Empowering Users of Health and Social Care Services

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Empowering Users of Health and Social Care Services

Aim

The aim of this unit is to enable learners to explore how to empower individuals using health and social care services to maximise their independence.

Unit abstract

It is essential for all health and social care professionals to understand that the service they deliver enables individuals to participate in the decisions that are made about their lives. First, learners will explore how legislation and the sector skills standards regarding the design and how review of services promote independence, which in turn is captured within organisational policies and procedures. Second, learners will investigate factors that can affect participation, independence and choice, including systems for assessing and minimising risk.

Finally, learners will investigate the administration of medicine and the effectiveness of policies and procedures for administering medication in achieving the best possible outcomes for users of services. Learners will study legislation and factors that affect the care that is received. Learners will also examine strategies to promote the best possible outcomes for individual users of services.

Learning outcomes

On successful completion of this unit a learner will:

1 Understand how the design and review of services promotes and maximises the

rights of users of health and social care services

2 Understand how to promote the participation and independence of users of health and social services

3 Understand the responsibility of managing and monitoring risks in health and social care setting

4 Understand how good practice in the administration of medicine is essential for

users of health and social care services

Considerations: possible tensions eg safety versus independence, rights

responsibilities; individuals, others

LO1 Understand how the design and review of services promotes and maximises the rights of users of health and social care services.

  1.             Explain how current legislation and sector skills standards influence organisational policies and practices for promoting and maximising the right of users of health and social care.

Legislation and sector skills standards: current legislation and sector skills standards that are relevant to promoting the rights of individuals; inspection processes, powers, duties, responsibilities, accountabilities, entitlements; organisations: providing services for vulnerable people.

The Data Protection Act 1998 was one of the policies that was initiated because of the review. This is a legislation that protects how the stakeholder’s information is used and kept by the care home. It is important to make sure that all the information concerning the stake holders are kept in safe and secure place and must only be accessed through proper authorisation to protect unlawful use of personal data of Service users. An example is that if Service Users data are not kept properly it can be used for fraudulently which can lead to a huge financial loss to the Service User and this is gross mismanagement of Service User Data going forward. The Equality Act 2010  is also an important factor in the running of a care home, the legislation states that all people must be treated fairly and equally irrespective of gender, sex, religion, race or disability. It is very important to apply this in the care home to protect the rights of the Stakeholders against abuse and discrimination by making sure that all Service Users have equal access in terms of the provision of their care. The Human Rights acts is also one of the recommendations that was initiated because of the review. This piece of legislation is crucial in that it protects individual rights by stating organisations and governmental bodies must not discriminate in the delivery of services to individuals irrespective of their circumstances, an example is if a Service User requires access to swimming or maybe they want to go to a holiday, arrangements has to be made for the to be able to do all this especially if they have the resources to be able to fund it. This can also be linked to the Equality Act 2010 in that it bounds organisations including the Local Council, Police and all other support services must give equal support to every individual irrespective of the race or disability and this is applicable to every Care Home. Health and Safety in terms of Safeguarding is an essential tool in every Care Home and this is essential for the protection of vulnerable people in Care to protect them from harm. The Care Act 2014 incorporates Safeguarding measures that is essential in running a successful Care Home, it states that when five or more staff are employed in a Care Home setting a written Health & Safety policy must be in place. These polices comprises of the statements of General policy, duties of managers and a section dedicated to the designated Safeguarding person. This is done to protect the staff, the Service Users and the organisation.

Service user’s rights

  • Safe environment
  • Healthy lifestyle
  • Make their own choices
  • Equal opportunities
  • Effective communication
  • To be treated with respect and dignity
  • Have their privacy respected

Service Users’ rights

The aim of good quality domiciliary care must always be to promote a way of life for Service Users which permits them to enjoy, to the greatest possible extent, their rights as individual human beings.  The following rights are fundamental to our agency’s work.

Privacy – An individual’s right to privacy involves being free from intrusion or unwelcome attention.  We aim to maximise our Service Users’ privacy in the following ways.

  1. Staff will enter a Service User’s property and rooms within the property only with express consent.
  2. A Service User has the right not to have to interact with or be interrupted by a worker when, for example, they are entertaining a visitor or are engaged on an intimate activity on their own account.
  3. We respect the fact that a Service User’s possessions are private and always act in accordance with the principle that our workers are guests
  4. Our staff respect a Service User’s right to make telephone calls and carry on conversations without being overheard or observed by a worker.
  5. We ensure that records of the service provided are seen only by those with a legitimate need to know the information they contain.

Dignity – The right to dignity involves recognising the intrinsic value of people as individuals and the specific nature of each person’s particular needs.  We aim to maximise our Service Users’ dignity in the following ways.

  1. We arrange for Service Users who require assistance with bodily tasks such as dressing, bathing and toileting to be helped as far as possible by the carer of their own choice and, if desired, of the sex of their choice.
  2. We ensure, if asked, that Service Users receive the necessary assistance with dressing and maintaining their clothes.
  3. We will try to provide help for Service Users with make-up, hairdressing and other elements of their appearance so that they can present themselves as they would wish.
  4. We aim to minimise any feelings of inadequacy, inferiority and vulnerability which Service Users may have arising from disability.
  5. We treat Service Users with the sort of respect which reinforces personhood and individual characteristics, addressing them and introducing them to others in their preferred style, responding to specific cultural demands and requirements, and aiming to maintain relationships which are warm and trusting but appropriate to the relationship of worker to Service User.

Independence – Independence means having opportunities to think, plan, act and take sensibly calculated risks without continual reference to others.  We aim to maximise our Service Users’ independence in the following ways.

  1. We help Service Users to manage for themselves where possible rather than becoming totally dependent on care workers and others.
  2. We encourage Service Users to take as much responsibility as possible for their own healthcare and medication.
  3. We involve Service Users fully in planning their own care, devising and implementing their care plans and managing the records of care
  4. We work with carers, relatives and friends of Service Users to provide as continuous a service as is feasible.
  5. We aim to create a climate in the delivery of care and to foster attitudes in those around a Service User which focus on capacities rather than on disabilities.

Security – In providing services to vulnerable people, there is a difficult balance to be struck between helping them to experience as much independence as possible and making sure that they are not exposed to unnecessary hazards.  Taking care for the security of Service Users therefore means helping to provide an environment and support structure which offers sensible protection from danger and comfort and readily available assistance when required.  This should not be interpreted as a demand for a totally safe or risk-free lifestyle; taking reasonable risks can be interesting, exciting and fun, as well as necessary.  We respond to our Service Users’ need for security in the following ways.

  1. We try to make sure that help is tactfully at hand when a Service User needs or wishes to engage in any activity which places them in situations of substantial risk.
  2. We hope to help to create a physical environment which is free from unnecessary sources of danger to vulnerable people or their property.
  3. We always carry out thorough risk assessments in relation to premises, equipment and the activities of the Service User who is being helped.
  4. Our staff will advise Service Users about situations or activities in which their disability is likely to put them or their property at risk.
  5. The staff at Milford Del Support Agency Ltd is well selected, trained and briefed to provide services responsibly, professionally and with compassion and never to exploit their position to abuse a Service User.

Civil Rights – We aim to help our Service Users to continue to enjoy their civil rights in the following ways.

  1. If a Service User wishes to participate in elections, we will try to access the necessary information and either provide or obtain any assistance which they need to be able to vote.
  2. We want to help our Service Users make use of as wide a range as possible of public services such as libraries, education and transport.
  3. We will encourage our Service Users to make full use of health services in all ways appropriate to their medical, nursing and therapeutic needs
  4. We will provide easy access for our Service Users and their friends, relatives and representatives to complain about or give feedback on our services
  5. If we can we will support our Service Users in their participating as fully and diversely as they wish in the activities of their communities through voluntary work, religious observance, involvement in associations and charitable giving

Choice – Choice consists of the opportunity to select independently from a range of options.  We will respond to our Service Users’ right to choose in the following ways.

  1. We avoid a pattern of service delivery which leads to compulsory timings for activities like getting up and going to bed.
  2. We will manage and schedule our services so as to respond as far as possible to Service Users’ preferences as regards the staff with whom they feel most comfortable.
  3. We respect Service Users’ eccentricities, personal preferences and idiosyncrasies.
  4. We hope to cultivate an atmosphere and ethos in our service delivery which welcomes and responds to cultural diversity.
  5. We encourage Service Users to exercise informed choice in their selection of the organisation and individuals who provide them with assistance.

Fulfilment – Fulfilment has been defined as the opportunity to realise personal aspirations and abilities.  It recognises and responds to levels of human satisfaction separate from the physical and material, but it is difficult to generalise about fulfilment since it deals with precisely those areas of lifestyle where individuals differ from one another. We respond to Service Users’ right to fulfilment in the following ways.

  1. We try to help Service Users to participate in the broadest possible range of social and cultural activities
  2. If requested, we will assist a Service User to participate in practices associated with religious or spiritual matters, and to celebrate meaningful anniversaries and festivals.
  3. We aim to respond sensitively and appropriately to the special needs and wishes of Service Users who wish to prepare for or are close to death
  4. We make efforts to understand and respond to the wish of any Service User to participate in minority-interest events or activities
  5. We will do everything possible to help a Service User who wants to achieve an unfulfilled task, wish or ambition before the end of his or her life.

Diversity – Britain’s social care services are used by people from diverse ethnic and cultural backgrounds.  Services therefore need to be accessible. We need to make efforts to reach out to vulnerable people who might have been deterred from approaching agencies which appear not to relate to their special needs and aspirations, and to demonstrate that we welcome and celebrate the wide range of people in the community generally and among the users of services in particular. We respond to Service Users’ right to express their diversity in the following ways.

  1. Positively communicating to our Service Users that their diverse backgrounds enhance the life of the community.
  2. Respecting the ethnic, cultural and religious practices of Service Users
  3. Outlawing negatively discriminating behaviour by staff and others
  4. Accommodating individual differences without censure
  5. Helping Service Users to celebrate events, anniversaries and festivals which are important to them

Some legislation and Standards that promote these rights.

  • Human Rights Act
  • Equality Act / Equal opportunity laws
  • Health and Safety at Work Act
  • Data Protection Act
  • Anti-Discrimination Laws
  • National Minimum Standards for Care Human Rights Act
  • Equality  Act / Equal opportunity laws
  • Health and Safety at Work Act
  • Data Protection Act
  • Anti-Discrimination Laws
  • National Minimum Standards for Care

Some organisational polices resulting from these Acts

  • Confidentiality Policy
  • Safeguarding Policy
  • Equal Opportunity Policy
  • Anti-discrimination Policy
  • Health and Safety Policy
  • Data Protection Policy

 

  • Empowering care
    • Identifying cultural differences and valuing them
    • Provide emotional support with good listening skills and empathy
    • Showing that you value others
    • Always offering choices to service users so they can make informed decisions
    • Using appropriate language to communicate
    • Respecting and promoting service user’s rights and maintaining confidentiality
    • Adapting the environment to improve communication
    • Providing appropriate support services communication aids and adaptations
    • Avoiding assumptions and stereotypes
    • Identifying and overcoming barriers to communicationC:\Users\Admin\AppData\Local\Microsoft\Windows\INetCache\Content.Word\baba1.jpg

 

 

Approaches to empowering individuals

 

 

1.Person-centred practice

build a trusting care relationship

Respect individuality, values culture and preferences (personalisation of care)

Freedom of choice with reasonable risk taking.

2. Enablement

Regaining skills. Aims to improve confidence and independence if service users are supported to do things for themselves.

3. Psychosocial approach:

considers the wider social context of the individual when assessing their needs.

4. Ensure best outcome for individuals

1.2. Analyse factors that may affect the achievement of promoting and maximising the right of users of health and social care.

One of the factors that was recommended by the review was proper staffing level as this is crucial in maintaining a good Care Home setting. Poor management can be detriment to staff levels through mismanagement which can also lead to poor shift patterns which in turn leads to inadequate support for Service Users. It is important to have properly trained managers in the running of a Care Home to ensure a smooth operation and to allow CPD within the workforce to ensure that staff are up to date with their training to promote the level of care and maximise the rights of Service Users. This includes proper training for staff on handling of various equipment’s and tools; they should also be aware of medication administration Act 1988 and all other relevant legislation that can promote residential care. These procedures will ensure that all Service Users ate taken care of. It is equally of utmost importance to manage effectively the level of dependence of Service Users and those with changing health status to avoid neglect through poor management of resources by the organisation which can contribute to poor treatment of Service Users which exposes them to harm. A good manager must be conversant of the various legislation and endeavour to equip staff with all the tools required to properly meet the diverse needs of all Service Users in compliance with the applicable legislations.

  1. Organisational policies and procedures
  2. Staffing
  • staffing levels: low numbers of staff can prevent promotion of SU rights.
  • Shift patterns: reduces staff commitment beyond a certain time.
  • CPD: Lack of Continuing Professional Development and staff training
  1. Individual service user e.g.
  • level of dependence,
  • changing health status
  • 4. Lack of resources: this may limit the choices that a service user has.
  • 5. Reduced staff commitment
  • 6. Leadership: ineffective manager may not be able to secure appropriate funding, promote a trusting relationship, improve resources etc

 

1.3. Analyse how communication between care workers and individuals contribute to promoting and maximising the rights of users of health and social care services

Communication: methods to overcome differences in communication e.g. second language, disability; recording information for continuous improvement eg best outcome for users of services, feedback, complaints, comments, inspection, recommendations for improvement

Communication:

methods to overcome differences in communication e.g.  second language if there is a language barrier.  use of communication aids for disabled people etc. improvement

There are various ways to overcome differences in communication in a Care Home setting. There are various communication aids available which can be utilized by the Care giver, an example is in the case of a Service User with heart disease that is refusing medication, a visual aid explain the importance of the heart to their wellbeing can be used to persuade the Service User and in the case of a scenario where there is a language barrier you can apply the use of body language to encourage the Service User to comply with your request, ultimately having a good communication skill will lead to the best outcome for Service Users. It is also crucial for staff to record all information accurately for continuous improvement, because the Care giver will be able to refer to the notes and be able to provide appropriate service and this will enable other Carers that come in on another shift to know what has happened earlier and be able to follow up to give appropriate support which will lead to the best outcome for Service Users. An example is If Mrs. C has to take a medication is a space of time that runs over a shift, the record will allow the career taking over the shift to know that the medicine had already been administered earlier in the day to avoid an overdose if it was administered again which can lead to the detriment of the health of Mrs. C, a good record keeping will ensure the safety of Mrs. C. Feedback from Service Users is important to make improvements within the care environment, this will help the management to identify instances of where more support is needed and be able to address various concerns of the Service Users.

There are other factors that promotes good service in a care home, for example a good complaints policy is crucial and the procedure must not be tedious to allow Service Users and their families to make their complaints know to the management of the Care Home and their concerns must be treated promptly and without bias. Robust inspection by the manager and other Stakeholders is crucial to ensure that adequate standards are being met by the care Home thus allowing for comments and recommendations to be implemented for the improvement of services to guarantee the quality of care for Service Users.

  • best outcome for users of services,
  • feedback,
  • complaints, comments, inspection, recommendations for improvement

LO3 Understand the responsibility of managing and monitoring risks in health and social care setting

  1.             Use a case study from a health or social care setting to identify the extent to which individuals are at risk of harm

Risks:

  • from harm;
  • from abuse;
  • from failure to protect

Turn to case study for assignment and identify the extent to which the clients are at risk of harm, abuse and from failure to protect

Assignment Case study

 Malnutrition and pressure sores and a resident’s capacity for personal relationship in a care setting.

Within a space of a few days, five older people residents in a care home died from causes that appeared to be consistent with the effects of severe neglect, including malnutrition and pressure sores.

A serious case review was held after this had happened. Although it was obviously too late for the five residents who had died, it was important that genuine lessons were learned as to what could be done in the future to avoid this happening again.

The review made several key points. First, when the first resident was admitted to hospital, action was swift. Hospital staff had immediately raised a safeguarding alert. Within a week all residents had been removed, once it was clear how poor standards were at the home, although even this was not a kneejerk reaction. There had been a balancing of the safety of residents against the disruption of a sudden move.

The review acknowledged that organisations such as a local authority, which place people in care homes, do rely on the grading given by the Care Quality Commission (CQC), but that, where the quality of a home is considered marginal, information should be sought from elsewhere, for instance, GPs or district nurses. Furthermore, those organisations that do place people in care homes have a duty to undertake regular reviews to make sure people’s needs are being met safely and contractual obligations are being discharged.

The review also stressed the importance of good communication between relevant agencies, such as the local authority, the NHS and the CQC. It also noted that a meeting held to share concerns about the care home at an earlier date was of indeterminate status, and nobody appeared to know what to do as a result.

Several staff were referred by the local authority and CQC to the Nursing and Midwifery Council (NMC) and/or the Independent Safeguarding Authority (ISA)

  1.             Analyse the effectiveness of policies, procedures and managerial approach within a health and social care setting for promoting the management of risks

The managing of risk assessment within a care setting is crucial, by managing their diverse needs to avoid situations that can lead to serious harm for employees and Service Users respectively. There are various issues which includes the moving and handling of the Service User using applicable tools. Staff must be given proper training in the use of these equipment’s to protect both parties from harm. There are other situations such as falling, slips, scalding and burning, robust policies must be in place to address all this scenarios in terms of what to do internally and externally if the situation requires it. This could be in case of serious injuries where visits to the emergency room is required, a risk assessment must be carried out promptly in accordance with national service standards. A good leadership style is required to effectively assess and distinguish between acceptable and unacceptable risks and a good risk assessment policy is crucial for the protection of Service Users from unacceptable risks for example a nursing home should have some legislation regarding acceptable and unacceptable risk, to have adequate equipment to deal with patients psychological and physical issues, this can also promote management of risk  an example a resident  who  has walked  to  the  local

Shop on a daily basis to collect their newspaper develops Alzheimer. They become confused and start to forget how to get back to their home .

Effective management of risks should cover

  1. Complying with relevant legislations and standards
  2. Understanding acceptable and unacceptable risks;
  3.  protection from unacceptable risk;
  4. assessing and recording risk,
  5. complaints policies and procedures;
  6. Whistle blowing policy
  7. leadership style

Use assignment case study for 3.2 or information from your work place and analyse the effectiveness of this care setting in managing risks using the performance indicators provided.

Every organisation must have some policies, rules and the procedure to run the business and also to achieve the goal of the organisation that is set by the top business management . Same in the case of the care workers, they should also have the legislation such as the acceptance and the unacceptable risk, creating abuse free environment, protection from the risk that is not acceptable by the organisation, leadership style of the leaders and the complaints procedure for the organisation (Lechering, 2014). Out of these only the assessing risk, complaint procedure and the leadership style are very important for the promotion of the managerial risk. A care worker should have a proper leadership style to influence the individuals that can assess the risk for the organisation and also have the procedure for complain. Besides this, the identification of the possible problem or abuse, screening of the people who are ready to minimise the abuse, a proper procedure for the report the people could be helpful to promote the management risk.

Conclusion

The different legislation, policies that influence the organisational practise is discussed in this paper with the help of the given case. The effectiveness of the policies and the procedure within the health and social care are also described. The tension between the patient that is suffering from the disease and the care workers along with the cause is described in the above paper.

LO 4: Understand how good practice in the administration of medication is essential for users of health and social care services

Introduction    

A strict legal framework regulates the supply, prescription and administration of medicines to protect patient safety. By inappropriately crushing tablets or opening capsules, healthcare professionals could be legally held to account for any harm caused by this action.

  • In summary, the law requires that the:
  • Right medicine is given to the:
  • Right patient, at the
  • Right time, using the
  • Right dose, in the
  • Right formulation

4.1 Review current legislation, codes of practice and policy that apply to the handling of medication

The following is a summary of the laws and professional codes of conduct which govern the prescription and administration of medicines in the UK.

  • DATA Protection Act
  • The Medicines Act 1968
  • Consumer Protection Act
  • Human Rights
  • Misuse of Drugs Act
  • COSHH
  • RIDDOR
  • The Human Medicines Regulations 2012

The Medicine Act 1968

  • This law regulates the licensing, supply and administration of medicines. Prescription only medicines can only be given in accordance with the directions of an appropriate practitioner. Unless instructed, there is no scope to alter the dose or change the form of a prescription only medicine, for example, by crushing or opening a capsule. To do so would be a breach of the 1968 Act.
  • Consumer Protection Act 1987 The crushing of a tablet before administration in most cases renders its use unlicensed. Consequently, the manufacturer will not be liable for any ensuing harm that may come to the patient or the person administering it under the Consumer Protection Act 1987. Where harm is caused as a result of the tablet being altered by crushing, it will not be the producer who is liable but the person who crushed or advised the crushing of the tablet

 

 

Misuse of Drugs Act

  • Possession of a controlled drug unlawfully
  • Possession of a controlled drug with intent to supply it
  • Supplying or offering to supply a controlled drug (even where no charge is made for the drug).
  • Allowing premise, you occupy or manage to be used unlawfully for the purpose of producing or supplying controlled drugs
  • The act creates three classes of controlled substances, A, B, and C, and ranges of penalties for illegal or unlicensed possession and possession with intent to supply are graded differently within each class.
  • The lists of substances within each class can be amended so the Home Secretary can list new drugs and upgrade, downgrade or delist previously controlled drugs.

Class A includes heroin, cocaine, crack, MDMA (“ecstasy”), methamphetamine, LSD and psilocybin mushrooms

Class B

includes amphetamine, cannabis, codeine, ketamine, methoxetamine and methylphenidate. Any class B drug that is prepared for injections becomes a class A substance.

Class C

includes GHB, diazepam, flunitrazepam and most other tranquillisers, sleeping tablets and benzodiazepines as well as anabolic steroids

Equality Act

This includes the right of access to and benefit from medicinal products.

Providing disabled patients with the support to manage and take a medicine safely is an essential duty under the Act. If a person, due to their disability, had difficulty taking medicines, the doctor, practice nurse and pharmacist would have a duty to ameliorate that impairment. A person with swallowing difficulties may require their medication in a suitable format like a liquid rather than a tablet or capsule.

The Human Rights Act 1998

  • The “right to life” is fundamental and now enshrined in UK law. The Act states that: “Care must be given with respect and be proportionate to the needs of the person.” Therefore, medication should be given in its safest form to protect patients from any adverse clinical outcome.

The Human Medicines Regulations 2012

The first comprehensive licensing system for medicines in the UK was the Medicines Act of 1968. … The government consolidated medicines legislation, including much of the Medicines Act 1968, into one set of new regulations, the Human Medicines Regulations 2012, which came into operation on 14 August2012

https://www.health-ni.gov.uk/articles/legislation-covering-medicines

  • COSHH
  • RIDDOR

4.2 Evaluate the effectiveness of policies and procedures within a health and social care setting for administering medication.

National standards:  codes of practice and policies; national inquiries eg the Shipman inquiry; ethical issues; service user choice; acceptable risk; standard for medication

Learning from tragedy, keeping patients’ safe

Overview of the Government’s action programmer in response to the recommendations of the Shipman Inquiry

Presented to Parliament by the Home Secretary and the Secretary of State for Health by Command of Her Majesty

Contents

Foreword 3

Chapter 1: Introduction 5 Harold Shipman 5 Early action 6 Setting up the Shipman Inquiry 6 The inquiry’s reports 6

Chapter 2: Main themes of the inquiry’s reports 8 The 1998 police investigation 8 Death certification and the coroners’ system 8 Use of routine monitoring data 9 Responding to complaints and concerns 10 The controlled drugs audit trail 11 Regulation of doctors 11

Chapter 3: Developments in the NHS since Shipman’s day 13 Clinical governance 13 Patient safety – An organization with a memory 14 Handling performance issues and the National Clinical Assessment Service 15 Towards a “patient-led NHS” 15 Regulation of healthcare organisations 16 Summary 16

Chapter 4: The Government’s action programmed 17 Police investigation of cases involving health professionals 17 Reform of the coroners’ system 18 Improvements in the process for death certification 19 Safer management of controlled drugs 20 Clinical governance and the identification of potential performance issues 22 A new approach to complaints and concerns 23 Local handling of identified performance issues 24 Reform of professional regulation 25 Making a reality of revalidation 26

Chapter 5: Taking the action forward 28

References 29

List of abbreviations 32

Annexes:

  1. The “three inquiries”: Ayling, Neale, and Kerr and Haslam 33 B. Further details on the Government’s action programme 35

Foreword from the Secretary of State for Health, the Minister of State for Policing, Security and Community Safety, and the Minister of State for Constitutional Affairs

 

There can be few people in the United Kingdom who are unaware of Harold Shipman, a respected GP from Hyde in Greater Manchester who, over a period of 20 or more years, was responsible for the murder of around 250 of his patients. In the years since Shipman was convicted, two questions are continuously debated. Firstly, what made an apparently caring, competent doctor turn to murder on such a horrific scale? And secondly, why did nobody in authority realise what was going on?

The Shipman Inquiry was set up in January 2001, following Shipman’s conviction the previous year for the murder of 15 of his patients. The Inquiry was tasked with investigating the extent of Shipman’s unlawful activities, enquiring into the activities of the statutory authorities and other organisations involved, and making recommendations on the steps needed to protect patients for the future.

The Inquiry published a total of six reports. The first and last addressed the extent of Shipman’s criminal activities, as a general practitioner (First Report) and in the early part of his career as a junior hospital doctor (Sixth Report). The other reports considered the various processes and systems which failed to detect his activities at an earlier stage – the 1998 investigation by the Greater Manchester Police (Second Report), death certification and the coroner system (Third Report), the systems for ensuring the safe and appropriate use of controlled drugs (Fourth report), and the arrangements for monitoring and disciplining GPs including arrangements for whistleblowing and handling complaints in the NHS (Fifth Report).

We owe an immense debt of gratitude to Dame Janet Smith and her team for their meticulous analysis of the weaknesses in existing systems which Shipman could exploit for his criminal purposes, and for the skill with which her recommendations balance the need to safeguard the normal processes of patient care and the need to protect the public from professional abuse.

As the Shipman Inquiry acknowledged, the NHS today is in many ways very different from the NHS in which Shipman practised. Among many other changes, there is a far greater acceptance of the view that the quality and safety of patient care is not just the responsibility of individual doctors, nurses and other health professionals – important though that is – but a shared responsibility of all healthcare organisations. New structures and processes have been put in place to ensure the quality of care, to focus healthcare organisations on continuous quality improvement, and to ensure that seriously deficient clinical performance is rapidly identified and dealt with. In this new climate, it seems unlikely that the activities of a Shipman would have gone unrecognised for long.

It is also vital to keep a sense of proportion. The overwhelming majority of health professionals are committed to providing the best care they can to their patients. We need to celebrate their commitment, support their efforts, and provide them with the means to seek even further improvement in the quality of the care they provide. It would be a tragedy if, in trying to protect

LEARNING FROM TRAGEDY, KEEPING PATIENTS SAFE 3

Foreword from the Secretary of State for Health, the Minister of State for Policing, Security and Community Safety, and the Minister of State for Constitutional Affairs

patients from the small minority of professionals who pose a threat to them through incompetence, ill health or deliberate malevolence, we were to put obstacles in the way of the vast majority of caring and competent professionals.

Nevertheless, the Government has always accepted the need to strengthen the existing safeguards in all the areas covered in the Inquiry’s reports. We have already responded formally to the recommendations on controlled drugs in the Inquiry’s Fourth Report and action on reform of the coroners’ system is underway. Today we are publishing a full response to the Inquiry’s Fifth Report, covering also the related recommendations of the Ailing, Neale and Kerr/Haslam Inquiries; a major White Paper with proposals for reform of the regulation of health professionals; and outline proposals for reform of the processes for scrutiny of death certificates. This paper provides an overview of all the action the Government is taking, summarising all these publications and spanning the responsibilities of four government departments, to respond to the challenges posed by the Inquiry reports.

As Dame Janet has acknowledged, no system can offer complete security against abuse from minds as devious as Shipman’s. We believe however that the government’s comprehensive programme of action will provide patients with robust safeguards against abuse, without imposing additional burdens on health professionals or impeding access of patients to modern patient care.

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1 Richard Baker Harold Shipman’s clinical practice 1974-1998: a clinical audit commissioned by the Chief Medical Officer (December 2000) 2 Shipman Inquiry Death disguised (TSO July 2002) 3 Shipman Inquiry Shipman: the final report (TSO January 2005) 4 Shipman Inquiry The police investigation of March 1998 (TSO, July 2003) 5 Shipman Inquiry Death certification and the investigation of deaths by coroners (TSO, July 2003) 6 Shipman Inquiry The regulation of controlled drugs in the community (TSO, July 2004) 7 Shipman Inquiry Safeguarding patients: lessons from the past – proposals for the future (TSO, December 2004) 8 Death certification and investigation in England, Wales and Northern Ireland: the report of a fundamental review (TSO, June 2003) 9 See reference 1 and additional analyses in reference 2 10 Revalidating doctors, ensuring standards, securing the future (General Medical Council, June 2000) 11 A first class service: quality in the new NHS (Department of Health, July 1998) 12 The new NHS – modern, dependable (Department of Health, December 1997) 13 Steps towards clinical governance (Department of Health, January 1999); Clinical governance – a practical guide for primary care teams (Department of Health, January 1999); Liam Donaldson and Aidan Halligan Implementing clinical governance: turning vision into reality (BMJ, June 2001 322 1413-1417) 14 Standards for better health, Annex A to National standards, local action (Department of Health, July 2004) 15 Improving quality and safety – progress in implementing clinical governance in primary care (National Audit Office, January 2007) 16 An organisation with a memory (Department of Health, June 2000) 17 Safety first (Department of Health, December 2006) 18 Health and Social Care Act 2001 19 Maintaining high professional standards in the modern NHS (Department of Health, February 2005) 20 Local GP performance procedures, available on the NCAS website www.ncas.npsa.nhs.uk/toolkit

LEARNING FROM TRAGEDY, KEEPING PATIENTS SAFE 29

References

21 Supporting doctors, protecting patients (Department of Health, November 1999); Assuring the quality of medical practice: implementing ‘Supporting doctors, protecting patients’ (Department of Health, January 2001) 22 The expert patient: a new approach to chronic disease management for the 21st century (Department of Health, June 2004) 23 Creating a patient-led NHS – delivering the NHS improvement plan (Department of Health, March 2005); Our health, our care, our say: a new direction for community services (Department of Health, January 2006); A stronger local voice (Department of Health, July 2006) 24 The future regulation of health and adult social care in England (Department of Health, December 2006) 25 Good doctors, safer patients: proposals to strengthen the system to assure and improve the performance of doctors and to protect the safety of patients – a report by the Chief Medical Officer (Department of Health, July 2006) 26 The regulation of the non-medical healthcare professions: a review by the Department of Health (Department of Health, July 2006) 27 Memorandum of understanding: investigating patient safety incidents involving unexpected death or serious untoward harm (Association of Police Officers, Department of Health and Health and Safety Executive, February 2006) 28 Oral Statement by the Minister of State for Constitutional Affairs, 6 February 2006; briefing note Coroners service reform (Department for Constitutional Affairs, February 2006) 29 Coroner reform: the Government’s draft bill – improving death investigation in England and Wales (Department for Constitutional Affairs, June 2006)

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