How do you think trusts can calibrate the appropriate level of preparation they should undertake when it's unclear to what extent they might be involved or called upon?
Questions of resource, particularly given the ongoing operational challenges, are always difficult. In circumstances where it is not yet known what role there will be for individual trusts, it is understandable that there may be concern about redirecting resource from other operations. We think we will all agree that preparation should be started now. If you are called upon in due course to provide disclosure (documentation or statements), you need to be ready to comply with any time timeframe imposed. You also need to ensure that all disclosure that may be relevant (and this could be very broad) is preserved, as failure to do so could adversely impact the accuracy of evidence given to the inquiry, the inquiry’s findings, and result in criticism on your trust and registered professionals.
There are some preliminary steps that can (and NHS England recommend should) be taken without extensive resourcing, such as issuing a stop notice to all staff (NHS England has offered its document for adapting); identifying key policy changes implemented by the trust in response to COVID-19 and collating the policy or procedural documents; and identifying key issues which impacted your trust and collating Datix (or other), policy and procedural documents. These documents should all be preserved, ensuring that they are stored in a way that will not be adversely impacted by systems changes.
There's a risk that the inquiry is very resource intensive for the NHS at a time when it is already under severe pressure. Do you think the inquiry will give some consideration to this? How can this risk be managed?
There does not seem to be any appetite, either from government or the public, to increase pressures on the NHS unnecessarily. There will be a balancing exercise to ensure that the inquiry is not hindered in exploring those matters which are ultimately determined to form part of the terms of reference, and to prevent the inquiry from being too burdensome and having an adverse impact on operational requirements and the delivery of care. Any request for information from an individual trust, or the NHS collectively, will need to be reasonable and proportionate.
This is in terms of the nature and extent of the information sought, and the timeframe for any response. Where a request (or the timeframe for compliance) is unreasonable or disproportionate, representations can be made to the inquiry team. Trusts are being asked to start collating documentation now so that when the terms of reference for the inquiry are established and disclosure requests made, trusts are not on the back foot and having to face a mammoth task in an unreasonable timeframe.
How might trusts approach the document management ask involved here? For example, is it a case of mapping or collating information? To what extent do you think we can develop position statements now? What might be a pragmatic approach? What might be the risks to consider?
There are many approaches that may be adopted, and the approach that you take is likely to be dependent on available resource. Consideration should be given to how are you going to identify documentation, store information, sequence and catalogue it, and make onward disclosure. Identifying and storing information are priority steps, whereas sequencing and cataloguing it for ease of cross referencing and onward disclosure are more time consuming and may be steps that you choose to undertake when the terms of reference are published and the role of individual trusts are known.
One way to identify information is by reference to generic themes. By making a simple timeline, you could note key dates nationally and locally, against which you should be able to identify when you changed local policy and procedure. Alternatively, you could collate documentation by reference to trust specific issues; those matters which most significantly impacted your organisation. Either way, be flexible until the terms of reference are known. Whatever approach you take, have a tested system and data management processes in place. At very least, store documents in clearly identifiable sub-folders for each theme or issue; have an index which includes policy/document name, number and dates active.
Ensure that your information governance structures are robust and that you are confident that you are not going to be affected by IT changes. Witness statements or position statements can be considered at this stage but you may wish to take advice from your legal team as to how best to do this and the form that they should take. Once prepared, they will be subject to disclosure rules and care should therefore be taken to ensure that they are both relevant and accurate. Briefly however, you may wish to consider statements for those specific issues that have significantly affected the trust in an adverse way, with any such statement being limited to one specific issue for ease of use and onward disclosure.