The importance of safe staffing has been highlighted in a new strategy for patient safety in the NHS, which includes the development of a major national training syllabus for all NHS workers.
According to NHS England and NHS Improvement, if implemented successfully, measures outlined in the new patient safety strategy have the potential to save nearly 1,000 extra lives and £100m in care costs each year from 2023-24.
“Workforce challenges clearly create pressures on the system”
Patient safety strategy
Meanwhile, there is scope to reduce the amount of negligence claims provision for neonatal brain damage alone by about £750m per year by 2025.
According to the document, the health service’s “dedicated, diverse and skilled workforce” are the key to making improvement and represent “our best opportunity to deliver the vision for patient safety”.
It goes on to flag up the importance of having enough staff and the serious impact under-staffing could have on patient safety.
“The Francis report on Mid-Staffordshire NHS Foundation Trust was a high profile and tragic example where staff reported ‘many incidents which occurred because of short staffing’,” said the document.
“The link between workforce capacity and capability and patient safety has many factors, but workforce challenges clearly create pressures on the system,” it stated.
“Those with experience of being harmed can be particularly effective as patient safety champions or in staff training”
Patient safety strategy
The strategy also stressed “the importance of staff well-being for patient safety” and said the Interim NHS People Plan was “a strong step” in addressing workforce challenges.
The strategy, which has been published following a consultation, has three key aims to support the development of a “patient safety culture” and new safety systems.
These include drawing on data from multiple sources to improve understanding of patient safety, and making the best use of digital technology.
The strategy also commits the NHS to implementing safety programmes in key areas including maternity and neonatal care, medicines safety and mental health.
Other priorities include work to improve the safety of older people, those with learning disabilities and tackle the ongoing threat of anti-microbial resistance.
In addition, the strategy promises to ensure staff have the skills and opportunities to deliver patient safety improvements, with plans to create the “first system-wide and consistent patient safety syllabus, training and education framework for the NHS”.
The syllabus will be for NHS workers at all levels and should include content on “safety science”, said the strategy document.
“This is not the same as teaching clinicians how to practise safely – that happens already. It is about teaching everyone in healthcare that error is normal and what the right approaches are to reduce risk and maximise the chances of things going well,” said the document.
“It’s reassuring this strategy acknowledges that unsafe staffing is one of the biggest threats to patient safety”
Under the plan, Health Education England will work with NHS Improvement and NHS England to develop the national patient safety syllabus, which will encompass everything from introductory training for those new to the NHS to specialist modules for new patient safety roles.
“Where possible, patient safety training will be delivered in multi-disciplinary teams and across patient pathways to reflect the way services are delivered,” said the strategy.
“This will help people learn about safety alongside others in a collaborative manner – this learning approach itself enhances patient safety,” it said.
The strategy includes plans to create a network of new “patient safety specialists” across the health service.
Rather than creating new posts, the idea would be to “develop existing people and roles”, said the document.
NHS organisations will be asked to identify at least one person to be their designated patient safety specialist by April 2020.
“The NMC is fully committed to working with NHS Improvement and NHS England to improve safety”
More work will be done to identify the skills and responsibilities of the role, including exploring the potential for “further professionalising the role” through accreditation or similar means.
“While work will be needed to specify further details, we think the patient safety specialist should have oversight of and provide support for patient safety activities across their organisations,” said the strategy.
“Part of their role will be to ensure that systems thinking, human factors and just culture principles are embedded in all patient safety activity,” it said.
It added: “They will need to work closely with others, including medical device safety officers and medication safety officers, and should support the fundamental principle that patient safety is everyone’s responsibility – a specialist is not accountable for an organisation’s safety on their own.”
Meanwhile, patients and carers will have the chance to get actively involved in efforts to boost patient safety by becoming “patient safety partners” – or PSPs.
According to the strategy, people who have themselves experienced harm in the NHS often make the most effective patient safety champions and it encourages trusts to draw on their expertise.
“PSPs can be particularly effective when the organisation recruits a team of PSPs that includes people who have been harmed when in the care of the NHS,” said the document,
“PSPs should be involved in deciding where their input might be needed,” it said. “Those with experience of being harmed can be particularly effective as patient safety champions or in staff training.”
The strategy was welcomed by RCN England director Patricia Marquis, who said it acknowledged the importance of safe staffing.
“This is the clearest sign yet that the NHS understands that workforce shortages have an impact of on patient safety and represents a serious wake-up call for an incoming prime minister. As long as there’s dither and delay on the part of government, this risk for patients only grows,” she said.
“When nearly one in 10 nursing posts in England are vacant, it’s reassuring this strategy acknowledges that unsafe staffing is one of the biggest threats to patient safety,” she added.
Ms Marquis agreed a culture change was needed, in order to improve safety in the NHS and that included being upfront about staffing challenges.
“A more ‘just’ culture means the NHS and ministers will be given more evidence of how staff shortages are detrimental to top quality care for patients,” she said.
“We welcome the extra commitment to transparency and safety and feel confident it will add weight to the current calls from parts of the NHS, politicians and academics to resolve this crisis,” she added.
Andrea Sutcliffe, chief executive and registrar at the Nursing and Midwifery Council, said she welcomed the aims and ambitions set out in “this important strategy”.
“When something awful happens in health and social care, we know what people, their families and carers, really want to see is that it doesn’t happen to someone else’s loved one,” she said.
“The NMC is fully committed to working with NHS Improvement and NHS England to improve safety by moving away from a culture of unfair blame when things go wrong – and instead develop more effective ways of working that can better support the safety of people using services,” she noted.
Ms Sutcliffe said the strategy highlighted some of the key issues that needed to be addressed in “ensuring better, safer care for the future”.
“Of course, a focus on improving systems, processes, frameworks and better sharing of information is vital,” she said.
“But we also need to make sure we have a workforce that is able to support people to raise concerns and for those concerns to be listened to and acted on swiftly, and with compassion and respect,” said Ms Sutcliffe.
She added: “I look forward to working with other regulators and our partners in contributing to the implementation of this important work.”
Head of policy at NHS Providers, Amber Jabbal, said the strategy would be “an important tool for NHS trusts to help foster a culture of learning in which staff feel able to speak up and contribute to continuous improvement to patient safety”.
“NHS staff are committed to ensuring that patients are kept as safe as possible and this strategy helpfully sets out how we can build on this commitment through the use of technology, sharing learning and empowering staff and patients when it comes to quality of care,” she said.
Ms Jabbal welcomed the idea of patient safety experts and commitment to staff training.
“It is right that NHS staff across all levels are given the training, expertise and resources needed to fully embed an effective safety culture and spot the risks of patient harm when they occur,” she said.
“Staff and trusts must also have the support and resource they require to adopt the digital solutions which will play a key role in delivering these aims,” she added.
“We fully support being part of creating a learning culture, not a blame culture”
Dr John Dean, the Royal College of Physicians’ clinical director for quality improvement and patient safety, welcomed the focus on bringing patients, staff and others together to improve patient safety
“We fully support being part of creating a learning culture, not a blame culture,” he said.
However, he said the challenge was now to implement the strategy amid widespread staffing shortages.
“The challenge now is how to implement the NHS Patient Safety Strategy at a local level within the constraints of an overstretched workforce with significant workforce shortages,” he said.