James Paget University Hospitals NHS Foundation Trust
NHS / Health Body
Action Planned
The Trust is reviewing its recruitment process for doctors to ensure appropriate training and induction, with changes to be implemented by the end of September 2020. The trust also describes existing processes for assessing locum doctors, offering substantive contracts after frequent employment, and encouraging staff to raise concerns. (AI summary)
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Dear Ms Lake Re: Regulation 28 Report to Prevent Future Deaths following the inquest into the death of Kobi David Wright. T~ank you for your letter dated 16 July 2020 following your inquest into the death of Kobi David Wright. Firstly, I would like to reiterate my condolences on behalf of the Trust to Kobi's family for his sad passing. Following the evidence heard at your inquest, the medical cause of death was given as: 1a) Pre term Stillbirth 1 b) Complicated Instrumental and Caesarean Delivery 1c)
2) Prematurity
1.understand that you have made this report under paragraph 7, Schedule 5, of the Coroners and Justice Act 2009 and regulations 28 and 29 of the Coroners (Investigations) Regulations
2013. The Trust has carefully considered the issues set out in your letter ih order to respond to your concerns. The Trust 'is continuing to take steps to recruit substantive doctors as first preference. Unfortunately, it is not always possible to employ only substantive staff, and to ensure safe staffing levels are maintained across the services, it is at times necessary to employ locum doctors. The Trust's Executive Lead for Workforce is currently reviewing the recruitment process fo ensure that suitably trained -and experienced doctors are comprehensively inducted at the hospital. This review will be concluded and the changes implemented by the end of September 2020.
At present, the i;nedical staffing team request information from framework agencies to ensure the Trust has all compliant information before employment of any doctor is agreed. This information includes a copy of the CV, two current references, GMC and DBS checks, and Occupational Health (OH) records which are also r~viewed with the Trust's OH provider. A copy of the individual's mandatory training log is provided by the agency: the agency's Responsible Officer will e·nsure that training is up to date. The CVs, training certificates and references are approved by the speciality's consultant body before employment to ensure they are safe to fulfil the vacancy. Following your inquest, the reviewing consultant will, in writing, respond to the staffing team confirming they are satisfied that the clinician meets their requirements. This confirmation will include the date and time the documentation was verified. Additionally, the Trust has started to work with the clinical leads to devise c;1 detailed person specification of all essential and desirable qualities for each speciality. This specification will be shared with the agency, with the expectation that only clinicians that meet these criteria will be nominated for employment. In a situation where a locum doctor is required at short notice, and they do not meet all essential criteria, the staffing team will carry out a risk assessment, with the clinical team, to decide whether the clinician can be employed. This risk assessment will consider any mitigating factors, for example if they are named on the specialist register. If it is appropriate for the clinician to work at the Trust, the risk assessment will be signed by the clinical lead or th_eir deputy and shared with the supervising clinician. On day one at the Trust, locum doctors attend mandatory training and engage in a supervisory period in their department to ensure they are orientated. During this period, the clinician will work alongside a substantive staff member to familiarise themselves with local practice and ensure they have the appropriate skills required for their employed position. This staff member will be responsible for observing experience and skills during this period, and will raise any concerns to the appropriate clinical lead for action. If a locum doctor is unable to participate in a supervisory period, this will also be risk assessed by the staffing team before working. After a period of frequent employment, the Trust's current practice is to offer a substantive contract to the clinici.an. The Trust supports its permanent staff to continue with their professional development and offer training courses and study leave to aid this. This helps increase the pool of substantive doctors at the Trust providing consistency within the services. The Trust works hard to maintain an open culture and encourages staff to raise concerns to appropriate manag·ement; this includes any capability issues. The hospital is focussed on patient safety and promptly investigates any concerns regarding a clinician's competence. The Trust's Medical Director actively considers whether steps outside of the hospital's local · policy is required and if referrals to the GMC are required. I would like to thank you for bringing your concerns to my attention. If you require anything further, then ·please do not hesitate to contact me.
I understand that this letter may be shared witt, Kobi's family and I would like to take this ·opportunity to again personally extend my sincere condolences for their loss.
2) Prematurity
1.understand that you have made this report under paragraph 7, Schedule 5, of the Coroners and Justice Act 2009 and regulations 28 and 29 of the Coroners (Investigations) Regulations
2013. The Trust has carefully considered the issues set out in your letter ih order to respond to your concerns. The Trust 'is continuing to take steps to recruit substantive doctors as first preference. Unfortunately, it is not always possible to employ only substantive staff, and to ensure safe staffing levels are maintained across the services, it is at times necessary to employ locum doctors. The Trust's Executive Lead for Workforce is currently reviewing the recruitment process fo ensure that suitably trained -and experienced doctors are comprehensively inducted at the hospital. This review will be concluded and the changes implemented by the end of September 2020.
At present, the i;nedical staffing team request information from framework agencies to ensure the Trust has all compliant information before employment of any doctor is agreed. This information includes a copy of the CV, two current references, GMC and DBS checks, and Occupational Health (OH) records which are also r~viewed with the Trust's OH provider. A copy of the individual's mandatory training log is provided by the agency: the agency's Responsible Officer will e·nsure that training is up to date. The CVs, training certificates and references are approved by the speciality's consultant body before employment to ensure they are safe to fulfil the vacancy. Following your inquest, the reviewing consultant will, in writing, respond to the staffing team confirming they are satisfied that the clinician meets their requirements. This confirmation will include the date and time the documentation was verified. Additionally, the Trust has started to work with the clinical leads to devise c;1 detailed person specification of all essential and desirable qualities for each speciality. This specification will be shared with the agency, with the expectation that only clinicians that meet these criteria will be nominated for employment. In a situation where a locum doctor is required at short notice, and they do not meet all essential criteria, the staffing team will carry out a risk assessment, with the clinical team, to decide whether the clinician can be employed. This risk assessment will consider any mitigating factors, for example if they are named on the specialist register. If it is appropriate for the clinician to work at the Trust, the risk assessment will be signed by the clinical lead or th_eir deputy and shared with the supervising clinician. On day one at the Trust, locum doctors attend mandatory training and engage in a supervisory period in their department to ensure they are orientated. During this period, the clinician will work alongside a substantive staff member to familiarise themselves with local practice and ensure they have the appropriate skills required for their employed position. This staff member will be responsible for observing experience and skills during this period, and will raise any concerns to the appropriate clinical lead for action. If a locum doctor is unable to participate in a supervisory period, this will also be risk assessed by the staffing team before working. After a period of frequent employment, the Trust's current practice is to offer a substantive contract to the clinici.an. The Trust supports its permanent staff to continue with their professional development and offer training courses and study leave to aid this. This helps increase the pool of substantive doctors at the Trust providing consistency within the services. The Trust works hard to maintain an open culture and encourages staff to raise concerns to appropriate manag·ement; this includes any capability issues. The hospital is focussed on patient safety and promptly investigates any concerns regarding a clinician's competence. The Trust's Medical Director actively considers whether steps outside of the hospital's local · policy is required and if referrals to the GMC are required. I would like to thank you for bringing your concerns to my attention. If you require anything further, then ·please do not hesitate to contact me.
I understand that this letter may be shared witt, Kobi's family and I would like to take this ·opportunity to again personally extend my sincere condolences for their loss.