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End of attachment training surveys – so did I have a patient safety concern?

Those of you who read my last blog will know that I, a little to my surprise, ended up defending the GMC national training survey as initiatives like this allow a culture of professionalism and democracy to exist. 

The last question in the survey asks if you have a patient safety concern.  Did I? 


It related to a problem many of us are experiencing where a day unit was being used consistently as an emergency in-patient unit for which it was neither fit for purpose, nor being administered safely as patients sent here for the night would often get three ward moves in 36 hours.  We visited the theme in frequently in our weekly departmental meeting and I’d seen consultants from all specialties voice concerns to multiple layers of management.

I happened to be sitting on the unit when the Care Quality Commission (CQC) suddenly appeared.  As an aside, their unannounced inspection does support the ideal that our national NHS whistle blowing mechanisms can smell the scent if enough is wafted in its direction.

I thought I’d share some of what I saw and learnt.

First of all they were in the right place in the hospital, which is no mean feat.  I reckon this was due to the number of public plus internal complaints.  The waiting room for elective procedures had become a place of continual verbal abuse towards staff such were the frustrations.

It appeared to the clinical staff that on the day of the inspection there was a level of deceit instigated by the management, who in the time between the CQC arriving at the chief executive’s office and the unit, moved the aforementioned patients to another waiting area in the hospital.  What leadership in professionalism and transparency!

The CQC singled out the nurses.  Question number one (no rapport hitherto established and I could read in her face concern as to what would happen with her answers): ‘Do you have any concerns about the standards of nursing care on this unit?’ 

I really felt for her.  If she said yes, was she undermining herself and/or the team which she belonged to?  We are, after all, protective of our individual professional reputation, and external adversity often makes us more protective of the individuals in our team.  If she said no, had she missed the chance to get things improved and could she possibly become culpable by the General Nursing Council? 

‘Sometimes.’  Good answer.

‘Give me an example.’  She talked about there being no hoists, as a day unit would not have this case-mix.  Now the unit was being consistently used for in-patients several patients were unable to get out of bed – and as a consequence to the bathroom for washing etc. 

Another good answer.  Not undermining herself, or her team, but nonetheless pointing to diminished standards of care.

The next nurse was taken to the patient board.  ‘You seem to have patients from many different specialties.  Let me see,’ – the inspector counts – ‘from seven.  Discharge planning must be very challenging.’

And so it went on.

As GP partners and commissioners we may have care pathways and services within our own practices or community.  I saw how people can be cautious about talking openly where they’re not sure how the information will be used and/or may be intimidated by the authority figure.  However where astute questions are asked that focus on process rather than the individual, the relevant information can be extracted.

For the record, following the CQC inspection the unit was not used for inpatients for two weeks.  Bed pressures have meant things have reverted to the status quo ante.  However the CQC have put the foundation trust application on hold because of the safety concerns outlined above. 

Dr Alex Thomson-Moore is an ST2 in the Severn Deanery.