Ronan Hynes: Patient safety reform – today or tomorrow?
Ronan Hynes, partner at Sellors LLP, calls for urgency on patient safety reform in light of the Covid-19 pandemic.
The brave and heart-rendering story of Linsey Bennett on the steps of the Four Courts last week brought back into sharp focus the utter human devastation of the CervicalCheck controversy and how it continues to affect the lives of women, families, and communities in Ireland.
Almost three years on from the scandal, key patient safety proposals remain at Dail Committee stage, a previous incarnation of proposals was contained in the Health Information & Patient Safety Bill 2016.
This article examines some of the key reforms proposed by the Patient Safety Bill (Notifiable Patient Safety Incidents) 2019 arising from the CervicalCheck controversy and asserts that time is now very much of the essence for its enactment against an ominous backdrop of the current Covid-19 pandemic.
Open disclosure and mandatory reporting
The government scoping inquiry into CervicalCheck led by Dr Gabriel Scally was scathing in its assessment. The principle of open disclosure, which requires a hospital or healthcare provider to provide an open, consistent approach to communicating with patients and their families when things go wrong, was found to be “deeply contradictory and unsatisfactory”.
The bill provides for mandatory open disclosure of serious patient safety incidents, and notification of reportable incidents. The legislation facilitates a consistent approach to communicating with patients and their families when things go wrong in healthcare and it restates the legal protections for healthcare professionals who engage in open disclosure. The emphasis in the bill is commendable, to remove the blame culture and ensure when mistakes are made, they are openly communicated and addressed.
Importantly, the bill closes the current loophole which did not include private hospitals under the regulatory remit of the Health Information and Quality Authority (HIQA). This means patients in both the public and private sectors will benefit equally in terms of ongoing monitoring and standard setting. If passed, the type of incidents covered by the new legislation will include wrong site surgery, patient deaths, a serious disability resulting from a medication or diagnostic error and errors with screening and maternal deaths.
It is proposed that health service providers will have to notify the State Claims Agency and either HIQA or the Mental Health Commission of any serious patient safety incidents. Any such incidents shall be reported as soon as the body becomes aware of the incident and, in any event, not later than seven days after becoming so aware.
The policy of mandatory open disclosure set out in the bill arguably goes further that the statutory duty of candour system introduced in the UK since 2014 following the public enquiry into Mid-Staffordshire NHS Foundation Trust. A lack of training for medical practitioners and staff in the UK prior to introduction of the legislation is thought to be one of the early learning lessons for Ireland.
In the US, research from Illinois and Michigan, where a duty of candour system was introduced, revealed that malpractice expenses and claims fell substantially. The pre-eminent US. expert on Patient Safety, Dr Timothy Montgomery, sums it up best when he states: “words and actions matter most.”
Impact of Covid-19
The current pandemic places our healthcare system under enormous strain for both healthcare professionals and patients alike. Unquestionably, our healthcare workers have been herculean in their efforts so far.
However, when the pandemic subsides and stretched and fatigued resources, longer waiting lists and overcrowding returns, the potential for a patient safety time-bomb is very real. CervicalCheck victims have already spoken of the delays in accessing treatment services. In short, the enactment of the Patient Safety Bill 2019 must become an immediate priority.
We must no longer seek to blame, but to learn. The Patient Safety Bill, when finally enacted, will improve our healthcare system for patients and healthcare professionals. Open disclosure and mandatory reporting will bring Ireland into line with international best practice but also promote accountability, learning and confidence. Under the bill, patients will become front and centre in the Irish health system whilst also supporting our health professionals.
Comprehensive training for medical professionals and staff together with robust enforcement regulation will be key elements to the bill’s success. The ongoing plight of CervicalCheck victims such as Linsey Bennett and others combined with a global health pandemic demand such reforms be implemented today, not tomorrow. The legislation can mark a new era and major positive step forward to build a truly patient centred healthcare system in Ireland.