§ Mr. Spring
To ask the Secretary of State for Health what progress there has been in implementing the recommendations made in the report of the Allitt inquiry published in February 1994.
§ Mrs. Virginia Bottomley
The following progress has been made:
Recommendation 1.1233WWe recommended that, for all those seeking entry to the nursing profession, in addition to routine references the most recent employer or place of study should be asked to provide at leas: a record of time taken off on grounds of sickness.From April 1995, there will be consistent and agreed guidelines on seeking references from the most recent employer or place of study on a record of time taken off on grounds of sickness. The English National Board for Nursing, Midwifery and Health Visiting (ENB) has issued draft regulations and guidelines which will meet this recommendation. Additionally, the University and Colleges Admission Service has agreed to harmonise their arrangements with those of the ENB.
Recommendation 2.We recommend that in every case Coroners should send copies of post mortem reports to any consultant who has been involved in the patient's care prior to death whether or not demanded under Rule 57 of the Coroner's Rules 1984.My right hon. and learned Friend the Home Secretary, in whose area of responsibility this recommendation falls, intends to commend the principles of the recommendation in a circular to be issued to all coroners in England and Wales later this month.
Recommendation 3.We recommend that the provision of paediatric pathology services be reviewed with a view to ensuring that such services be engaged in every case in which the death of a child is unexpected or clinically unaccountable, whether the post mortem examination is ordered by a Coroner or in routine hospital practice.This recommendation has been considered by the Strategic Review of Pathology Services which advises that more work is required on a number of detailed operational issues. A Working Group to look at the issues involved will be set up.
Recommendations 4,5,6,7,8 and 9
Recommendation 4.We recommend that no candidate for nursing in whom there is evidence of major personality disorder should be employed in the profession.
Recommendation 5.We recommend that nurses should undergo formal health screening when they obtain their first posts after qualifying. We acknowledge that in Allitt's case this was done.
Recommendation 6.We recommend that the possibility be reviewed of making available to the Occupational Health Departments any records of absence through sickness from any institution which an applicant for a nursing post has attended or been employed by.
Recommendation 7.We recommend that procedures for management referrals to Occupational Health should make clear the criteria which should trigger such referrals.
Recommendation 8.We recommend that further consideration be given to how the suggestion of the Chairman of the Association of NHS Occupational Physicians could be applied in practice.The Chairman suggested that applicants who show one or more of (excessive absence through sickness, excessive use of counselling or medical facilities or self-harming behaviour) should not be accepted for training until they have shown the ability to live an 1234W independent life without professional support and be in employment for at least two years.
Recommendation 9.We recommend that consideration be given to how GPs might, with the candidate's consent, be asked to certify that there is nothing in the medical history of a candidate for employment in the NHS which would make them unsuitable for their chosen occupation.Guidance on occupational health is to be issued shortly which will cover all these recommendations. Together with the English National Board's new guidelines, this guidance will establish better procedures for selection of student nurses for training, the selection of staff to work on children's wards and the follow up of staff who have a history of excessive absence through sickness.
Recommendation 10.We recommend that the Department of Health should take steps to ensure that its guide "Welfare of Children and Young People in Hospital", is more closely followed.The guide referred to make clear that hospitals themselves should determine the number of staff they require to look after the children in their care. It also made a number of recommendations about staffing levels. We have surveyed the current staffing arrangements in paediatric nursing and identified a need for further improvement in some places. For daytime shifts nearly 50 per cent. of hospitals meet the recommendations and among those units not yet there some 40 per cent. have plans in place for increasing the numbers of trained childrens nurses. The results of the survey will be made available shortly and a copy will be made available in the Library. There has been a considerable growth in the number of nurses entering training for paediatric nursing in recent years: up from 183 in 1988 to 819 in 1992–93 for pre-registration training and from 628 to 811 for post registration training over the five year period. Training commissions for paediatric nurses rose by 36 per cent. between 1991–92 and 1994–95 (from 879 per year to 1198) reflecting increased employer demand.
Recommendation 11.We recommend that in the event of a failure of an alarm on monitoring equipment, an untoward incident report should be completed and the equipment serviced before it is used again.This recommendation has been considered by the Expert Advisory Working Group appointed by the Medical Devices Agency who have responsibility for the safety and quality of medical devices. The draft recommendations of this Expert Group go further than those of recommendation 11. The Group is expected to present its final report later this month.
Recommendation 12.We recommend that reports of serious untoward incidents to District and Regional Health Authorities should be made in writing and through a single channel which is known to all involved.We will shortly be writing to all Regional Directors requiring them to establish lines of reporting with Chief Executives of all NHS Trusts so that there can be swift and effective reporting of any such untoward incidents.