White Paper: Services Fit for the Future

Transcription

1 White Paper: Services Fit for the Future Consultation response form Your name: Katie Laugharne / Huw Anslow Organisation (if applicable): General Medical Council Katie.laugharne@gmc-uk.org / huw.anslow@gmc-uk.org Your address: General Medical Council Cyngor Meddygol Cyffredinol 4 th Floor 4 ydd Lawr Caspian Point 2, Caspian Way Pwynt Caspian 2, Ffordd Caspian Cardiff Bay Bae Caerdydd CF10 4DQ Responses should be returned by 29/09/17 to: Healthcare Quality Division Welsh Government Cathays Park Cardiff CF10 3NQ. or completed electronically and sent to: HQDMailbox@wales.gsi.gov.uk Responses to consultations are likely to be made public, on the internet or in a report. If you would prefer your response to remain anonymous, please tick here:

2 GMC Response to the Consultation on the White Paper Services Fit for the Future Thank you for the opportunity to respond to the Welsh Government White Paper. Before providing comments on the White Paper, we thought it might be helpful to reiterate the role of the GMC. We have an office in Wales and have done so since We are an independent organisation that helps to protect patients and improve medical education and practice across the UK. We decide which doctors are qualified to work here and we oversee UK medical education and training. We set the standards that doctors need to follow, and make sure that they continue to meet these standards throughout their careers. We take action when we believe a doctor may be putting the safety of patients, or the public s confidence in doctors, at risk. Every patient should receive a high standard of care. Our role is to help achieve that by working closely with doctors, their employers and patients, to make sure that the trust patients have in their doctors is fully justified. We are independent of government and the medical profession and accountable to Parliament. Our powers are given to us by Parliament through the Medical Act Whilst many of the questions fall outside of our role and remit, we have endeavoured to provide information where appropriate.

3 Summary of questions Chapter 1: Effective Governance 1.1. Board Membership and Composition The Welsh Government believes that the Boards of both health boards and NHS trusts should share some core key principles which are outlined including delivering in partnership to deliver person centred care and a strong governance framework to enable the Board to work effectively and meet its responsibilities. All Boards should have Vice Chairs in order to support focussed and skilled leadership. The Welsh Government also believes that Ministers should have the authority to appoint additional Board members on time limited appointments if an NHS Health Board/Trust is under performing or under escalation procedures in accordance with the NHS Wales Escalation and Intervention arrangements. The Welsh Government believes that Board Executive Officer membership for local health boards should probably include some key positions which are consistent across local health boards but also allow some flexibility to appoint based on remit and priorities. Do you agree with these proposals? What further issues would you want us to take into account in firming up these proposals? We recognise the desire to enable and encourage more effective governance of NHS organisations, and welcome the inclusion of a range of core principles committing to a culture of openness, quality improvement, and co-production. We would seek assurances that our core functions, carried out by organisations on our behalf, are not affected by any changes to health board governance. This includes health boards providing, and assuring the quality of, training places Board Secretary

4 In order to deliver on the key principles outlined the Welsh Government believes that the role of Board Secretary should be placed on a statutory basis and have statutory protection to allow the role to be independent with safeguards in place to challenge the Chief Executive of an NHS organisation or the Board more widely. Do you agree with these proposals? What further issues would you want us to take into account in firming up these proposals? Chapter 2: Duties to Promote Cultural Change 2.1. Duty of Quality for the Population of Wales The Welsh Government believes that the duty of quality should be updated and enhanced to better reflect our integrated system. This duty should be sufficiently wide in scope to facilitate the needs of the population of Wales to facilitate and enable collaborative, regional and all-wales solutions to service design and delivery NHS bodies should also be placed under a reciprocal duty with local authorities to co-operate and work in partnership to improve the quality of services provided. Welsh Government also believes that strengthening the existing planning duty will make sure health boards work together on the needs of the population of Wales in the planning and delivery of quality healthcare services. Do you agree with these proposals? What further issues would you want us to take into account in firming up these proposals? The GMC welcomes the ambition to achieve a systematic approach towards quality improvement within the health service. Quality improvement is part of doctor s responsibilities, as made clear in our core guidance stating both that doctors must regularly take part in activities that maintain and develop your competence and performance, and that they must take steps to monitor and improve the quality of your work. Regular engagement in quality improvement activities is a requirement of our Supporting Information for Appraisal and Revalidation. The responsibility to maintain and improve quality is a prerequisite to meeting the White Paper s ambition to establish a person-centred health service. As part of this,

5 we welcome the specific proposal for a Duty of Quality to reinforce existing commitments to delivering high quality care. The GMC s National Training Survey (NTS) is an important tool allowing NHS organisations to identify firstly areas of good practice, as well as those areas of concern in terms of quality of training, which are addressed through our comprehensive quality management framework. This could be a useful indicator of particular areas where a duty of quality would be most useful in engendering improvements to particular services. This would also support our aspiration to be more proactive as a regulator to ensure that doctors are supported to comply with GMC guidance and standards. Regarding the implications of the proposed duty on cross-border working between health boards, we welcome the opportunities this represents in terms of the management of training and the provision of training places. The GMC is committed to ensuring that such opportunities to improve education and training are valued and built on, evident in the focus on the importance of these within organisational culture in our guidance Promoting excellence: standards for medical education and training Duty of Candour The Welsh Government believes that the development of a statutory duty of candour across health and social services in Wales would consolidate existing duties and be in the interests of a person centred system. Do you support this proposal? What further issues would you want us to take into account in firming up this proposal? The GMC welcomes the intention to strengthen the legal duty of candour, and aligning with both England and Scotland on this. We have taken an active role in encouraging doctors to embed honesty within their practice and relationships with patients. GMC guidance makes clear the importance for doctors to be transparent in their communications with patients, and their responsibility to raise concerns where patient care may be compromised. We would anticipate that a legal duty of candour would be in line with our core guidance Good Medical Practice, which stresses the requirement for doctors to be

6 open and honest with patients if things go wrong, and that they must be honest and trustworthy in all of your communication with patients and colleagues. Furthermore, GMC guidance Raising and acting on concerns about patient safety states that All doctors have a duty to raise concerns where they believe that patient safety or care is being compromised by the practice of colleagues or the systems, policies and procedures in the organisations in which they work. Openness is an important part of delivering on the White Paper s objective of a person-centred health service. This was recognised by the Francis Inquiry report, which recommended introducing a statutory duty of candour in order to strengthen both transparency within the health service, and patient safety. As part of our response to this report, the GMC issued joint guidance with the NMC Openness and honesty when things go wrong: the professional duty of candour. This stressed that, in the event where something has gone wrong with a patients care, healthcare professionals are required to tell the patient when this has happened, offer an apology, provide an appropriate remedy or support if this is possible, and explain fully to the patient both the short and long term effects as a result of what has happened. We would seek assurances that a statutory duty of candour would not conflict with this professional duty of candour. Additionally, we would seek an assurance that training and support would be provided for staff involved in the process of implementing and maintaining the duty. Introducing a legal duty of candour would support existing GMC guidance to strengthen both patient safety and transparency within the health service. It would also help to engender moves towards a culture of quality improvement within the sector. Chapter 3: Person-Centred Health and Care 3.1. Setting and Meeting Common Standards The Welsh Government believes there should be a common set of high level standards applied to health and social care and that the standards should apply regardless of the location of care. Do you support this proposal?

7 What further issues would you want us to take into account in firming up this proposal? As described previously, it is absolutely fundamental to the GMC that every patient should receive a high standard of care. Our role is to help achieve that by working closely with doctors, their employers and patients, to make sure that the trust patients have in their doctors is fully justified. We do this by setting standards and providing guidance for all doctors regardless of their location or role. We would welcome seeing this enhanced with consistent standards across health and social care provided they align with our existing guidance Joint Investigation of Health and Social Care Complaints The Welsh Government believes that requiring different organisations to work together to investigate complaints will make it easier for people to complain when their complaint is about both health and social services. We also believe it will encourage organisations to learn lessons to improve their services. Do you support this proposal? What further issues would you want us to take into account in firming up this proposal? The GMC recognises the benefits this would bring, simplifying the complaints process for patients in relevant cases, while also improving the ability of health and social care organisations to learn lessons when things go wrong with an individual s care. The GMC recognises the importance of learning lessons from such situations, with our core guidance stating that doctors must be open and honest with patients if things go wrong. Additionally, What to expect from your doctor: a guide for patients states that doctors have to report when things go wrong for patients so lessons can be learned. The White Paper includes the proposal for health and social care organisations and independent providers of health and social care to collaborate on an agreed joint complaints process. We would seek assurances that this collaborative effort will be completed within an agreed timescale, so as to ensure that doctors and patients are

8 able to enjoy the benefits this process would bring in a timely manner. Chapter 4: Effective Citizen Voice, Co-production and Clear Inspection 4.1. Representing the Citizen in Health and Social Care The Welsh Government believes that local health and social care organisations should be working with the public to co-design and co-create services and that the way they do this needs to be independently monitored. We propose replacing the current statutory CHCs and their functions with a new national arrangement to represent the citizen voice in health and social care, to advise and provide independent assurance. The new body will work alongside Healthcare Inspectorate Wales and Care and Social Services Inspectorate Wales and have autonomy to decide how it will operate at local level. Do you support this proposal? Can you see any practical difficulties with these suggestions? The GMC welcomes the aspiration to make the platform for patient views in healthcare more visible. The move towards a national body is also in keeping with the aim to encourage greater cross-border working, a necessary move in light of financial and workforce pressures facing health boards. This also reflects the reality of health boards needing to collaborate to address patient needs where particular health boards do not have adequate capacity to provide certain treatments. The principle of collaboration within the health service is recognised as part of a doctor s responsibility on our core guidance Good Medical Practice, stating that doctors must work collaboratively with colleagues, respecting their skills and contributions. The White Paper s assertion that this proposal would improve the issue of visibility of the patient voice is welcomed. Ensuring the public is aware that their concerns and experiences are consistently included in scrutiny of the health service is integral to achieving the White Paper s ambition of a person-centred service. The GMC recognises the importance of ensuring patient views are aired and responded to, with our core guidance stating that doctors must listen to patients,

9 take account of their views, and respond honestly to their questions. Additionally regular patient feedback on the services individual doctors provide is a requirement of our Supporting Information for Appraisal and Revalidation reflecting the importance we place on the views of patients. The GMC would want to be assured that, as well as fulfilling a representative role, any new patient voice body ensures that the citizen voice is heard and that this is at an individual and local level as well as regional and local. We seek assurances that the arrangements for the proposed body would not weaken the patient voice as it currently stands within the health and social care sectors. We would like to see examples of good practice of CHCs and others already being involved in the planning and review of services being recognised and built upon Co-producing Plans and Services with Citizens The Welsh Government believes that introducing an independent mechanism to provide clinical advice on substantial service change decisions, with advice from the proposed new citizen voice body, will encourage continuous engagement and increase the pace of strategic change through enabling a more evidence-based, transparent process and a more directive and guiding role on the part of Welsh Government. Do you agree with this proposal? What further issues would you want us to take into account in firming up this proposal? The GMC welcomes the White Paper s support for ensuring patient views and experiences are consistently included and influential on the design and creation of health services. Alongside an explicit statement that patients must be treated as individuals, our core guidance states that doctors must listen to patients, take account of their views, and respond honestly to their questions and that they must work in partnership with patients, sharing with them the information they will need to make decisions about their care. The White Paper notes that one of the first steps that the Welsh Government will take is to revise existing guidance to illustrate what effective engagement based on co-production principles looks like and to provide greater clarity on what is meant by substantial service change.

10 We welcome the White Paper making clear that any proposals for service change need to be based on clinical evidence to provide the right health outcomes for patients. We would want assurances that what is understood as substantial service change is not just an arbitrary categorisation determined on a financial basis, but also in terms of the impact it has on the ability of doctors to act as professionals and maintain GMC standards. Crucially, as the White Paper proposals are designed to strengthen a person-centred health and social care sector, substantial service change should also be understood in terms of the impact on patient care Inspection and Regulation and single body The Welsh Government believes that ensuring a clearer underpinning legislative framework for HIW will help to foster closer integration and joint working with CSSIW and at the very least this should be taken forward. What do you think of this proposal? The GMC welcomes the White Paper s aim to clarify responsibility for the inspection process in regards to the duplication of these functions by CHCs. Addressing this would provide patients with greater assurances over when premises have been effectively inspected. Are there any specific issues you would want us to take into account in developing these proposals further? The GMC has a strong working relationship with HIW through various agreements. The GMC and HIW are joint members of the Wales Concordat, and have in place a Memorandum of Understanding, as well as an Information Sharing Agreement. This Agreement is currently being updated to allow the live sharing of data from the GMC to HIW. The GMC s aim is for this relationship to be maintained throughout any legislative changes being made to the working arrangements of HIW. We would seek assurances that the boundaries of both HIW s and the GMC s remit, as a system regulator and a professional regulator respectively, are recognised. This would ensure a continuation in the clear separation of functions between HIW and the GMC. We recognise the benefits of a closer working relationship between HIW and CSSIW, providing a consistent approach to inspection of services which overlap between the health and social care sector. We would seek greater detail regarding how complaints and concerns would be managed, and how these processes would

11 interface with our role as a regulator. However we also believe there could be merit in considering a new body for example, a Welsh Government Sponsored Body to provide more independence in regulation and inspection and citizen voice. Would you support such an idea? What issues should we take into account if this idea were to be developed further? Multi-disciplinary team working is an existing reality within the health service, and is anticipated to become much more widespread in the future. Taking this into account, we would want to see the new arrangements be future proofed to facilitate the need for closer working between professional regulators, particularly if there is regulatory reform in the future. I hope that this submission is helpful to you and your colleagues. If you require any further information please contact Huw Anslow GMC Welsh Policy and External Affairs Officer on huw.anslow@gmc-uk.org or