As yet another NHS scandal hits the headlines. BBC Health Editor Hugh Pym asks;

Patient safety – will there be a big step forward?

BBC News 8.7.20

Hugh Pym has been around long enough to know that the latest scandal concerning vaginal mesh is unlikely to result in the cultural change needed to turn the defensive NHS into a service which admits and corrects mistakes as soon as they are brought to attention.  He lists the recent catalogue of shame in his opening paragraph.

The list is a dismal and shameful one – Mid-Staffordshire, Morecambe Bay, the rogue surgeon Ian Paterson, maternity care at the Shrewsbury and Telford.

All those who monitor the health sector know that the 3D strategy is an automatic response when the NHS receives a patient complaint.

 Deny – Delay – Defend 

The NHS has been allowed to deflect valid complaints due to the compliance of the regulators, who receive due condemnation in the Baroness Cumberlege report.

They claim that the remits of HSIB and the Ombudsman are too narrow, and that only a limited number of complaints are followed up. It is a scathing indictment that, even after previous instances of patient mistreatment, and repeated calls for lines to be drawn and new safety regimes established, another review has found systemic faults.

The dangers of vaginal mesh, used to treat women with post-birth incontinence or pelvic organ prolapse, have been known about since at least 2017, when more than 800 women threatened to sue the NHS .  

This report from woman&home  gives a detailed account of the appalling suffering of those affected and their long fight to be heard.

Baroness Cumberlege’s mesh review was released today

A damning report published yesterday has stated that vaginal mesh concerns from women have been ‘dismissed’ by the medical profession for years. It states that too often, the worries over vaginal mesh – as well as the ill effects over other procedures and medicines – has been dismissed as ‘women’s problems’.

Review chair Baroness Julia Cumberlege said she was shocked by the “sheer scale” of suffering from women, and urged that the health care system must apologise to women for being so dismissive.

She said, “I have conducted many reviews and inquiries over the years, but I have never encountered anything like this. Much of this suffering was entirely avoidable, caused and compounded by failings in the health system itself.”

The voices of these women, suffering chronic pain and disability, were dismissed not just by the medical profession but by the Health Service Ombudsman. Once again it was not the Ombudsman who alerted the world to this scandal by investigating complaints and laying a report before parliament.  The Ombudsman’s casework report 2019  does not include any investigations into vaginal mesh though it is inconceivable that no complaints were made to PHSO on this issue.  A key word search on the PHSO website does not link to any information on this subject, and neither was any found on the Patients Association website apart from their ‘shock’  at reading the report. It was a fierce patient-led campaign which resulted in the independent medicines and medical devices review

The proposal of the Cumberlege review was to bring about a cultural change by the introduction of a Patient Safety Commissioner.

So what will a Patient Safety Commissioner mean?

The plan is to have an individual with “real standing” outside and independent of the system, accountable to the parliamentary Health and Social Care Select Committee.

The Commissioner would be expected to take up and investigate patient complaints where appropriate, and hold organisations to account – the review had stated that the failure of health authorities to respond to concerns was a recurrent theme.

It is interesting to note that a new Patient Safety Commissioner would have ‘real standing’ outside and independent of the system which rather begs the question as to the ‘standing’ of the current Health Service Ombudsman. Importantly, the Cumberlege review acknowledges that accountability can only be achieved by establishing a Patient Safety Commissioner who is a ‘legally empowered patient champion.’  Anyone who has taken their complaint to the Ombudsman would know that PHSO are not legally empowered and neither are they a patient champion. With a very low uphold rate (fewer than 20% of all complaints were assessed and less than 3% upheld via investigation in 2018/19) it is clear that the Ombudsman is part of the problem and not part of the solution.

A Patient Safety Commissioner would be a step in the right direction and PHSOtheFACTS, a citizen-led campaign group, have long claimed that NHS complaints should be handled by a dedicated body with both clinical and legal expertise. But the Ombudsman is also failing the public with regard to parliamentary complaints. It was not PHSO who revealed the shocking treatment of the Windrush generation at the hands of the Home Office, neither are they reporting on the continuing scandal of slow compensation payments. In 2018/19, 861 complaints were made about the Home Office to PHSO. They investigated 21 cases and partially upheld just 13 complaints.

Neither have PHSO protected the WASPI women, many of whom have been made destitute by changes to the pension age, poorly notified by the DWP.  The Ombudsman decided to intervene on these cases in 2017 in order to speed up resolution but to date the six sample cases are still awaiting investigation outcomes.  1,553 complaints were made about the DWP in 2018/19, 30 cases were investigated and just 4 partially upheld.

With the Cumberlege Report it has been officially recognised that PHSO are not to be relied upon for patient safety. It should also be recognised that PHSO are not to be relied upon to uphold the rights of the citizen against government departments. It would appear that the Ombudsman has dubious ‘standing’ as an ‘independent’ body, it has no powers of legal enforcement and an extremely low uphold rate.

With the call for a new Patient Commissioner to be the strong voice of complainants, you have to ask;

 What’s the point of the Ombudsman?