Medical insurers – 'a fundamental force for good in patient safety'

The CORESS event was chaired by the Lord Ribeiro. Click here for a recording of the event, which also featured Mr John Machin, Clinical Lead for Litigation at GIRFT; Dr Annie Hunningher, National Safety Standards for Invasive Procedures Lead, and Professor Ashok Handa, Director of the Collaborating Centre for Values-based Practice.

What role should medical insurers play in patient safety? I’d argue AXA Health is a key stakeholder in the complex system that protects patients from avoidable harms – and this month my colleague, Dr Pallavi Bradshaw, spoke at the CORESS Safety in Surgery Symposium about how we’re leading  by example.  

(CORESS promotes safety in surgical practice by encouraging operating theatre staff to report, in complete anonymity, near misses as well as incidents. Dr Bradshaw, AXA Health Deputy Chief Medical Officer, sits on the CORESS advisory board that reviews and publishes the learnings from these reports.) 

We in the private sector need to support each other and build an open and transparent culture, given that the case of Ian Paterson, the rogue breast surgeon, has highlighted gaps in governance.

At AXA Health we use our influence to improve patient safety and promote an open, learning culture in our organisation and with the doctors and hospitals we work with.    

Dr Annabel Bentley, Chief Medical Officer, AXA Health 

Annabel read medicine at King’s College, University of London, and studied evidence-based healthcare with a special interest in medical tests at the Centre for Evidence-Based Medicine at the University of Oxford. Following surgical practice in the NHS she moved into the private healthcare sector, leading clinical risk and governance for a diagnostics service and for private medical insurance companies, including Executive Medical Director and Responsible Officer roles.

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Some of the ways we work for patient safety

We have developed a Patient Safety Tool based on evidence about the safety and efficacy of treatments. This framework uses consistent, objective guidelines for evidence-based decision making, with patient safety as an underpinning principle.  

We assess new pathways and propositions for clinical risk and perform checks on hospitals and individual providers.  

We look at information about clinical risk and safety that we can gather, internally and externally, on how our providers are working. We take a more detailed look when we spot highly unusual or inappropriate billing and treatment patterns. When appropriate we raise concerns to the Responsible Officer – such as when outlier practice poses a risk to patient safety or calls into question fitness to practice.  

Our obligations

We need to be prudent, not only financially, but also in terms of safe healthcare, as we have moral and regulatory obligations to ensure our customers are protected from avoidable serious harms.

The Chief Medical Officer team, which I lead, includes doctors who each have an obligation under General Medical Council (GMC) Good Medical Practice to raise concerns about patient safety. As professionals we feel a strong moral imperative and duty to safeguard not only the interests of our members, but the wider safety of all patients, both NHS and private, UK and globally. Safer practice in one hospital, I believe, should translate to safer practice worldwide.  

Dr Pallavi Bradshaw,
Deputy Chief Medical Officer, Medicolegal

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Where we get involved

We work closely with hospitals to understand Care Quality Commission (CQC) ratings of concern. Among the cases Dr Bradshaw described during the Symposium was the provider that had received a ‘requires improvement’ rating for safety from the CQC. The ratings in the safe domain are a priority for all parties, as we want to ensure continuity of care for our members where possible. In this case, the provider was open with us, sharing its action plan and timeframe for making improvements. This gave us confidence to continue authorising treatment there, pending future CQC reinspection. 

Dr Bradshaw also discussed how we respond when we detect unusual clusters of data from surgeons – a high conversion to surgery rate, for example, combined with unusual coding patterns and high patient numbers; or a surgeon using bespoke implants with a safety rating lower than what we or the NHS would normally accept, with poor consent records. We did escalate our concerns about these doctors to the relevant authorities, but only after we’d engaged with them and found they were unwilling to discuss their unusual practice with us. 

An open culture

In all these cases, what influenced our decision was the openness of the doctor or hospital to engage with us; a willingness (or otherwise) to share their practice or action plans; plus a commitment to deliver on the action plan and mitigate risks.  

We’re committed to fostering an open culture that supports the reporting of incidents and complaints, and turning these into learnings which are shared with staff so they can change practice.

We also hear how hard it is for individual doctors to speak up when they have concerns about patient safety, and encourage them to contact us if they have safety concerns.

We hope, by showing CORESS and other patient safety forums how we work, to encourage this desired culture of openness towards reporting errors and incidents and learning from these.  

AXA Health Patient Safety Forum

In November 2022 we’ll host the first AXA Health Patient Safety Forum, which will bring together the governance teams and medical leaders of hospital groups we work with, so that we can have a two-way conversation about sharing learnings and the steps we can take together to foster a true safety culture in healthcare.