PATIENT SAFETY
length body and we won’t be in the future; that much is certain.
“We have to look at a business model where we are making income ourselves, which we think will take us a year. We then need to design the form that will fill that function.”
Part of NCAS’s existing function has been reforming the way medical suspen- sions and exclusions are handled, which Professor Scotland is particularly inter- ested in.
He said: “There’s a bit of ancient history in all this, and a bit of personal history. I first became very closely associated with the whole field of difficulty in practice be- cause of the interest I had in suspension and whether it was being done correctly.
“Suspension, in those days, covered eve- rything. Now, we use two different words, suspension and exclusion, to separate the question of suspension in employment from suspension of a general practitioner from the provision of service.
“Years ago, there was a lot of interest, po- litical and public and professional, in what was described as the ‘scandal’ of long-term suspension. The worst case ever was a paediatrician in east London who was sus- pended for 11 years on full pay; that’s a half a consultant post.
“That case came to a close in the late 1980s, early 1990s, but in terms of the individual tragedy, whether or not the original alle- gations were true, it would be impossible to do anything with it. The reality was that was a terrible use of public money. You might argue that it doesn’t achieve public protection either.
“What NCAS was brought in to do was to settle the question about concerns regard- ing practice, but also to put an end to un- fair suspension or exclusion.”
NCAS is forced to estimate the number of suspensions and exclusions in the years before it existed, using professional bod- ies’ data, as it was not rigorously recorded. Professor Scotland said: “A reasonably ac- curate estimate of the reduction over the first few years after we became involved was 80%. The total length of suspensions dropped by a third. Evidence now shows that there’s been a slight upturn in the ab- solute numbers, but the average length has stayed down.
“The one figure that still troubles us is that, pro rata, more GPs are excluded than doc-
tors in employment in hospitals and so on.
“There’s an awful lot that bears on that and in certain circumstances the suspension is enforced on an organisation. For example, the police may be conducting an investiga- tion, or the regulator, or the GMC or GDC may have imposed some restrictions on someone’s practice which will force them into a suspension situation.
“There may be a process being followed where it would be quite inappropriate for that person to be working until the regula- tory process is settled. The employer has no control over the length of time that someone remains suspended or excluded in that situation.
“There will be situations where you need to separate someone from their duties in order to achieve something else. Now, it’s conventional to say that suspension is a ‘neutral act’ – but it does not feel like that to anyone in that situation.
“Its purpose is to create a ‘safe space’ for something else to happen, whether it’s an investigation there is little chance a person can influence, whether it’s because there’s a worry about patient safety, or so on.
“You cannot outlaw suspension. But our belief is that now there’s a greater degree of understanding of when and how and for how long it is reasonable to use suspen- sion.”
Before NCAS existed, around 500 doctors in employment tended to be excluded at any one time. Since NCAS got involved however, the figure dropped to around 50, before a slight upturn in recent years.
Professor Scotland said: “The National Audit Office estimated our contribution to that reduction was saving the NHS more than £10m a year – that one element of what we do alone – which is about 1.5 times our operating cost.”
That is a big indication of the value of the organisation, he said.
“We’re very proud of the work we do. We’ve ploughed quite a challenging furrow, in being independent of practitioner and em- ployer. In moving to self-funding, we have to keep the freedom to say uncomfortable things; things the employer or practitioner may not want to know. But then, you pay an accountant to do the same thing!
“We’ve had thousands of cases and I can only think of one assessment report where
we had no recommendations for the or- ganisation to change, and I can only think of one where there were no recommenda- tions for a practitioner. There are always recommendations for both.
“That sounds challenging and it is chal- lenging. But it gives them the ability to say they sought the help of the appropriate au- thority in the field, which is entwined with our ‘brand image’ – the independence, challenge and thoroughness. The down- side is that we take a long time on the most complex cases, which can be quite expen- sive if they’re going to be defensible.
“If we’re putting someone’s career on the line, and putting ourselves on the line be- cause patient safety is at stake, then it has to be defensible.
“We are an international brand leader in this field – the global gold standard of how this should be done in a health system. Our challenge is how we move to self-funding, while retaining that NHS brand image.”
The organisation has around 80 staff and costs around £7-9m a year as part of the NPSA.
Professor Scotland concluded: “If you think about the three professions we look after – medicine, dentistry, pharmacy – that’s where, if something goes wrong, it hits the press big time. The public’s image of the NHS is intimately tied up with those professions. They are ‘high impact’ – low volume, high cost, in management-speak.
“Since all the scandals in the press in pre- vious decades, the agenda has completely moved on, during our time, and it’s about failing systems, not about failing practi- tioners.
“If we cease to exist I suspect the tension on the elastic would relax, and we’d hear a twang!”
So does he remain confident about the fu- ture?
“I was recruited to set NCAS up from a standing start with nothing there before- hand. No-one, any- where in the world, had done this.
“We’ve done it before, and we’ll do it again.”
Alistair Scotland
FOR MORE INFORMATION Visit
www.ncas.npsa.nhs.uk
national health executive Mar/Apr 11 | 51
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