Vicarious

Creative Commons

Vicarious now that is an interesting word which is frequently followed by the word “liability”.  Is that just because we live in what in seems to be an ever increasing litigious environment?  Or is it because health and social care professionals continue to develop their knowledge and roles and responsibilities in relation to raising concerns?

There have been many significant reports following inquiries;  such as The Mid Staffordshire NHS Foundation Trust Public Inquiry, The Report of the Morecambe Bay Investigation and more recently The Gosport Independent Panel, which have reflected upon situations where patients and clients have not received a high standard of care.  Often the crux of what had gone wrong in the organisations, which were the subject of investigation, was a failure to ensure the protection of the very people the organisation existed to serve.  Students and practitioners are frequently encouraged to read and reflect on these reports as reminder of how not to care for patients and their families.  Several of such reports when reported in the media were accompanied by a phrase that went something like “these matters have been explored in great detail so that we might reflect and learn from what this situation has shown and so ensure that it will never be repeated in the future”. Sadly we all know that not to be true, otherwise there would be no need for any such further reports.

Many such reports have been influential in shaping the delivery of high quality care and improving the manner in which organisations manage situations which raise concerns. You might also argue that eventually there should be no need for disciplinary and fitness to practise processes and procedures within a health and social care environment if all health and social care practitioners consistently demonstrated the standards of conduct and behaviour that their various professional preparation programmes have carefully explained to them.   Whilst we still rely upon human beings for the delivery of health and social care there will always be the possibility of errors and mistakes.  In the wake of the Mid Staffordshire Inquiry Report 2013 chaired by Robert Francis, into the breakdown of client care, Professor Don Berwick, an international expert in patient safety, was asked in 2013 to advise about how to improve patient safety in the NHS. His report made a raft of recommendations including moving away from blaming an individual to looking to learn from errors. The report was subtitled “A promise to learn  – a commitment to act”. Individuals working within organisations such as the NHS should not fear raising concerns or speaking up when they make a mistakes or something goes wrong.  Merely dismissing or punishing people is insufficient if no attention is paid to helping people understand what happened in an open and transparent manner and apologising when things have gone wrong. The Freedom to Speak Up Report 2015 further emphasized the need to foster a culture of learning and safety in all organisations so staff feel safe when raising concerns. Organisations must cease to foster a blame culture which fuels fear and move to a culture “which celebrates openness and commitment to safety and improvement”. Several of these issues have been explored in previous posts within this blog such as Duty of Candour, Honesty, Integrity, Professional and Trustworthy.

There is a company in the United States of America called Vicarious which is concerned with developing artificial general intelligence for robots.  Human level intelligent robots may be a long way from completely replacing Health Care practitioners but they are certainly making a significant contribution to Health Care. Artificial intelligence permeates our lives. We travel in planes flown by auto pilots and driver less cars are becoming a reality on our streets.  There is conceivably a place for increasing artificial intelligence in the delivery of Healthcare but we should also possibly be cautious in giving vicarious authority to robots in place of human practitioners. You may be interested to view a video from the Chief Executive Officer of Vicarious talking about future data applications.

The NHS as the largest employer in the United Kingdom is the likely destination for the first post of the majority of neophyte practitioners. It is important to remember that the vast majority of professionals adhere to their professional Codes and are safe, competent and caring practitioners who consistently make a valuable contribution to ensuring the health, safety and well-being of patients, clients and service users. In so doing they also help to maintain the integrity of the NHS. The number of individuals who have their conduct and behaviour scrutinised by the regulators is tiny in comparison to the number of registered practitioners. The number of individuals who it is deemed necessary that they receive a sanction in order to protect the public is even smaller.

Professionally qualified staff within the NHS have the security of knowing that the NHS takes vicarious liability very seriously. The NHS accepts full financial responsibility where negligent harm has occurred as a result of the actions and omissions of its employees provided they were working within the sphere of their competence. All employees must exercise a duty of care and registered healthcare practitioners are accountable to their regulatory body for the standards of their practice and patient care. The Royal College of Nursing published their latest guidance on Accountability and delegation in September 2017.  It is a useful document to review, particularly for those for whom delegating tasks to others will be their experience in their new post rather than having tasks delegated to them as has been during their experience during their education.

The NMC (2015)

Appropriate Indemnity Insurance has been a legal requirement for all healthcare professionals since 17 July 2014.  It is a mandatory requirement of the Code that all nurses and midwives have an appropriate indemnity arrangement in place. The Nursing & Midwifery Council publish guidance on its website about professional indemnity arrangements.  It is important that healthcare professionals appreciate that whilst they may not need to individually hold an indemnity arrangement it is their responsibility to make sure that appropriate to cover for their practice is in place and confirmation of this is required from all registrants on re-validation.

Maybe over the coming month there will be many academics across the UK experiencing vicarious enjoyment as the students they have taught and supported conclude their Pre-Registration studies and embark on their professional careers. Personally it is a joy to read positive feedback from students confirming their knowledge and understanding of the demands of their future professional lives. These neophyte practitioners will be moving into their new posts acting under vicarious authority performing clinical care that is being delegated to them.  It is important that these, and all, practitioners remember their responsibilities under the NMC Code 2015 with regard to practising effectively when undertaking delegated tasks. Many of those practitioners will be meeting family members and carers who express the view that they wish they could vicariously suffer for their loved ones.  Countless times in a paediatric environment practitioners will listen to parents expressing the view that they wish they could endure on their child’s behalf or act as a substitute in their place.  It is hoped to that these neophyte practitioners will always deliver the highest possible standards of care, mindful of all they have learnt about professional conduct and behaviour, always putting the client first, treating them as individuals with dignity and respect. If the clients’ care and safety is paramount and enhances their health, practitioners may just have a vicarious experience of well-being themselves and feelings of joy and celebration rather than fear in their working lives. Make every experience count,