in culture to ensure the services are appropriate and there’s compassion in what you’re doing and actually looking at ensuring that members of your team are contributing to that team – or if there’s one where that performance is poor then that has to be addressed.

“This document gives you templates offering some guidance on how to do that.”

The need for greater efficiencies would affect the way staff are monitored and information shared, Cooper added.

“The line of reporting is very different. Although they have responsibility to the NHS Commissioning Board, the CQC are tightening up their requirements as part of the core standards, so annual assessments and things like that are currently in place will get more rigorous.

“They’ll be looking for hard evidence where things are moving and looking for examples of positive change.”

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