An independent external inquiry into the issues leading to the withdrawal of junior doctors from Bedford Hospital’s paediatrics department has been published today.
The review, which was undertaken by Sally Williams, an independent health policy consultant affiliated to the Royal College of Paediatrics and Child Health, makes ten recommendations to the Bedford Hospital NHS Trust.
The recommendations have been set out to ensure that it continues to improve support to junior medical staff, and tackles long-standing issues surrounding the quality of training provided in paediatrics.
The report examines the history of issues surrounding the support and training environment in paediatrics, from 2005 to 2011 with a strong focus on 2012 and 2013.
It also examines the Trust’s processes around risk and governance and the culture of the organisation. It also includes a chronology of events, leading up to the series of multi-agency risk summits, where decisions around service provision following the withdrawal of junior doctors were made.
The Trust has published its action plan in response to the report, detailing how it has and continues to tackle the issues raised, and ensure a significant and sustained improvement in the quality of
junior medical training provision in paediatrics, and across the organisation as a whole.
Chief executive Stephen Conroy said: “This report serves as a sober reminder of the mistakes and missed opportunities that led to the withdrawal of junior doctors in paediatrics; and the inherent risks to
patient safety in substandard supervision and support.
“We have made many fundamental changes in the six months between the withdrawal of junior doctors in paediatrics and the publication of this report.
“Although we have made significant progress, we know we still have work to do to continue to embed the changes we have made; sustain improvement and transform our culture from board to bedside.
“The impact of not getting right for our junior doctors, and our student nurses and midwives, is felt by our patients – in the quality and, critically, the safety of the care and treatment they receive.
“If we don’t get it right for staff in training, we let our patients down.
“That is unacceptable to all of us and we made a commitment in July to act to support and nurture our students and ensure they have the opportunity to flourish. I restate that commitment today.
“We have an improvement plan, led by the director of medical education and the director of workforce and organisational development, which we have been and will continue to put into action.
“We are carrying out an internal assessment of our achievements in education. The result of this assessment will determine when we are ready to apply to return junior doctors to training in paediatrics.
“We also continue to assess our progress in ensuring consistently, sustainably, high standards in
medical education across the organisation as a whole.
“I feel deep personal regret that patients and local families suffered the consequences of our failure to act robustly enough to tackle issues around support for junior doctors in paediatrics before it
reached crisis point.
“I would again like to sincerely apologise for the months of disruption and undoubted distress this caused.
“We now have the vast majority of children’s services back at the hospital and the paediatrics department - under the clinical leadership of Dr Andy Raffles - continues to develop and improve the
way care is delivered to children to ensure Bedfordshire families receive the best possible local acute health service.
“I hope we can now look to the future, while continuing to learn from the past, to focus on ensuring we have high quality, sustainable children’s services for our children and for future generations.”
The Trust will be discussing the report findings and its action plan in response, at a meeting of stakeholders today (Tuesday) and at its public Board meeting at 10am on Wednesday, January 8 (held in the committee room South Wing.
All children’s services, with the exception of ambulance to A&E transfers and in-patient stays of more than 23 hours’ duration (as a new Royal College of Paediatrics and Child Health-approved model of
inpatient care is now in place) are being provided at Bedford Hospital’s Riverbank Children’s Unit.
The ten recommendations are:
1. The trust board should give attention to the capture, management and escalation of risk by the Paediatric Quality Committee as part of its work to strengthen risk management at corporate level. Unless risks are appropriately identified at the Paediatric Quality Committee for upward reporting to the Quality Board, efforts to improve the management of risks by the trust board will be undermined.
2. There should be a standing item on training at trust board meetings. This should include receiving feedback from trainees (both local and benchmarked information), and compliance across the trust against the GMC’s standards for medical education and training.
3. The trust should not rely solely on external validation visits to understand compliance against GMC standards. The Director of Medical Education should test processes for assessing compliance by
regularly undertaking a deep dive into areas of training within the trust. Some interviewees suggested departments where problems were ‘bubbling’.
4. The Medical and Dental Education Committee should review its approach to monitoring implementation of actions arising from educational visits.
A number of the actions contained in the trust’s plan to meet CQC essential standards (arising from the CQC inspection in July 2013) are predicated on this Committee receiving action plans.
There is a risk that the existence of this Committee will provide false assurance to the trust board unless meaningful and in-depth scrutiny of action plans is demonstrated.
5. The trust should learn from its experience in paediatrics by striving to become an exemplar for trainee engagement.
This should include identifying mechanisms for trainees to share concerns and
experiences outside of managerial structures, such as through a trainee forum, and supported with stronger trainee representation across the organisation.
Any mechanisms need to be given time to embed and mature, and need to enable trainees to feel safe about speaking up. Feedback should be seen as fundamental to understanding compliance against standards.
6. Any clinical manager in receipt of concerns from trainees should map the concern against the GMC’s standards for medical education and training.
This should help in deciding whether to escalate the concern and understanding its implications for compliance with the standards.
7. The trust board should begin any meeting to discuss paediatric services with a patient story from parents with experience of Bedford Hospital’s services.
This should help the board in gathering intelligence about how paediatric services are performing and
reinforce the importance of parents as partners in the design of future services.
8. The trust board should consider ways of supporting the paediatric College Tutor in his role, including asking HEEoE to facilitate arrangements whereby he can be mentored by a senior College
Tutor within another trust.
9. Efforts currently underway to develop a strategy for paediatric services should incorporate a review of the culture required to support the implementation of new ways of working. With new medical
staff joining the department, there is an opportunity to agree and affirm departmental values and unite behind a shared aspiration for the service.
10. An important area of learning within the department must be around sharing responsibility for compliance against standards of training, including asking searching questions where deficiencies are
identified and sharing responsibility for embedding improvements.
Independent Review Author