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NHS staff must have 'safe space' for investigations say MPs

Trusts should not hold internal patient safety investigations

Adrian O'Dowd

Thursday, 02 August 2018

NHS staff must feel safe to open up and discuss mistakes and incidents without fear of unjust recrimination, according to MPs and peers.

Government plans to create a new organisation called the Health Service Safety Investigations Body (HSSIB) are analysed in a report* published today by the parliamentary Joint Committee on the Draft Health Service Safety Investigations Bill.

There are an estimated 12,000 avoidable hospital deaths every year and more than 24,000 serious incidents reported to NHS England, out of a total of 1.4 million mostly low-harm or no-harm incidents annually.

In order to improve patient safety, the government has decided to establish a new body to conduct patient safety investigations into a small number of incidents so the system can learn from common failures.

The report authors supported the planned “safe space” approach to investigating incidents where patient safety has been compromised because this would give greater confidence to healthcare professionals in alerting authorities to potential safety problems.

In these “safe spaces”, the HSSIB will be prohibited from disclosing the information given to it, but will use this information to produce reports making recommendations that will apply not just to the incidents on which the investigation is focused but also across the health service.

The report authors, however, called on the government to reconsider plans that would allow HSSIB to accredit NHS trusts and foundations trusts to conduct internal “safe space” investigations, saying there was a likely conflict of interest.

The report expressed concern about the limited remit of the HSSIB, being restricted to incidents during the provision of NHS services, or at NHS premises and said it should include all interactions of health and social care services, provided by local government and private providers.

During the inquiry, Professor Clare Gerada, a GP and medical director of the NHS Practitioners Health Programme – a confidential service concerned with the mental wellbeing of doctors – told the committee members that fear had become “part of the fabric” of daily working life for people at all levels of the NHS.

This was because of a blame culture attached to investigative attitudes and practices, she had argued.
Committee chair Sir Bernard Jenkin said: “When serious incidents take place patients have a right to find out what went wrong and staff need to feel that they can be open without being blamed or made a scapegoat.

“Poor quality investigations fail to address the concerns of patients, breed mistrust amongst health professionals, and do not help to make care safer. Putting the HSSIB on a statutory footing to conduct independent safety investigations will help to address each of these concerns.

“Creating a legal ‘safe space’ where doctors, nurses and anyone else involved in the delivery of care can speak openly is crucial if the health system is to learn from its mistakes.”

Dr Robert Harwood, BMA consultants committee chair, said: “When mistakes occur in the medical environment, the results can be tragic. However, if we as doctors, and the health service as a whole, are to learn from such mistakes and stop them happening again, staff must feel able to report and reflect openly.

“Overall, we hope that in creating a ‘safe space’ in which staff can reflect, errors can be addressed more effectively and ultimately make healthcare settings a safer place for patients. The BMA has long called for the NHS to move away from its culture of blame to a culture of learning.”

*Draft Health Service Safety Investigations Bill: A new capability for investigating patient safety incidents. A report prepared by House of Lords, House of Commons, Joint Committee on the Draft Health Service Safety Investigations Bill, August 2018.

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