Acting on concerns Ralph Tomlinson Head of Invited Reviews

Background Highly important subject Difficult and sensitive area – often not managed well – easier to talk about than take action on Focus of significant current attention But not new Changed expectations – public, patients, healthcare profession 2

Prevention is better than cure Value of “anticipatory” clinical governance Importance of team working between consultant surgeons Normalise discussion of individual and group performance – make it routine in your team Use existing mechanisms well – audit, MDT, M and M Clinical leadership – lead a service you would like to be treated in 3

Resources Acting on concerns – your professional responsibility Improving surgical practice – learning from invited reviews RCS invited review team office

RCS “Acting on concerns” guidance Three sections 1.“How to avoid becoming a whistleblower” - proactive steps you can take to create a safe culture in your surgical service 2.Raising concerns in your workplace and supporting others to do the same 3. Supporting others with concerns to raise them – including the support/resources How organised 1.Quick summary for those in a hurry 2.Key issues 3.What good practice looks like 5

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Points to consider when discussing quality Aspects of performance – clinical, behavioural, health, individual/team Distinguishing between concerns about care and organisational grievance/grudge Risks of informal networks / “corridor conversations” Risks of the psychology of everyday practice 7

Acting on your own concerns If you are concerned about safety you have professional responsibility to act When acting take time to plan your approach - careful, and considered – but commit to seeing the situation through Review and organise the evidence you have – and what else might be needed Follow clear process and work through logical sequence of steps Ensure that what you do is carefully and appropriately documented Access advice and support where necessary 8

Steps for raising concerns First step Use routine organisational frameworks and local policies, procedures and resources – enable those responsible to address issues raised Second step If concerns not addressed and there continue to be concerned about safety - escalate concerns internally and/or externally by referring to regulators Final step Consider your other options - including bringing your concerns to attention of a wider public audience Remember - value of seeking advice at each stage and that resources are available 9

Helping others to raise concerns Detailed advice in part three of document – page 36 onwards Senior member of surgical community Support others to raise their own concerns but without them considering they have discharged their responsibilities to you Use role to help others to assure safety and develop their own skills 10

In practice – general introductory points Clarify role(s) of individual raising concerns and in what capacity they are raising concerns. Confirm own role(s) – personal and Royal College of Surgeons/other - and in what capacity you are acting. Agree basis on which conversation being held and individual’s expectations. Provide advice on the limits to this - for example where there is a wider responsibility to patient care. Note both the individual’s duties and your duties as a surgeon and as a registered doctor. Acknowledge that this might sometimes mean you give a view about the steps that should be taken that the individual raising concerns might not want to hear. Recognise that raising concerns can be a difficult process both in terms of the specific circumstances involved and for the individual raising concerns. 11

In practice – discussion of specific concerns Clarify specific concerns that are being raised by the individual. Clarify the steps taken by individual to date to have concerns addressed. Confirm: Has individual raised concerns with Trust / employer / the body with overall clinical governance responsibility? Has individual raising concerns received a response from their Trust / employer? Identify precisely the current position in relation to the individual’s concerns. Determine explicitly – does the individual concerned consider there to be a “live” issue putting patient safety at risk? If yes, determine explicitly what specific steps has the individual concerned has taken or will be taking to ensure that their concerns are addressed? Have these been acted on? Is this process documented? Are any other bodies involved in the situation? (GMC, CQC, NCAS, etc). Should they be? Agree with the individual the next steps they will be taking. Agree that you will document conversation and the next steps agreed. 12

Further information