1. Choice, Risk and Safety in the PCT context Peter Mansell NPSA and Maria Dineen Consequence UK

2. Three questions How do we best harness choice to improve patient safety? What information is going to be most useful to inform safer choices? How can the NPSA complement the work of PCTs?

3. building a safer NHS for patients June 2001 establishment of National Patient Safety Agency governments response to An Organisation with a Memory new national system for learning from adverse events

4. Using choice to improve patient safety

5. Information for choice What are some of the ways of engaging patients and the public about a safer choices? Complaints RCAsPatient Surveys Patient ForumsThematic reviews

6. Aim: Choice between equally safe services; all services to be safe so that choice is on the basis of whats best for you and your family. Challenge: Currently, the NHS provides little or no information about quality that patients can use Kings Fund, 2003

7. What does choice mean in the context of patient safety for a PCT? It can mean… –Safer practice? improved access through being able to attend a Walk-In Centre. –New risks? choosing a generalist over a specialist surgeon because of a preferred location. More transition points between care providers.

8. Managing the new risks to patients from choice Involve patients in pre design work as well as traditional consultations. Risk assess: Pro-actively check whether new systems are safer; identify and quantify the risks. Learn lessons: patients already choose their optician and pharmacist. Electronic patient record.

9. Motivation to act Variation in quality exists and I may not get the best quality Failure to act will have a negative effect on health The harm that will result from failure to act: –is greater than any risk which is perceived to be associated with the action; –is greater than the burden of time and effort involved in taking action OPM/The Nuffield Trust Involving People in Public Disclosure of Clinical Data

10. Discussion How can we motivate people to be concerned about safety as an important element of choice without unduly undermining their confidence in the health care system?

11. What choice? Choice of time and place of service Choice of treatment Choice of provider What sort of information would be helpful to patients in making these choices?

12. Which is the safer organisation? Reported incidents per annum

13. Options for information for safer choices Comparative information on safety performance of healthcare organisations and services –how do we guard against unintended outcomes National patient safety goals/standards –can we assure a core level of safety Publishing data –what will be meaningful and not unduly erode trust? Other?

14. Supporting Choice What information about the safety of their services could PCTs provide? How might the NPSA help? Discussion