In safe hands

Appropriately, the day I sit down with Dr Jason Leitch, Clinical Director of the Scottish Government’s Quality Unit, is health stats day for the Scottish Government and my inbox, and later the newspaper front pages, are bulging with the latest nursing staffing levels and missed waiting-times revelations. Questions about the performance of Scotland’s health service have dominated parliamentary debate in recent weeks and provoked a raft of government announcements in response, including a ‘hospital at home’ initiative, a waiting-times advice line, and a £50m Unscheduled Care Action Plan designed to help meet the growing demand on A&E services. However, in amongst these important figures is another that deserves to stand out but that, Leitch tells me, he fears will be overlooked.

Since 2008 and the introduction of the Scottish Patient Safety Programme, the mortality rate in Scotland’s hospitals has fallen by 12.4 per cent – meaning that 8,500 lives have been saved.

The SPSP launched with the primary aim of reducing mortality in Scotland’s hospitals and its success has attracted widespread interest, including from Sweden, the US, Canada, South Africa and Denmark, with the latter choosing to duplicate the programme ‘exactly’. Leitch insists this reduction in mortality cannot be entirely attributed to the safety programme – “So please don’t write the sentence, ‘Jason says the safety programme has saved 8,500 lives.’ I don’t believe that.” And yet, he does “sincerely” believe, and insists he can prove, that it has changed the culture in Scotland’s hospitals and, therefore, has played an important part in achieving that reduction.

Leitch is a passionate advocate for the safety programme and the Scottish health service more generally. He is also an entertaining and engaging interviewee whose enthusiasm for his work runs through every sentence as he switches seamlessly from amusing anecdote to digestible impromptu macro health policy lecture. Refreshingly, he also seems completely unable to give a politician’s answer to any question – during our interview, he frequently pauses to glance at the communications officer as if to gauge how much trouble he will be in if he answers honestly, and then says it anyway.

He originally trained as an oral surgeon, or “surgery from the neck up” as he describes it – “I didn’t do fillings, I hated it. My mother still hates the idea that she can’t come to me for her dentistry!” Once qualified, he worked in the west of Scotland with patients who had experienced trauma to the face until, he admits, he “got a bit bored”.

“I wanted new challenges. I went to America to the Institute for Healthcare Improvement, which is in Boston. It is probably the global leader in healthcare improvement, and when I say healthcare improvement, I mean improvement of the delivery system, I don’t mean smoking and alcohol. Actually making the delivery system better.”

There he met and worked with Don Berwick – a famous figure who went on to work with President Obama on his healthcare reforms, was recently appointed by Prime Minister David Cameron to advise on the UK’s NHS, and is now said to be mulling over running for governor of Massachusetts — who Leitch says became “a bit of a hero”.

He left America inspired with a Masters in Public Health.

“I became an odd combination of a surgeon with a public health degree, which is very unusual. [Chief Medical Officer, Sir] Harry Burns is just about the only other one you’ll ever meet, actually! It gives you a unique insight into the day-to-day operational management.”

He returned to the dental hospital but admits that didn’t work out.

“I had always had this slightly extrovert personality but now I had a new skill and they didn’t know what to do with it. So I left and I came to work for the Scottish Government.”

Leitch became the National Clinical Lead for Safety in 2007 and was put in charge of the Scottish Patient Safety Programme by Derek Feeley, who is now the Chief Executive of NHSScotland and Director-General for Health and Social Care.

“As a result of the safety programme going well, people started to pay attention — not to me, but to the method, to what had happened, because it seemed to be uniquely achieving something. The dots seemed to be moving in the right direction. So, we then published the Quality Strategy in 2010 and I became the Clinical Lead for Quality,” he says.

The job morphed again at the beginning of last year into Clinical Director for the Quality Unit, which sees him advising ministers and senior civil servants on the delivery of the healthcare system, including adverse events and infection, but also around things like how you do unscheduled care and manage ‘hospital at home’.

Keeping patients safe from harm is and will always be a priority for the NHS. Later this month Leitch will address Holyrood magazine’s Infection Control conference in Edinburgh where he will outline Scotland’s efforts to achieve the “irreducible minimum” of harm.

“We should be pushing and pushing and pushing to be the best in the world at reducing and preventing adverse events. When I have a family member or myself in healthcare, I want cured to the best ability of the health service. But we kind of presume that to be the case. We tend to think if you have a renal problem you will get your kidneys fixed. But step one is: ‘Don’t harm me with the healthcare I receive.’ And the most prominent version of that harm is infection.”

While the whole world has had a challenge with healthcare-associated infections, he believes Scotland has “got to grips with it”, pointing out that Clostridium difficile is down nearly 80 per cent since 2007.

“So the numbers are really dramatic. That is lives saved. It is morbidity reduced. It is less time in hospital,” he says, which is good for patients and families, and, with each HAI costing roughly £2200, it is also good for the health service.

But Leitch believes we can go further still. He identifies three main areas to focus on. First, helping the public to understand their role in reducing harm by decreasing the use of broad spectrum antibiotics and making them aware of the importance of hand hygiene and not visiting patients if you are sick. Likewise, with staff, he says there is a need to ensure everyone “from the guy delivering the newspapers to the consultant surgeon” is washing their hands. And finally, ensuring facilities are clean and safe.

“And I don’t think we are at the minimum in any of those areas. I think there is still work to do. And I’m not sure we will ever get to the bottom. No country in the world has no HAI, because it is a risky world. You are opening people’s stomachs up. You are giving them new hips. It is probably impossible to do it without any infection, but we are at the lowest level we have ever been.”

However, he acknowledges that these reductions have come from a high starting point. In spring of 2009, then Health Secretary Nicola Sturgeon announced an inquiry into deaths associated with C. difficile at the Vale of Leven hospital, which Scottish Labour health spokesperson and local MSP, Jackie Baillie, has described as “the worst outbreak in terms of mortality for any hospital in the UK”.

The inquiry is yet to report. However, I ask Leitch what has been learned from the outbreak and how such incidents have informed current infection control policy.

“This sounds a bit harsh. But never waste a crisis, whether that crisis is of our making or somebody else’s,” Leitch replies plainly.

He explains: “The Vale of Leven was tragic, completely tragic. And we’ve been learning since it happened and will continue to learn once the report comes out. But that burning platform that was created by the Vale of Leven, and the general wish inside the workforce to make it better, is partly responsible for that 80 per cent reduction in C. difficile. I have no doubt.”

Likewise, he assures that he will also be seeking to learn from the recently published Audit Scotland report on hidden waiting lists and the Francis inquiry into the deaths at Mid Staffordshire.

On waiting lists, he says that while the Audit Scotland report found there was no widespread fraud, it did expose the complexity of the system.

“We should make that as easy as we possibly can for the population. We should make it easy to understand, we should make it easy to access, we should make it easy to change and we should be transparent about it. So we completely agree. And we should try, as far as possible, to make the system helpful to patients and families first, and to staff and health boards second.”

On the Francis report, he stresses that Mid Staffordshire is not a Scottish hospital and this is not something he would recognise in a Scottish hospital.

“But, why would I not pay attention to that crisis? If I’m the guy charged with looking at healthcare quality in Scotland, along with hosts of others, why would I not pay attention to what he [Francis] says and assess those recommendations?”

However, he adds that change does not happen by simply “publishing big books and telling people to wash their hands”. Instead, you require a method for change and in Scotland, he says, by teaching the science of improvement, the Scottish Patient Safety Programme gives frontline staff a method to drive that change.

The safety programme is now a family of safety programmes and in addition to the original acute hospital programme and a more recent mental health safety programme, they will also be launching maternity and primary and community care programmes this month, which Leitch believes will make Scotland the first country in the world to have a recognised safety programme throughout the whole patient journey.

He is proud of what it and the staff involved have achieved.

“There is something about the patient safety programme brand that has achieved something that change programmes struggled with. And that is engagement of doctors and nurses. So typical government change programmes don’t tend to light a fire in the hearts of clinical staff. But this one has.”

Running through all of this work, of course, is the ever-present focus on quality. I ask what his next ambitions are for NHSScotland. He pauses and risks another sideways glance towards the very patient communications officer.

“The answer I should give you is the 20:20 vision,” he says with a smile.

“The standard policy answer is patients and families will receive the care they want and need in a setting at home or as close to home as possible. And I think that is true.

“But what do I actually want?” he asks aloud.

“I think I want patients and families to feel safe in two senses: to feel safe that the healthcare system will deliver them the healthcare that they want and need. So whatever their illness is, whether it is mental health or a broken hip, I want them to feel confident that their healthcare system will deliver the care they need. But I also want them to feel safe and loved while they have it.”

The new healthcare movement in the world is not just about patient safety, it is principally about compassion, he says. And making sure that compassion is reliably delivered every day should be an ambition for everyone.