By John Tingle, Associate Professor, Birmingham Law School, University of Birmingham
The NHS patient safety environment always appears to be in a constant state of flux with new policies, organisational changes and care quality crises happening on an all too frequent basis. In a real sense the NHS can be seen to be running to stand still when it comes to patient safety culture development. Just as one patient safety, health quality policy begins to bed down another comes along to take its place on the same or similar subject area. It is revolving door policy and practice type scenario which is unsatisfactory in any modern-day health service.
A crowded, confusing, complex NHS patient safety environment
The NHS health regulation, governance environment within which patient safety sits is a crowded, complex, and confusing place with several NHS organisations having overlapping patient safety remits. This causes confusion for both NHS staff and patients. This point has been made many times in past reports on patient safety, health regulation and governance over the years.
Back in 2018, England’s regulator for health and social care, the Care Quality Commission (CQC) stated:
“The current patient safety landscape is confused and complex, with no clear understanding of how it is organised and who is responsible for what tasks. This makes it difficult for trusts to prioritise what needs to be done and when.” (p23).
In 2024 the Infected Blood Inquiry in its recommendations pointed to issues in achieving an NHS patient safety culture and what needs to happen. Three aspects which demand action are stated. Changing the culture, a more rational approach to regulation and safety management, and ensuring a coherent approach to data.
The report stated on the second aspect:
“Second, a more rational approach to regulation and safety management resolving the problems created by the current systems for trying to deliver safer care: which are fragmented, overlapping, confusing, and poorly understood.” (p.225)
Significant changes on the horizon?
Changes are on the horizon and the government have announced a review of NHS patient safety. A review which I hope will lead to an NHS patient safety reset with a focus on simplification, consolidation and efficiency. Wes Streeting, the Secretary of State for Health, and Social Care has ordered two independent reviews, one of which will look at several NHS organisations that have patient safety and quality remits. The organisations are.
-Care Quality Commission (CQC) – including the Maternity and Newborn Safety Investigations programme
-National Guardian’s Office (NGO)
-Healthwatch England (HWE) and the Local Healthwatch (LHW) network
-Health Services Safety Investigation Body
-Patient Safety Commissioner
-NHS Resolution (patient safety-related learning functions only, not clinical negligence functions).
“This government will never turn a blind eye to failure. An overly complex system of healthcare regulation and oversight is no good for patients or providers. We will overhaul the system to make it effective and efficient, to protect patient safety.”
The first review will look at these organisations and, “make recommendations on whether patient safety could be bolstered through a different approach.”
Another will focus on quality and its governance. Findings of the Safety Landscape Review can be expected, the report states, in the new year. More details are contained in the review’s terms of reference.
The reviews are to be led by Dr Penny Dash who did the review into the CQC, the final part of which was recently published. This report found major failings with the CQC, and important remediable recommendations were made.
Moving forward
Hopefully, these reviews will bring some common-sense structure to the NHS patient safety landscape. Whether root and branch reform will take place with the merger of some NHS patient safety organisations remains to be seen. A probable course could be the merger, reform of some organisational functions such as education, training and the issuing of patient safety recommendations, guidelines to name just some possible changes that could be made. The foundations of the NHS patient safety system need to be firm so that a proper culture can be built and developed on it.
Conclusion
The writing has been on the wall for some time that the NHS patient safety environment has to change. There are too many NHS organisations with, complex, duplicated and competing patient safety remits. This has led the NHS patient safety landscape being left in a fractured and poor state. You cannot build a proper patient safety culture on such poor foundations. A landscape that is both confusing for health carers and patients. Some degree of change will be inevitable.
This blog is based on a column submitted to the British Journal of Nursing: https://www.britishjournalofnursing.com/authors/john-tingle/