This issue of Health Care Risk Report (HCRR) provides coverage of the key case of Birch v University College and its ramifications. The case shows that Mrs Birch, when asked to consent to an investigation which resulted in her having a stroke, was not given sufficient information before making a decision. She was asked to sign a form that did not accurately reflect the true picture of risk for her as an individual. Stuart Marchant provides a legal perspective and Dr Jeff McIlwain gives a clinical viewpoint on its implications for consent. As Dr McIlwain has previously pointed out in HCRR, such a form should be the conclusion of a proper discussion between clinician and patient, not a substitute for it.
Over the years the balance has swung away from medical paternalism and towards patient empowerment, as evidenced by both legal cases and society in general. The Department of Health (DH) is trying to ensure that society does not ignore the rights of the most vulnerable – those who do not have capacity to make decisions for themselves (whether temporarily or permanently). To this end, the independent mental capacity advocacy (IMCA) service has been introduced and has now been in operation for 18 months. Referrals to this have not been as high as expected so the DH is urging NHS clinicians to refer more often for serious medical treatment decisions. Where referrals are being made (by psychiatrists, psychogeriatricians or hospital social workers) patients are benefiting. Two case studies are contained in this issue of HCRR that provide evidence of this.
Frail older patients and those with learning difficulties are also vulnerable within the physical environment of care, and Phil Gifford looks at the issue of deaths associated with poorly-fitted bedrails. Injuries and deaths from this cause are a perennial problem for hospitals and for residential or nursing homes, and can lead to substantial fines as well as the personal cost to patients, their families and staff involved.
Also in this issue, Claire Bentley covers violence and aggression towards NHS staff, including a look at the important issue of violence by mental health service users. The DH code of practice to the revised Mental Health Act, which came into force in November 2008, contains useful guidance on this.
Last, but not least, HCRR also covers, in separate articles, patient safety in general practice and the issue of loss of patient data. Preserving patient confidentiality is essential and the information commissioner views general practice as a key area where data must be protected.
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Declaration of interest: Stuart Emslie, editor of Healthcare Governance Review, is on the editorial advisory board of, and is a regular contributor to, Health Care Risk Report.