Healthcare providers, reviews and inquiries

The Independent Inquiry into Child Sexual Abuse (IICSA) has recently published an update report in connection with the seminars held in September 2017 to consider current approaches to the prevention of child sexual abuse in healthcare services. Although there is not a specific investigation focused upon sexual abuse of children within the healthcare sector, there have been a number of high profile cases involving medical and care professionals which might suggest that the healthcare sector may represent as much of a risk as any other sector involved in the care of children. Of course it is not just children who are at risk and although they are the focus of IICSA, other inquiries and reviews are also looking at abusive behaviour towards adults, most currently the Independent Inquiry into the issues raised by Paterson (the surgeon convicted of assaults arising from unnecessary breast tissue surgeries).

The IICSA report considers the issues discussed at the seminars which were attended by 16 organisations including government departments and agencies, NHS organisations, regulatory bodies, Royal Colleges and frontline health professionals. The following topics were covered.

• Education & training – in particular focusing on how to respond to specific risks of child sexual abuse occurring. Challenges included: how to ensure all, including new workers, had appropriate and up to date training, the need for greater standardisation of education and training, and creating awareness that children might be abused during treatment.

• Recruitment & employment practices – the importance of regulatory bodies was highlighted including the benefits of maintaining a register of those fit to practice and setting standards. There was also discussion about the responsibilities of organisations to check that workers are suitable for their jobs and of inconsistencies in the frequency of DBS checks.

• Access to children receiving healthcare and treatment – a significant issue here was the use of chaperones, which had been a focus in the reviews following the abuse of children by Myles Bradbury. The IICSA report highlights the importance of chaperones but notes that there is significant work still needed to ensure that chaperones understand their role, are able to challenge and question, and have sufficient knowledge of what treatment is being provided in order to be able to identify if it seems something might be wrong. IICSA have recommended that national policies are now developed and implemented for the training and use of chaperones in healthcare services. Other factors discussed included the challenges of children being treated on adult wards and ensuring that other patients, visitors and workers do not gain unauthorised access to children.

• Reporting of child sexual abuse and concerns – it was acknowledged and discussed that there can be barriers which prevent concerns being reported, that there needs to be better support to enable concerns to be raised and that good leadership is critical. These themes are to be developed at a Mandatory Reporting seminar due to be held on 27 September 2018.

• Supporting children and families to report child sexual abuse or concerns – information sharing was seen as key.. It includes ensuring that children and their parents and carers know exactly what should happen during a child’s care and treatment and that there should be regular opportunities for children and families to talk about their worries and know how to report concerns.

It is likely that as IICSA progresses healthcare providers will remain a focus. There may be a specific healthcare investigation announced in due course or healthcare providers could be called upon to provide information in other investigations which, while not specific to the sector, might require input because of the overlap with other organisations. Rule 9 letters might be sent out by IICSA at any stage and could ask lengthy and detailed questions, requiring extensive documentation and not allowing a great amount of time for responding. All healthcare providers should be prepared for the possibility of participation in IICSA, including providing evidence about how they are already learning from the information published by IICSA and how that has been put into practice.

On a somewhat smaller scale, the Paterson Inquiry – which is examining the circumstances and practices surrounding the abusive behaviour of Ian Paterson – is likely to be seeing information in the near future. Its terms of reference make clear that it is focused on the treatment of patients in the independent healthcare sector and in the NHS in England. It will look at Paterson’s behaviour as “a case study”, and will “consider other past and current practices, so as to draw conclusions in relation to the safety and quality of care provided nationally to all patients”.

The issues the inquiry will consider are wide and listed below

A. a comparison of the accountability and responsibility for the safety and quality of care received between the independent sector and in the NHS; including the roles of hospital providers and others in appraising, reporting, considering concerns and monitoring as regards healthcare professionals’ activity levels, conduct and performance;

B. how and when information is shared between the NHS, independent sector, and others, including concerns raised about performance and patient safety;

C. the arrangements for assuring that healthcare professionals maintain appropriate professional standards and competence, including appraisal, revalidation, scope of practice, and the role of hospital providers, professional and quality regulators, and other oversight bodies;

D. multi-disciplinary working, including a comparison of practice in the NHS and the independent sector;

E. the role of independent sector insurers, medical indemnifiers and medical defence organisations (including sharing of data);

F. the arrangements for medical indemnity cover for healthcare professionals in relation to all patients receiving care in the independent sector, whether such patients are medically insured or their treatment is NHS-funded or self-funded;

G. the means by which patients are referred from the NHS to the independent sector by individual healthcare professionals, including the role of NHS waiting times in relation to that practice;

H. the adequacy of the response to patients following adverse incidents, including clinical recall, in both the independent sector and the NHS; and

I. any other significant matters that may arise during the course of the Inquiry.

As can be seen, some overlap with those mentioned above in connection with IICSA. To date, the Paterson inquiry has met more than 150 patients and families and received observations from many more. Before publishing its report in summer 2019 it will inevitably be seeking evidence from a wide range of organisations, not just those specifically involved with Paterson. Again, organisations should be prepared for requests for evidence and to participate in the work of the inquiry. Those who have good examples of relevant practices and procedures should consider working with the inquiry by volunteering the information they have available.

While all of these reviews and inquiries will make important recommendations in due course, the crucial next step is ensuring that lessons are learned and that the recommendations implemented. That has not always been the case and in a further blog on this subject we will consider the impact of past inquiries in the health sector and beyond.

Paterson Inquiry issues for consideration:

A. a comparison of the accountability and responsibility for the safety and quality of care received between the independent sector and in the NHS; including the roles of hospital providers and others in appraising, reporting, considering concerns and monitoring as regards healthcare professionals’ activity levels, conduct and performance;

B. how and when information is shared between the NHS, independent sector, and others, including concerns raised about performance and patient safety;

C. the arrangements for assuring that healthcare professionals maintain appropriate professional standards and competence, including appraisal, revalidation, scope of practice, and the role of hospital providers, professional and quality regulators, and other oversight bodies;

D. multi-disciplinary working, including a comparison of practice in the NHS and the independent sector;

E. the role of independent sector insurers, medical indemnifiers and medical defence organisations (including sharing of data);

F. the arrangements for medical indemnity cover for healthcare professionals in relation to all patients receiving care in the independent sector, whether such patients are medically insured or their treatment is NHS-funded or self-funded;

G. the means by which patients are referred from the NHS to the independent sector by individual healthcare professionals, including the role of NHS waiting times in relation to that practice;

H. the adequacy of the response to patients following adverse incidents, including clinical recall, in both the independent sector and the NHS; and

I. any other significant matters that may arise during the course of the Inquiry.


jefferson_p_web Authored by Paula Jefferson, BLM Partner and head of the London office

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