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The HIT lists - which have been designed by Dr Imran Ahmad, consultant anaesthetist and deputy clinical director for Theatres, Anaesthetics, & Peri-operative medicine at Guy's and St Thomas', to eliminate 'turnaround time' - were inspired by Formula 1 motor-racing pitstop techniques, to achieve maximum efficiency and safety, by boosting the surgeon’s operating time (the most expensive and most scarce resource) from the 40% per session of a conventional list to an unexpected 90%, and eliminating all possible patient delays on the day. Dr Ahmad - working with his colleague Dr Kariem El-Boghdadly - confesses that the success of the HIT lists has exceeded his expectations. The one-day Saturday events at three sites across the Guy's and St Thomas' trust, have consistently delivered four times the number of operations normally expected using conventional 'one-surgeon one list' methods. No short-term or long-term complications have been observed and there were only two on-day cancellations across eight speciality areas (including gastrointestinal, gynaecology, orthopaedics, and ear nose and throat). The HIT lists are always scheduled for a Saturday, in order not to put pressure on the routine working of the Trust, and have used only volunteer surgeons, working to the following model: Clinician led. Two theatres with one surgeon and three surgical teams. Single centre environment, eliminating potential delays such as porters. 50% more theatre staff than two conventional lists. Specially-selected low-risk patients. Best results with operations lasting 30-45 minutes. Single speciality list. Intense list planning for maximum efficiency. Several pre-op meetings with patients to inform them, gain consent, eliminate risk factors, and arrange post-operative medication. Lists always finish at least 1 hour (sometimes 3 hours) before the end of the shift.

The Quality Improvement Programme (QIP) for Surgical Site Infections (SSIs) has been developed to enable healthcare teams and hospitals to carry out their own quality improvement projects to prevent SSIs. The QIP was developed as an output of an advisory board convened by Mölnlycke, which focused on developing a resource to aid healthcare professionals to deliver successful infection prevention programmes in their organisations. This meeting was attended by representatives from the surgical community, infection prevention leads in the NHS, and patient safety advocates. The QIP showcases best practice in preventing SSIs across the patient pathway, and provides a step-bystep guide to how hospitals can implement a similar programme. It also provides links to useful tools for healthcare professionals, such as Excel document templates, to help measure improvement processes. The QIP helps healthcare professionals to: Use tools to understand prevalence of SSIs. Consider what aspects of care, process, culture or behaviour may be contributing to the prevalence of SSIs. Identify which aspects to focus on first to realise the greatest chance of improvement. Identify the improvement tools that will best suit the individual project. Click on the link below to request the QIP document.

The Government’s response and action needed The Government’s response to the publication of the Inquiry’s report advised that they would look at these recommendations and report back ”in three to four months’ time”.[3] When doing this it is vital that these recommendations are considered holistically as part of the wider change that is needed, where patient safety is treated as a strategic purpose of healthcare. Patient safety is currently treated as one of many priorities to be weighed against each other. We think it is wrong that safety is negotiable. Patient safety must be core to the purpose of healthcare, reflected in everything that it does. We look forward to the Government’s response to the Inquiry recommendations. This must include action for change, including: Culture change Creating a culture in healthcare where staff feel safe and secure in reporting patient safety concerns, knowing their concerns will be actively welcomed, listened to and acted upon. Healthcare organisations should regularly and independently assess their organisational culture and have programmes of action to ensure a just and learning culture is in place. Staff reporting concerns An open and learning culture clearly signposting staff on how to raise concerns and that these concerns are acted upon. Harmed patients are supported Patients receive the support they need when things go wrong. ‘Harmed patient care pathways’ outline the provision of advice, guidance, practical and psychological support to patients and families. Learning from complaints All private patients have the right to mandatory independent resolution of their complaint. Patient safety applies to all, irrespective of whether care is provided for in the NHS or independent sector. #Share4Safety Organisations develop systems and measurements to improve patient safety, collecting data on patient safety and sharing learning. We strongly support the recommendation made by the Inquiry that where a healthcare professional is suspended with a perceived risk to patient safety, these concerns should be communicated to other providers that they work for. Leading and owning patient safety A new model for leadership and governance for patient safety that operates in both the NHS and independent sector. There should be high standards and behaviours set for our leaders and they should be supported by specialist patient safety experts in executive and non-executive board roles. Organisations need clear and published goals for patient safety with board focus and effectively oversight on reducing patient harm. The healthcare system operates as one coordinated system with patient safety as a core purpose. If action isn’t taken, then the Paterson Inquiry will become yet another report of unsafe care where sympathetic noises are made but no real learning and change occurs. If Government and leaders say that ‘lessons have been learned’ then they need to tell us what those lessons are, what actions they are taking, and publish updated reports on their progress and share these publicly. Without having these measures in place, how can the public and patients be assured that there won’t be future reports of unsafe care? As the Inquiry Chair said, “it is wishful thinking that this could not happen again”. References The Guardian. Ian Paterson inquiry: more than 1,000 patients had needless operations. 4 February 2020. The Right Reverend Graham Jones. Report of the Independent Inquiry into the Issues raised by Paterson, February 2020. House of Commons Debate, Paterson Inquiry, 4 February 2020, Volume 671.

This report is not simply a story about a rogue surgeon. It would be tragic enough if that was the case, given the thousands of people whom Ian Paterson treated. But it is far worse. It is the story of a healthcare system which proved itself dysfunctional at almost every level when it came to keeping patients safe, and where those who were the victims of Paterson’s malpractice were let down time and time again. This video report was streamed live on ITV News on 4th February 2020.

Recommendations from the report There should be a single repository of the whole practice of consultants across England, setting out their practising privileges and other critical consultant performance data, for example, how many times a consultant has performed a particular procedure and how recently. This should be accessible and understandable to the public. It should be mandated for use by managers and healthcare professionals in both the NHS and independent sector It should be standard practice that consultants in both the NHS and the independent sector should write to patients, outlining their condition and treatment, in simple language, and copy this letter to the patient’s GP, rather than writing to the GP and sending a copy to the patient. Differences between how the care of patients in the independent sector is organised and the care of patients in the NHS is organised, should be explained clearly to patients who choose to be treated privately, or whose treatment is provided in the independent sector but funded by the NHS. This should include 219 Recommendations clarification of how consultants are engaged at the private hospital, including the use of practising privileges and indemnity, and the arrangements for emergency provision and intensive care. There should be a short period introduced into the process of patients giving consent for surgical procedures, to allow them time to reflect on their diagnosis and treatment options. We recommend that the GMC monitors this as part of ‘Good Medical Practice’ The CQC, as a matter of urgency, should assure itself that all hospital providers are complying effectively with up-to-date national guidance on MDT meetings, including in breast cancer care, and that patients are not at risk of harm due to non-compliance in this area. Information about the means to escalate a complaint to an independent body is communicated more effectively in both the NHS and independent sector. All private patients should have the right to mandatory independent resolution of their complaint. The University Hospitals Birmingham NHS Foundation Trust board should check that all patients of Paterson have been recalled, and to communicate with any who have not been seen. We recommend that Spire should check that all patients of Paterson have been recalled, and to communicate with any who have not been seen, and that they should check that they have been given an ongoing treatment plan in the same way that has been provided for patients in the NHS. A national framework or protocol, with guidance, is developed about how recall of patients should be managed and communicated. This framework or protocol should specify that the process is centred around the patient’s needs, provide advice on how recall decisions are made, and advise what resource is required and how this might be provided. This should apply to both the independent sector and the NHS. The Government should, as a matter of urgency, reform the current regulation of indemnity products for healthcare professionals, in light of the serious shortcomings identified by the Inquiry, and introduce a nationwide safety net to ensure patients are not disadvantaged. The Government should ensure that the current system of regulation and the collaboration of the regulators serves patient safety as the top priority, given the ineffectiveness of the system identified in this Inquiry. If, when a hospital investigates a healthcare professional’s behaviour, including the use of an HR process, any perceived risk to patient safety should result in the suspension of that healthcare professional. If the healthcare professional also works at another provider, any concerns about them should be communicated to that provider. The Government addresses, as a matter of urgency, this gap in responsibility and liability.

In this article, Glynns Solicitors gives advice on what to do if you have suffered a diathermy burn during surgery.

The AANA has provided a set of resources, including videos, posters, tools and news items, to increase knowledge about and take steps to mitigate the risk of surgical fires.