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Leslie Hamilton – Surgery

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Leslie Hamilton, 63, is consultant cardiac surgeon at Newcastle upon Tyne's Freeman Hospital and a former president of the Society for Cardiothoracic Surgery in Great Britain and Ireland. He views his role as specialist advisor as a rare chance to see how surgical departments in other trusts function.

"I have nearly 25 years' experience as a consultant cardiac surgeon – 16 of that as a consultant paediatric cardiac surgeon – and before becoming a specialist advisor I'd already been involved in professional reviews.

As the president of the Society for Cardiothoracic Surgery at a time when there were problems in many of the paediatric cardiac units around the country, I was one of the clinicians involved in the NHS Safe and Sustainable review which began in 2008 and ran until 2013 when the courts intervened  (the ongoing review is the New Congenital Heart Disease review).

Plus, I played a part in coordinating The College of Surgeons' Invited Review Mechanism, an independent external review service for trusts with concerns about individual surgeons or surgical services.

This experience meant that when 14 NHS trusts were investigated as part of the Sir Bruce Keogh review after the Mid-Staffordshire Hospital scandal, I was asked to be a member of the inspection teams.

CQC took over the same inspection methodology in 2013, and as I was already on their books I became one of their specialist advisors. I've since done three CQC inspections as a surgical inspector (and have also chaired two ambulance trust inspections).

My role on inspections

Cardiac surgery is an area that not all trusts provide but as a surgical inspector my specialism isn't relevant as I look at the overall approach to surgery.

The surgical inspection team looks at the whole patient journey, from admission to assessment, into theatre and then recovery afterwards. I observe surgery in action and see how clinicians work together in theatre. I also aim to go on a ward round and to some of the handovers so I can get a feel of how the service is functioning.

The value of specialist advisors

One of the great benefits of specialist advisors is that we can reassure those being inspected. When clinicians see that you understand the pressures they face, it dispels any potential hostility there might be towards the teams coming in to speak to them.

There are around 60 people on the average hospital inspection team. Around half of those are clinicians who understand the realities and problems faced in practice; the other half are CQC inspectors who are used to making critical evaluations of services, and making difficult decisions.

This mix means that inspection teams have good, active debates. Plus, one of the things we find difficult as clinicians is being critical of our colleagues – and it's about finding ways to be constructively critical about things that need to change.

Getting out of my comfort zone

My role as specialist advisor challenges me and makes me think differently about my own practice. On every inspection, I've picked up something positive I can take back to my own trust.

These learnings aren't specific to cardiac surgery, but I've been able to see how other theatres and teams function – even the different ways others approach the WHO checklist can be fascinating. In the NHS, there'd be no other way to get these new insights.

On an interpersonal level, it's refreshing to meet other people outside medicine and get someone else's perspective on the whole system. I'll be retiring later this year, but still hope to continue with the specialist advisor role in some capacity after that.

Taking learnings back to my trust

Most inspections mean being away from work for about a week, so it's vital your trust supports your work as a specialist advisor.

My employer, Newcastle upon Tyne Hospitals NHS Foundation Trust, recognises the value I can bring back after inspections and I regularly feed back things I've learned to the clinical governance team.

We have our own CQC inspection coming up later this year, and I've given presentations on how the process works. I've taken care to stress that we shouldn't focus on preparing for the inspection itself, but use it as a positive process on the quality of care we provide.

More emphasis on how complaints are handled

Patient complaints are increasingly being recognised as a valuable source of feedback on how the system of care is working. CQC now formally looks at how trusts handles and learns from complaints. This is something I hadn't fully appreciated or given much thought before becoming a specialist advisor.

The junior doctors in my department have compulsory training sessions on issues around professionalism. As part of this, I give presentations to them on how the complaints process works. Teaching them to view complaints as a positive rather than a negative is a culture change – and a welcome one if it helps improves the care we can give our patients."

Last updated:
29 May 2017


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