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James Titcombe: 'It’s time to improve the safety culture in the health service'


I’ve been shocked to observe the contrast in safety culture between the NHS and the nuclear industry, says James Titcombe

With the Francis report, the Grant Thornton Care Quality Commission scandal and the failures identified across 14 other NHS trusts by the Keogh review, we appear to have reached a watershed moment in recognising there are serious problems within the NHS. Health secretary Jeremy Hunt has recently articulated what many patient safety campaigners have been saying for years; that regulation of the NHS has been dysfunctional, that too often the culture has been to cover up and hide problems and that standards of care in some parts of the system have fallen far below any acceptable standard. This acceptance is already paving the way for change.

The disastrous problems within NHS regulation are now being reversed. Hospitals will be subject to expert inspections with patients being involved in the process. It is now vital that the Francis recommendations are fully implemented, including action on safe staffing levels and a duty on all NHS professionals to be honest when mistakes are made.

‘It is now vital that the Francis recommendations are fully implemented, including action on safe staffing levels and a duty on all NHS professionals to be honest when mistakes are made’

For people who work within the NHS, the constant stream of negative reports and media focus must be draining. The majority of staff go to work to do their best for patients, often in difficult circumstances. While there must always be individual accountability for breaches of standards, the reality is that most instances of poor care and avoidable harm arise from a much more complex set of circumstances. Systems, processes, pressure of work, quality of leadership and the cultural mindset of the organisation itself are crucial factors in keeping patients safe. Too often, these factors combine to create a system that pulls in the wrong direction and this has let staff as well as patients down.

I experienced the consequences of this myself in 2008, when I lost my baby son due to serious failures in his care at the hospital where he was born. Since then, I’ve been shocked to observe the contrast in safety culture between the NHS and my experience working as a project manager in the nuclear industry. I have seen how a good safety culture is developed. It’s a continuous process; about sharing information, making people aware of concepts and principles and demonstrating the link between outcomes and behaviour. It’s also about fostering a culture that encourages not just open reporting and learning from mistakes after they happen, but the reporting of situations, conditions or systems of work that have the potential to cause unnecessary harm. The barriers to any organisation operating in this way should not be underestimated, but experience in other sectors shows it can be done.
With this in mind, this week I have written to Mr Hunt detailing eight key ideas that could make a big difference to improving patient safety in the NHS.

These are an NHS safety culture accreditation scheme; the development of a specific patient safety qualification; human factors training; development of clear minimum standards for investigating all NHS serious untoward incidents; a central patient safety knowledge hub; protected patient safety awareness days for all NHS staff; a truth and reconciliation panel for all NHS whistleblowers that will independently handle the issues these people raise, as recommended by Patients First; and publication of key patient safety information, such as the number of specialist patient safety staff employed by the trust and staff to patient ratios on wards.

There has never been a time where there has been more acceptance that things need to change. While no system will ever be perfect, now feels like the right time to start talking about how we can make the current system better.

James Titcombe is patient safety campaigner


Readers' comments (4)

  • michael stone

    I've noticed that since he has removed the spending decisions away from himself, Hunt is now much keener to say 'The NHS is getting this wrong, and must do better'.

    What James writes is sensible, and every recent report has called for what could be described as 'better but less prescribed behaviour' - in other words, 'less tick box, more intelligence'. The LCP review, even put that in its own title: 'More Care, Less Pathway'.

    But the NHS is hugely complicated, and presumably to prevent chaos it is also seriously hierarchical: throw in that whenever something really bad happens, whoever is Watch Commander throws out a new set of guidelines to try and make sure it cannot happen again, and it isn't obvious how we get to 'more sensible and less-prescribed behaviour' ? And different people - especially if coming from different roles or professions - also have different opinons about 'what sensible behaviour is'. By contrast, when something like Mid Staffs has happened, almost everyone can see immediately 'what was wrong there'.

    It is hugely difficult !

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  • Look at the work that has been and is still being done in Scotland around the SPSP. (Scottish Patient Safety Programme). There was a recognition at all levels that Safety needs to be at the forefront of what we do.

    The work with the IHI has been positive and having the patient at the centre of this work has improved safety. However as with all change it is a continuous process and we need to ensure safety and the patient stay at the centre of how we plan and deliver our care now and in the future.

    Yes it is difficult but we need to grasp the thistle!

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  • tinkerbell

    working collaboratively with patients must be the safest way forward for all, it should never be a 'them and us' scenario.

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  • For some it has always been the "patient at the centre of everything". For others, it has never been so. Only the colleagues of the "uncaring and unconcerned" can turn things around, by making them shape up or ship out.

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