John Tingle, Associate Professor, Birmingham Law School.
The last few weeks have seen plans established that will lead to mammoth changes taking place in the way the NHS handles health quality and patient safety matters. The plans are stated in two recent publications the ,10 year health plan for England and the Review of patient safety across the health and care landscape, the Dash review. Both these publications present analyses of what is wrong with our present NHS health quality, patient safety system and what needs to change to significantly improve matters. These are both hard hitting reports displaying clearly the frustration that the government and others feel about the endemic NHS patient safety failures that continue to plague the NHS, and which have done so for many years.
History has not served the NHS well
History has not served the NHS well when it comes to developing a proper patient safety culture. The NHS has and continues to see, major patient safety crises. Unfortunately, the lessons from past patient crises are not sufficiently leant and the same or similar errors are often repeated. This is particularly so with NHS maternity care services as the following patient safety investigations reports show, Morecambe Bay and East Kent. These investigation reports reveal the terrible tragedies that occurred and the repeated significant patient safety error trends.
The ten-year health plan
In chapter 6 of the plan, a new transparency of quality of care, several aims are discussed. These are power to the patient through transparency, voice and choice, clearer accountability and stronger incentives for high quality care. Streamlining regulation to focus on quality of care. Details of how these aims will be met are given in the plan.
In addressing, Morecambe Bay ,East Kent and other NHS patient safety crises, the plan states:
“The failures that underpin each are consistent: incompetent leadership, toxic culture, rampant blame, workplace bullying, and a failure to learn from mistakes. There is also a fundamental lack of transparency, which means low quality or neglectful care does not come to light quickly; that the response is not fast or decisive enough; and that patient, staff and public attempts to sound the alarm go unheard. It is time for the NHS to learn” (p.86).
Matters also discussed include the NHS complaints system and change will happen here as the plan states that,” it is far from where it needs to be” (p.89).
Clinical negligence litigation
Clinical negligence litigation is also mentioned in the plan:
“We have asked David Lock KC to provide expert advice on the rising legal costs of clinical negligence claims, ahead of a review by the Department of Health and Social Care (DHSC) in the autumn” (p.132).
There will be a significant amount of upheaval for all the NHS organisations involved in implementing the changes in the plan, but these should prove positive for both patients and NHS staff in terms of developing a proper patient safety culture. The plan does have a much broader remit than patient safety, but the focus of this blog has been on that area.
The Dash review: the review of patient safety across the health and care landscape
The Dash review, chaired by Dr Penny Dash was commissioned by Wes Streeting , the Secretary of State for Health and Social Care .The review followed a previous report on the CQC (Care Quality Commission) which found serious failings in that organisation The CQC is the independent regulator of health and social care in England.
The new review looked at 6 specific organisations that are concerned with NHS care quality, patient safety to see whether there any gaps, overlaps and whether the system framework could be made better. Reference was alco made to the wider landscape of organisations influencing quality of care, the review states. The 6 organisations reviewed were:
- CQC (Care Quality Commission)
- Health Services Safety Investigations Body (HSSIB)
- Patient Safety Commissioner
- National Guardian’s Office
- Healthwatch England and Local Healthwatch
- the patient safety learning aspects of NHS Resolution
The need for reform and rationalisation was identified
The review identified several key trends, findings and made some important recommendations for change which will significantly alter and improve the NHS health quality and patient safety landscape. The review should be also read with the 10-year health plan as these documents are complimentary to each other in terms of what will be happening next in NHS patient safety. The review found that change was needed and drew five principal conclusions on matters which include but are not limited to:
“There is a need to streamline, simplify and consolidate functions where considerable
duplication and overlap currently exist – specifically when it comes to:
- user, patient or community engagement
- capturing and learning from user or patient experience, or the ‘voice of the user’
- investigations” (p.12).
Recommendations include but are not limited to, according to the review, the functions of HSSIB being transferred to the CQC where It should continue to operate as a discrete branch within it whilst retaining its independence for providers (p.91).
The writing on the wall
When reading the Dash review and the 10 year health plan the findings, themes, aims and recommendations will come as no surprise to many as the writing has been on the wall for their analysis and conclusions for some time. A whole host of NHS patient safety stakeholders have regularly and commonly spoken about the problem of the NHS having a too complex, fragmented and overlapping health quality, patient safety framework system.
A key question to ask why this has all taken so long when the problems have been so well known and articulated for many years? Reform and rationalisation should have taken place much sooner than it has been.
The changes brought about by the Dash review and the 10 year health plan will not happen overnight. At the same time, as reform and rationalisation are taking place, the current health quality and patient safety framework must also deal with ongoing, arising matters. Given the scale of the likely changes, there will be implementation challenges that must be overcome.
Conclusion
The Dash review and the 10 year health plan will fundamentally alter the NHS health quality and patient safety framework. The present one is unsatisfactory, it is too complex, fragmented with overlapping functions and this has been well catalogued for many years. The impending changes are to be welcomed.
This blog contribution is based on recent column submitted to the BJN (British Journal of Nursing)