An outline of the FIPO meeting at the RSM in association with the Forum on Quality in Healthcare- 20th June 2006
This meeting was set up jointly between the Forum on Quality in Healthcare Section of the Royal Society of Medicine and FIPO to explore methods of improving professional quality and measuring patient outcomes in the independent healthcare sector based on NHS and other systems.
The first session was chaired by Dr. Gerard Panting formerly of the Medical Protection Society and now a consulting advisor to FIPO.
An overview from the independent sector was presented by Mr. Stephen Collier of General Healthcare who looked at the approach to clinical governance in the independent sector. He was reassuring about the general standards and gave an upbeat presentation of the current status of information technology throughout the sector noting that there was lack of uniformity in computer systems.
Mr. Jon Billings, Head of the Independent Healthcare Division of the Healthcare Commission discussed the ways in which the Commission was moving forward to analyse data in the independent sector and the NHS with a more risk based approach. There were new indicative indicators being developed for the sector, which would be out for general consultation.
Dr. Kamran Abassi from Dr. Foster Intelligence discussed the Dr. Foster approach to quality indicator measurements in the NHS and showed how generic data could be of value in the assessment of NHS hospitals. There was some question as to its applicability in the independent sector due to coding and computer differences and also in the types of data collection.
The second session was chaired by Mr. Dai Davies, Consultant Plastic Surgeon and FIPO Board Trustee.
The first presentation by Mr. David Rosin, Senior Vice President of the Royal College of Surgeons of England was an explanation of the new training requirements under MMC and PMETB. Mr. Rosin noted that the new training scheme coupled with reduction in the hours of duty under the European Working Time Directive would inevitably mean that future trainees would be less experienced at the end of their training than their predecessors and this would, therefore, lead to more team working and a narrower scope of practice. The implications for the independent sector and the ability of these doctors to undertake unsupervised full consultant practice were as yet unclear.
Professor Aidan Halligan, Director of Clinical Governance of the NHS discussed professional accountability within the NHS. He noted that there were common themes and similar underlying problems in different hospitals or specialties and there were methods by which these could be addressed locally. Behavioural problems could often be identified well in advance of clinical problems. This type of pre-emptive approach needed wider application in order to head of potential problems.
Dr Christine Tomkins, Deputy Chief Executive and Professional Standards Director of the Medical Defence Union discussed the rising number of complaints against doctors and noted specialty differences. Her net conclusion was that legal outcomes and complaints were not a clear indicator of consultant competence.
The third session was chaired by Professor Nick Bosanquet, Professor of Health Policy at Imperial College.
In the absence of Dr Hauser from the United States, Miss Rosemary Hittinger, Director of Clinical Governance of the HCA group discussed methods of measuring and benchmarking hospitals and illustrated this with a variety of examples from her hospital group. She demonstrated some clear cut outcomes such as the very low MRSA rates and the excellent survival in ITU cases. Others outcomes such as QUIP were non specific but allowed hospitals to compare their general performance with other institutions.
Professor A. M. Thompson, Professor of Surgical Oncology at the University of Dundee described the Scottish Audit of Surgical Mortality, which was now well established and involved an independent review of all surgical deaths in Scotland. This was a voluntary scheme with excellent compliance on behalf of consultants and it had shown improvements in general care as the scheme has evolved over the years. Problems, however, have arisen with the introduction of a media driven league table for consultants and this necessitated action by the CMO of Scotland to defend surgeons because these tables did not take account of case mix severity.
Mr Glazer, Chairman of FIPO summarised the conference and presented FIPO’s proposals to improve clinical standards in the independent sector. These involved both clinical audit functions and also professional issues relating to the MAC. FIPO had initiated and produced detailed guidelines for MAC Chairmen (with input from the GMC, Medical Defence organisations, Healthcare Commission and others) which would be the bedrock for local clinical governance. The development of FIPO CGAC (FIPO Clinical Governance Advisory Committee) was going ahead subject to suitable funding and would hopefully co-ordinate audits and outcomes in the independent sector.
A total of 5 CPD credits were awarded for the meeting and the feedback evaluation from the audience was good to excellent.