Annex A > Chapter 8 - Management and Culture of the UBH and the UBHT > The development of the clinical directorate structure > Pathways for expressing concerns
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Pathways for expressing concerns
239 After the UBHT was established, there were in general terms two separate pathways which could be taken by those members of staff seeking to raise concerns about any aspect of the delivery of healthcare in the Trust: the professional advisory route, leading to the Chairman of the HMC and the `three wise men' [279] on the one hand; and the management route through the clinical directors ending, ultimately, with the Chief Executive on the other. [280]
240 Dr Roylance was questioned about this in the course of his evidence:
`Q. Would you have expected a member of hospital staff, whether medical or non-medical, to have had other means of raising concerns about unacceptable practice before getting to the stage of going to the three wise men or one of them?
`A. There was a whole mosaic of routes that were available and were used and it is difficult to answer specifically unless I really hypothesise a situation ... It would be very likely to be through their district professional adviser, and then to Margaret Maisey or me.' [281]
241 There was no formalised system governing with whom a particular concern or complaint should be raised. In Dr Roylance's view, such a system would have:
`... constrained and restricted the opportunities of staff to choose an appropriate route to resolve a situation.' [282]
242 The evidence as to the raising of concerns about paediatric cardiac services in Bristol, and the possible alternative routes which were or could have been followed in raising such concerns, is dealt with fully from Chapter 20 - Concerns: Foreword, 1984 and 1985.
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Footnotes
[279] A Health Circular issued in July 1982 (HC(82)13) had required all DHAs to introduce procedures to prevent harm to patients resulting from the physical or mental disability of medical staff employed by them. Dr Roylance explained to the Inquiry that in practical terms this included incidences of suspected incompetence of staff (see T25 p.6). The Circular recommended that the HMC of each DHA set up a panel of members, the Special Professional Panel, from the senior medical staff. From this panel a small sub-committee would then be appointed to receive and take action on any report of incapacity. In Bristol, the panel comprised the Chairman elect, the Chairman and the past Chairman of the Medical Committee, and they became known as the `three wise men' (see T25 p.6-7)