PRSB welcomes the government response to the Paterson Inquiry

By Professor Maureen Baker CBE

Openness is critical for safe healthcare and all consultants should be writing directly to you to ensure that you have the right information to make informed decisions about your health, treatment options and care. This is one of the recommendations made by the Paterson Inquiry, accepted by the government today, for improving practice and preventing medical malpractice.

In 2017, former surgeon, Ian Paterson, was sentenced to 20 years in jail for ‘wounding with intent’ hundreds of women by performing unsafe and often unnecessary operations for breast cancer.  In some cases, women were subjected to surgery even though they did not have breast cancer. The inquiry analysed not only how his actions were allowed to happen but how they were able to continue for so long and it became clear that organisations weren’t sharing information which may have raised questions about his work.

The Inquiry recommendations call for a culture shift in the NHS and independent sector, recommending that all consultants write to people, outlining their condition and treatment plan, in simple language, and copy this letter to the person’s GP, rather than writing to the GP and sending a copy to the person, as is common practice now. 

PRSB’s CEO, Lorraine Foley, have been advising the Inquiry since 2018 and have specifically stressed the importance of writing directly to people, a practice we have long been advocating. In 2018, AoMRC published its ‘Please, write to me’ guidance, which supports consultants in writing directly to you in language that is commonly understandable to non-clinicians, and then copy this letter to your GP. The PRSB fully supported this guidance and all PRSB standards, in particular the outpatient letter information standard, emphasises the importance of writing to people in a person-centred way.

Writing directly to you doesn’t change the content of the information in your care records, it will just ensure that the information is written in plain English. By doing this and then copying the letter to your GP, your care records will contain all the detail necessary for your GP to administer high quality care but the information will be transparent and clear, ensuring that you have greater understanding and control over your health and care information and can ask questions and spot issues before problems occur.

Writing directly to people is a practical way of meeting the NHS’s goals of personalising care and making you active participants in your own care. As a doctor, I am reaffirming my commitment to this practice and calling on all fellow doctors to drive this culture shift within the profession towards making writing to people the norm. PRSB recommends the full implementation of the Paterson Inquiry recommendations accepted by the government today, for safer care and better patient outcomes.

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CHAT theory also explicitly addresses five areas which if addressed systematically will help overcome stakeholder differences in pursuit of the common goal:

1. Understanding the artefacts that characterise the group and its activity.
• The artefacts might be clinical settings or the forms and templates used to capture and share information. During the pilot we heard about hard copy Dialog response forms; locally generated templates for collating information from different systems; letters and emails to GPs; images, poems or other non-text artefacts that service users might want to include in their ‘about me’ or care plan.

2. Understanding the multi-views of the group. Such groups are always a community of multiple points of view, traditions and interests. 
• Different participants in the group will have different roles and will bring to the group and their roles their own histories, language, and ‘rules’. During our Stocktake preparations and workshops we worked with psychiatrists, mental health nurses, occupational therapists, social workers, transformation leads and voluntary sector representatives, all professions and interests with their own language, approaches professional ‘rules’ but united in their interest in care plans, care planning.

3. Activity systems (like the ICSs) take shape and get transformed over periods of time. ‘Historicity’ is a term coined to express how the group’s problems and potentials can only be understood against their own history. 

 

• ‘We’ve always done it this way’, ‘that didn’t work before’, ‘it’s always like this’, ‘it wasn’t always like this’, ‘they are changing things again’, are all typical statements that often frustrate those charged with overseeing change initiatives. Without addressing the experiences that lie behind such comments you risk repeating mistakes of the past, alienating your stakeholders or just not understanding the real starting point for your transformation project. This is particularly the case for the implementation of the PCSP standard, the success of which will be largely reliant on point-of-care practices and information protocols as well as having systems which are user friendly and appropriately configured.

4. The central role of contradictions as sources of change and development. Contradictions are not the same as problems or conflicts. Contradictions are historically accumulating structural tensions within and between activity systems. Collectively addressing contradictions in how policy, practice, culture and technology interact will empower teams to find genuinely novel solutions for apparently intractable challenges, like interoperability and shared care plan/planning. 

This links to the fifth principle that:

5. the possibility of expansive transformations in activity systems. As the contradictions of an activity system are aggravated, some individual participants begin to question and deviate from its established norms. In some cases, this escalates into collaborative envisioning and a deliberate collective change effort. “An expansive transformation is accomplished when the object and motive of the activity are re-conceptualised to embrace a radically wider horizon of possibilities than in the previous mode of the activity.”