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‘Safe space’ approach would boost nurse confidence in safety investigations, say MPs

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MPs have backed a so-called “safe space” approach during patient safety investigations, where nurses and other health professionals can openly discuss what went wrong.

Such an approach would give “greater confidence” to healthcare professionals in alerting authorities to potential safety problems, according to a report on new legislation by a group of MPs.

“We believe that the ‘safe space’ will help HSSIB to establish facts and identify the underlying causes”

Bernard Jenkin

The Joint Committee on the Draft Health Service Safety Investigations Bill has published its findings on the government’s plans to establish the Health Service Safety Investigations Body (HSSIB).

Under the plans, the HSSIB will be independent of the NHS and at arm’s-length to the government, with far-reaching access to investigate serious safety incidents or risks to patient safety.

The government said it decided to establish the new body to conduct patient safety investigations into a small number of incidents, in order for the system to learn from common failures.

It was viewed as necessary due to the present system being considered slow to detect and learn from mistakes and that investigation procedures were over-complicated, ineffective and, in some cases, designed to protect staff and hospitals rather than discover the truth.

At the same time, clinical staff believed that they were unfairly blamed when things go wrong for reasons outside their control.

The draft bill, published in September last year, allows the HSSIB to conduct investigations using “safe space” – legal powers that prevent it disclosing information it gathers during an investigation.

“Establishing HSSIB will be a key step towards improving the culture in healthcare”

Bernard Jenkin

The move is designed to remove current pressures that can deter healthcare professionals from alerting the authorities to potential safety problems or being frank about failings in patient care.

The joint committee’s report said it supported the planned safe space approach to investigating incidents where patient safety has been compromised.

“This gives greater confidence to healthcare professionals in alerting authorities to potential safety problems,” stated the committee’s report, which was published on Thursday.

However, it called on ministers to reconsider “misconceived” plans to allow HSSIB to accredit trusts to conduct internal “safe space” investigations, citing the likely conflict of interest.

Instead, funding of the new body should be sufficient to allow comprehensive investigation, advice and assistance across the health network, said the MPs in their report.

In addition, the report expressed concern about the “limited remit” of the HSSIB, which meant it was restricted to incidents that occurred during the provision of NHS services, or at NHS premises.

“We expect reporting on staff numbers to become standard practice for every investigation”

Donna Kinnair

This “does not reflect the complex interactions” of health and social care provided by local councils and private providers, it warned, calling for the body to cover “all aspects of the care pathway”.

Sir Bernard Jenkin, chair of the joint committee, 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,” he said.

Sir Bernard said: “Creating a legal ‘safe pace’ 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.

“Far from restricting patients from finding out what happened to them, we believe that the ‘safe space’ will help HSSIB to establish facts and identify the underlying causes of the most serious incidents that take place each year,” he noted.

“For too long health professionals have worked in an environment where blame can be part and parcel of investigations and speaking openly could be damaging to career prospects,” he said.

He added: “Establishing HSSIB as a new independent capability will be a key step towards improving the culture in healthcare and will give staff the confidence to speak openly about the challenges they face.”

It was estimated in 2015 that there were 12,000 avoidable hospital deaths every year. More than 24,000 serious incidents were reported to NHS England, out of a total of 1.4 million annually.

Donna Kinnair, director of nursing, policy and practice at the Royal College of Nursing, said the HSSIB was an “important step in creating a culture that prioritises learning, not blame”.

Donna Kinnair

Dame Donna Kinnair

Donna Kinnair

“Healthcare is beginning to be recognised as a safety critical industry, and with safeguards in place, will allow staff to discuss incidents without fear of retribution or being scapegoats,” she said.

She noted that nursing shortages were “central” to many of the issues facing the healthcare system and it was positive that HSSIB would be free to reflect what was a “major patient safety concern”.

“We expect reporting on staff numbers to become standard practice for every investigation HSSIB undertakes,” said Dame Donna.

She added that the RCN welcomed the proposed expansion of HSSIB’s remit to include elements of social care, highlighting that systemic issues “seldom arise in a vacuum”.

Clare Padley, general counsel at the Nursing and Midwifery Council, said: “We welcome the publication of the report by the joint committee.

“We believe that prioritising learning and creating a culture of openness and transparency across the whole healthcare and regulatory sector is crucial to improving patient safety,” she said.

“We will now consider the report in detail and look forward to engaging with the government as they take this legislation forward,” added Ms Padley, who gave evidence to the joint committee.

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