Dean Russell: My question, coming back to you, Simon, is regarding the learning and the process of learning. As part of the process, do you have a record of all the data on similar types of incidents and what led up to them, so that other organisations in the NHS can learn from that and make sure that they do not repeat the same mistakes that may have led up to an incident or an accident, or a situation that then leads to litigation?
Simon Hammond: Yes. We hold a really unique position. We have all of the data from clinical negligence claims that are presented to us. We have a safety and learning function in our organisation that reports back to trusts on annual scorecards. They also do thematic reviews and publish volumes of literature to help the system. We also recognise that it cannot just be us that deliver that learning. We work with system partners across the whole of the NHS to derive learnings. For example, in the EN scheme we work with a variety of system partners in the maternity safety space to deliver some of the learnings that we see occurring through claims. Those learnings are obviously triangulated with incident reports and complaint reports through such initiatives as the Getting it Right First Time production that we co-authored with them on learning from litigation claims.
Dean Russell: Do you have a track record of how much that has impacted on or reduced incidents of a similar nature? For example, if there is a particular type of issue that has happened in the past, has that learning been truly embedded, and is the impact of the learning measurable, or is it the case that people are doing the training but it is not necessarily seeping through to the whole organisation to reduce future harm?
Simon Hammond: I would probably refer back to earlier comments made in some of the international comparisons for that question, because it is difficult to measure the impact specifically that we can provide. We are not the training body. We can make recommendations but we obviously work in a complex health system, where lots of others are also system partners with us, to deliver those learnings. Therefore, it is difficult for us to actually measure a direct impact and say, “This piece of literature had that impact on the totality of the system.” We are confident that people take into consideration the publications that we produce, and then embed them for the purposes of learning from what we have seen in clinical negligence claims.
Dean Russell: Would it be helpful if there was a wider body or measure of those sorts of things? If a particular type of incident or accident has then led to litigation, surely as a body of the NHS you would want to be able to see that there is a fall in that, post litigation or post the incident, across the entirety of the NHS. I understand what you are saying about the training piece, but if that does not exist as it currently stands, would it be something that would be worth perhaps putting into place in the future?
Simon Hammond: I think I would reference there the Getting it Right First Time initiatives. In conjunction with many others, including us, they have documented where there have been falls and different variations of standards that have been applied across the NHS. As a result of their programme, they have witnessed reductions in both the claims and incidents that have occurred. I think that type of learning already exists.
Dean Russell: Thank you. It is more the measurement of the reduction. Finally, if I may, with regard to patients and those who have gone through what at times can be life-changing and awful situations, how much are patients involved in the post-learning process? Do you have patient voices within that training so that it is not just looking at it from a clinician’s perspective but also understanding the sorts of issues and the concerns and language that patients might have been using in the run-up to raise their concerns that were not perhaps picked up on in previous cases?
Simon Hammond: If I can be clear, we do not deliver the training as such at local level. We often necessarily implement and encourage training programmes, but we do not deliver them across the totality of the systems. I thought I would make that point clear. Coming to your main question, we take families’ views, and we often publish literature that includes case histories. Our safety and learning function attends mediations as well, so they can include families in discussions with the trust and clinicians on what can be learnt from their individual cases.
Dean Russell: Excellent. Can I ask one further question, if I may go to you, Lauren, from a dispute perspective and your expertise in that area? How important is it for families during the dispute resolution process to know that learnings are in place so that others do not go through the same issues, or are they generally more focused on their own situation? What is the general trend of that?
Lauren McGuirl: First and foremost, they will be dealing with the impact that personally affects them, but of very, very high importance—you heard it from the patients who spoke to this Committee—is that they want to ensure that there are lessons learnt and protections put in place so that it does not happen again. That sits well above the priority of compensation, which is often the lowest on the list. It is being able to ensure that the issue is being dealt with holistically and appropriately, and, lastly, as we heard time and again from all of the panellists, in a very timely manner, so that it is not lingering for several years before potentially the learning fully comes out. That is really what they are looking at. It is a very high priority, and it is why, whether you want to call it mediation or facilitation, having a neutral party who can essentially help the parties have that discussion in a safe and constructive manner is really key early on.
Dean Russell: Very finally to you Lauren—my final, final, final question; it is such an important topic around the learning and putting patients at the heart of this—how much do you see that long-term engagement happens? Once the dispute resolution happens, and perhaps litigation, do you happen to know whether there is long-term engagement with those families to let them know how things have been embedded in the system and let them know that those learnings have been put in place to let them know that their raising it made a difference?
Lauren McGuirl: That is where our involvement ends. While we are there for the mediation, and often we will be involved for a small time afterwards helping the parties to solidify their agreements in relation to that, what we are involved in is the next stages, which is where it goes after the patient has been able to voice their issues. I think that is where Simon comes in and, more importantly, where safety and learning comes in. As Simon mentioned, it is very common for the safety and learning team to attend a mediation in order to gain learning. One of the things that the mediators invariably ask at the end of the mediation is, “Are there any more general points? Is there anything else you would like to share or discuss?”, and the parties are able to deal with that. That is all done in a confidential and privileged discussion, which helps go back to the issue that we talked about earlier, which is having clinicians or representatives from the NHS being concerned about how it is going to impact. It is a confidential and privileged discussion, so they are able to share more openly and candidly.
Dean Russell: Thank you very much.
