Final Report > Chapter 14: External Assessment and Monitoring of the Quality of Care in Bristol > Assuring and monitoring the competence of healthcare professionals

Assuring and monitoring the competence of healthcare professionals

23 The issue here is whether there were mechanisms in place at the relevant time to provide any assurance as to the competence of healthcare professionals, and thus as to the adequacy of the care provided.

24 As regards hospital consultants, once specialist training was completed, there was no system for ensuring that they remained competent. Once qualified, the prevailing view was that it was up to them to maintain their competence. They did not answer to anyone, save in exceptional circumstances such as to involve the GMC or the employing health authority or trust. The hospital consultant effectively had a job for life. For the employer, the process of responding to issues of alleged incompetence was, and until very recently remained, very time-consuming and complex. The adequacy of the care provided to patients could not, in other words, be effectively addressed through regulatory or employment mechanisms. It is out of this state of affairs and a series of much-publicised examples of incompetence and bad professional behaviour, [24] that the current pressure for appraisal and revalidation has grown. In the thinking of today, therefore, the mechanisms in existence in 1984-1995 were less than adequate. In the thinking of the time, they were taken for granted and barely changed over the period in question.

25 As regards nurses, once qualified they were subject to a system of quality assurance, in that they were required to go through a regular, if not particularly rigorous, process of re-registration. Further, both the employer and their professional body (the United Kingdom Central Council (UKCC), now the Nursing and Midwifery Council (NMC)) have always had considerable authority to respond to issues arising from poor performance by nurses. [25] Mechanisms of quality assurance were, therefore, in place. The difficulty throughout the period of our Terms of Reference (and until today) was that shortages in trained nurses meant that employers routinely required nurses to undertake responsibilities for which they had not been fully trained. The problem in relation to the adequacy of care received by patients was not, therefore, one of assuring and monitoring competence, but of employers cutting corners, for wholly understandable reasons.

26 As regards managers, no systems existed (or exist even now) stipulating the criteria which a senior manager must satisfy so as to be appointed to and remain in office. Thus, insofar as senior managers contributed to the healthcare of patients in Bristol (and their contribution was significant), the absence of any such systems undoubtedly gave rise to the risk that the adequacy of care provided could be compromised.

Footnotes

[24] See, for example, J Ritchie, 2000; `The Report of the Inquiry into Quality and Practice Within The National Health Service Arising from the Actions of Rodney Ledward'

[25] Indeed, we heard evidence that these powers were sometimes used in a draconian manner. T34 p.114 Mrs Jenkins and T27 p.91-2 Mrs Ferris