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  • Patient Safety Spotlight on Bill Kilvington, Trustee for Action Against Medical Accidents (AvMA) and Patient Safety Lead at the College of Operating Department Practitioners

    Summary

    This is part of our series of Patient Safety Spotlight interviews, where we talk to people working for patient safety about their role and what motivates them.

    Bill talks to us about how patient safety and transparency have been key priorities throughout his career as an Operating Department Practitioner (ODP) and then a leader in the NHS. He highlights the need for a longer-term approach to workforce planning and talks about how leaders can set a culture that engages with and prioritises patients.

    About the Author

    Bill has worked in the NHS for 45 years and is proud to be a registered Operating Department Practitioner (ODP), one of the 14 Allied Health Professions. As well as having a leading role in the development of the profession through the College of Operating Department Practitioners (CODP), he has always championed patient safety and the rights of harmed patients to proper support and, where necessary, redress.

    Until recently, Bill was the Divisional Director for Women and Child Health Services at Surrey and Sussex Healthcare NHS Trust, where he is now leading the development of a capital project for children’s services. He is the Patient Safety Lead at the CODP and a Trustee of the charity Action against Medical Accidents (AvMA).

    Questions & Answers

    Hello Bill. Please can you tell us who you are and what you do?

    I’m Bill Kilvington, and I’m an operating department practitioner (ODP) by profession - it’s a little known profession, but is one of the fourteen allied health professions. As the name suggests, we primarily work in perioperative care - looking after patients through anaesthesia, surgical care and post-anaesthetic care, although the role has expanded to many other areas of critical care outside of the operating department. I qualified as an ODP in 1980 and worked clinically for around nine years, before going into management as a theatre services manager. Since then I have had a range of roles managing clinical services within the NHS.

    At the end of April I ‘re-retired’ having initially retired at the end of 2019, just before the pandemic hit! In August 2021, Surrey and Sussex Healthcare NHS Trust (SASH) asked me to come back to my old role as Divisional Director for Women and Child Health Services.

    Although I am now officially retired, I am still very much involved in the Trust and am currently leading on a capital project, setting out the case for a rebuild of the children’s department. I am also a trustee of the organisation Action against Medical Accidents (AvMA) and the patient safety lead for the College of Operating Department Practitioners.

    How did you first become interested in patient safety?

    The role of an ODP is safety critical as we are dealing with patients in the riskiest healthcare environments, anaesthesia and surgery. Since my earliest days as an ODP, keeping patients safe throughout their hospital and perioperative journey has been ingrained in me as essential. A guiding principle throughout my career has been thinking about the patient being a loved one, and providing the care and standards you would expect for them.

    ODPs have only become a regulated profession comparatively recently when we joined the Health and Care Professionals Council in 2004. I was very engaged with the work that led up to that happening. There were two schools of thought; some ODPs at that time saw it as a status issue, but we in the College were always focused upon it being about protecting patients. We were signing up to be accountable for our actions and inactions, and that accountability could mean that you are no longer able to practise.

    I remember one patient I was asked to meet who had suffered harm in an anaesthetic room, caused by an ODP. A colleague and I went to meet this patient in her home, and she explained what had happened to her, telling us that her main drive was to make sure this could never happen to her children in future. I had to sit there and tell her that the individual could not be held professionally accountable for their actions through regulation. We couldn’t guarantee they wouldn’t do the same thing again. That had a really powerful impact and meeting patients like that helped embed in me the importance of making sure ODPs became a regulated profession.

    What part of your role do you find the most fulfilling?

    I found the latter part of my career working with maternity and children’s services incredibly rewarding. I am well aware of the challenges these services face nationally. We are now seeing, with the Ockenden Review and other scandals coming out, why safety and leadership are so important in those departments. I’m proud of our work at SASH, as although we have been through significant challenges, it has become a high-performing trust. Both the maternity services and wider Trust are rated outstanding by the Care Quality Commission (CQC), and that is largely due to the way we have prioritised patient safety and patient experience.

    Like any large organisation providing complex care, things can go wrong and patients are sometimes harmed. But I’m proud of the way we respond to that in a really open way, making sure we provide support to patients and their families, and that where possible we put things right. We have an open culture that genuinely puts patients first, and leadership is so important in building that culture. In any organisation, the chief executive and the board set the tone, which is then inculcated across the whole organisation.

    I am also hugely proud of my profession, and the fact that ODPs aren’t widely known is frustrating! When we went into registration in 2004, there were 7,500 of us and there are now 15,000 registered ODPs. During the first waves of the pandemic, many of my colleagues were redeployed into intensive care units to bolster the staffing there because of our skills in looking after patients on ventilators. Many ODPs also set up and ran satellite ICUs in operating theatres. As we move out of the pandemic, ODPs are also absolutely fundamental to the elective recovery and waiting list agendas.

    What patient safety challenges does the health system face at the moment?

    The major issue right now is workforce - it underpins everything in the health service. But it’s not just numbers, we need a workforce that is trained and competent.

    We know that in recent years, workforce planning and sustainability has been neglected - doing away with the bursary for allied health professions and nursing has had serious implications for recruiting and retaining students. The whole austerity agenda had a big impact across the board. Healthcare workers are the biggest spend and taking money out of the NHS affected the workforce hugely.

    Fortunately, we’re seeing some change now, with more routes into healthcare professions. For example, degree apprenticeships mean people can train on the job and still earn a salary. We need to be open to these new ways of training; it’s the end point that counts, and we need people to come out with the right skills and competencies.

    We are also seeing the development of enhanced clinical practitioners and advanced clinical practitioners, and these roles enable nurses and allied health professionals to expand their clinical role. With the right training, giving more clinical decision making to people on the front line will make patient care more effective. We don’t always need to be relying on a doctor or consultant to make decisions and the balance is changing, with broader teams of clinical staff able to provide better care.

    What do you think the next few years hold for patient safety?

    I think awareness of patient safety has grown significantly, particularly in maternity as the public becomes aware of the scandals coming to light. It’s changing the discussion. 

    When Jeremy Hunt was health secretary, he was very concerned with patient safety and some of the initiatives he set up have been really valuable. I have been involved in a few of these initiatives, such as the Never Events Taskforce and the development of the National Safety Standards for Invasive Procedures (NatSSIPS). But so often the learning from this work fades away over time and we end up repeating the same mistakes. For example, SASH took part in the Maternal and Neonatal Patient Safety Collaborative, which was a year-long programme of training for trusts. It was really good and a lot of learning came out of it which we embedded in practice.

    We really need to make sure this learning filters through and affects outcomes everywhere. I think that rather than always coming up with new initiatives we really must embed some of the work that’s already been done.

    If you could change one thing in the healthcare system right now to improve patient safety, what would it be?

    I’d go back to workforce planning; the government needs to be planning for the next 10, 15, 20 years. The conversation at the moment is always about what trusts will do in the next few months, which is far too short-term.

    f you work in NHS management, you’ll know every year come late summer, you’ll be submitting plans on how to handle winter pressures. There will be millions of pounds to spend before the 31st March that financial year, and with a fair wind, four months to implement everything you need. You can’t train people in that time, you can’t get new workforce in that time and it’s very difficult to get a significant capital budget spent. We need less short-termism and much more long-term sustainability planning.

    Are there things that you do outside of your role which have made you think differently about patient safety?

    My work as a trustee of AvMa has been eye-opening - even the fact that there needs to be an organisation there to help patients to get justice. Things still go wrong and patients need access to support and justice, but I wish that in the NHS we would be better at doing that ourselves.

    When I’ve looked after harmed patients in the system, I’ve always tried to make their needs my main focus. There are two ways of looking at it: one is, “I’m there to protect the public purse and not get sued.” The other is, “I’m there to support someone who has been harmed by our work and to provide them with every potential avenue of redress that is open to them.” I encourage people to take legal advice and introduce them to the trust legal team as well, rather than shutting up shop to try and avoid being sued.

    Meeting people directly affected by harm in healthcare always has a profound effect on how I see patient safety. When I was part of the surgical Never Events Taskforce in 2013, I met patient representatives including Clare Bowen, whose daughter was killed during surgery. Getting to know people like that, who are passionate about developing safety for the wider population, has a powerful impact on you.

    Tell us one thing about yourself that might surprise us!

    In the last year I’ve taken up walking football! I haven’t played since I was at school and I’m still pretty rubbish at it, although I enjoy it immensely. It’s great fun and lots of good exercise.

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