Regulate or risk too many 'never' events happening

The NHS remains susceptible to failings in care and errors that put patients at risk.

Many of these, while serious, thankfully do not result in long term harm. Some affect patients’ recovery and quality of life. And some are grievous and should never happen – the so called “never” events.

Any failing in standards should be regarded as unacceptable. But if there is even the remotest sliver of comfort when a never event occurs, it is that lessons can be learned so the incident cannot – or at least should not – happen again.

That’s the theory. The reality, however, is that the NHS is even more susceptible to egregious failures than we might wish to admit.

‘The NHS is even more susceptible to egregious failures than we might wish to admit’

This is because it remains possible for serious failings to go unreported and unaddressed, particularly when those responsible fall outside the scope of professional bodies such as the General Medical Council.

Clinical physiologists are such a group – thousands of specialist practitioners who, despite their training and nature of their work, remain unregulated and therefore subjected to minimal professional scrutiny.

Their work informs that of doctors and nurses. They are the professionals who adjust pacemakers, and who perform endoscopies, diagnose hearing loss and perform other invasive procedures and investigations.

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Lack of power

You would, and should, expect that a professional adjusting your pacemaker would be regulated and subject not only to rigorous professional standards, but also checks to ensure their fitness to practice. Dream on.

These professionals are subject to no more than voluntary registration. That means they do not undertake fitness to practice assessments and fall outside the previous government’s “duty of candour”.

Errors and mistakes are difficult to identify, while the voluntary register – the Registration Council for Clinical Physiologists (RCCP) in this instance – lacks the power to penalise, censure or strike off incompetent practitioners.

It should consequently come as no surprise that, despite the vast majority of these professionals working to the highest standards, there have been examples of never events involving clinical physiologists and other unregulated practitioners.

‘An absence of statutory regulation makes it difficult for incompetent practitioners to be struck off’

Examples of these were recently collated and published by the RCCP as a demonstration of the seriousness of the situation. They included instances in which patients had been caused harm, and in some cases lost their lives. In the most horrifying example, a child died because her pacemaker stopped working. The practitioner responsible for its maintenance had forgotten to schedule an appointment to change the battery.

These examples are no less shocking than many of the never events that appear in the news. The difference is that an absence of statutory regulation not only makes it difficult for incompetent practitioners to be struck off, it makes it easy for them to find alternative employment oblivious to the devastation left in their wake.

This is compounded by numerous NHS trusts, according to freedom of information requests, failing to have either specific policies for the employment of voluntarily registered professionals or fitness to practice requirements.

The coalition took steps to improve patient safety and quality of care in the aftermath of scandals such as Mid Staffordshire. And the new government has not only the opportunity, but responsibility, to take this agenda forward and ensure the protection of patients.

Flawed system

Despite its efforts to improve safety, the coalition clung to a policy of assured voluntary regulation when it came to unregulated professionals. Quite simply, it didn’t want more regulation.

And this policy has been proven to be fatally flawed. Examples such as those in the RCCP’s report, The Other Never Events, and evidence from NHS trusts on their employment policies have demonstrated that if voluntary registration is supposed to be a safety net for patients, it is one riddled with holes.

‘It would not be bureaucracy for its own sake’

So, how can the new government help prevent never events in the future?

Quite simply, it has to plug the gaps in professional oversight that exist throughout the NHS. It has to let go of an outdated and unfit for purpose concept that regulation is bad, and accept that in some cases – where practitioners’ work presents a risk to patients – regulation is not good, but sorely needed.

It would not be bureaucracy for its own sake. Nor would it be a costly and laborious exercise.

Rather it would be a realisation of the flaws in the current system accompanied by action to bring the likes of clinical physiologists under the auspices of the Health and Care Professions Council, which has recommended statutory regulation twice in the past 11 years.

If that happens, the government has taken an important and responsible step to protecting patients.

If it doesn’t, it will risk failing its duty to those in need of the NHS. And never events will remain far more possible than they should be.

Amanda Casey is the chair of the Registration Council for Clinical Physiologists