The largest single patient safety improvement programme in the world will be created by NHS England in response to the Francis report, the director overseeing it has explained.

The organisation’s patient safety director Mike Durkin explained the plans to HSJ and said he believed they would bring “the greatest” benefit of all the developments taking place in response to the Mid Staffordshire Foundation Trust public inquiry.

Mike Durkin

Mike Durkin

Plans are being finalised but NHS England, with NHS Improving Quality, is set to invite organisations to form partnerships to lead and run 15 geographical patient safety learning “collaboratives”. NHS England will fund them.

Previous patient safety programmes in England have not been commissioned nationally by the NHS nor designed to be long lasting, although some areas of the country had established their own lasting arrangements.

Dr Durkin said the new approach would be “sustainable through to the next decade” nationally, and create a “learning culture that becomes self-sustaining and powerful”.

Also in NHS England’s patient safety plans

  • Overhaul the incident reporting system, particularly to improve reporting from primary care, and potentially reports from patients
  • Overhaul the safety alert system, including monitoring how alerts are implemented
  • Begin publishing ward level patient safety and staffing data next year
  • Agreeing safety indicators and interpretation with the Care Quality Commission

The work will also see 5,000 “patient safety fellows” nominated in the service in the next five years.

The moves will create the “largest whole system patient safety improvement programme in the world”, Dr Durkin said.

He said: “The learning from Robert Francis and Don Berwick [reports] in particular has given us a great opportunity to build a new system of safety improvement across the England that will cover the whole country, and every sector and every setting.”

He indicated the new focus on improvement would bring more benefit than other responses to the Francis report, such as a strengthened inspection regime.

While inspection highlighted failure to meet quality standards and variation against them, improvement work was able to address variation and raise future standards, Dr Durkin said.

“To shape and improve local systems you need a systemic approach that will reduce the variation…

“That for me is the greater part of the cycle. That’s why I believe the improvement area is the one where the greatest gain is. There is the greatest gain for the patient in improving care and reducing harm.”

Dr Durkin, who was previously NHS South of England medical director, said part of the work of improvement programmes would be to ensure staff feel able to be honest about incidents with patients, and also to report them.

This challenge is against a backdrop of a government and public focus on strengthened legal and professional penalties for poor care and failure to be open.

Dr Durkin said clinicians “understand our responsibility to share information with our patients”, but added: “It’s a difficult thing to know exactly when you should share information with patients”.

He said he believed information should be shared “as soon as is possible, regardless of whether you think any long-term harm has taken place”.

“Sometimes there has been the impression that first you must understand the legal implications of what you say before you say it,” he said. “[However I believe] our responsibility first of all is for your patient and the legal implications are important but secondary.”

He said part of the work of the patient safety collaboratives would be to “give confidence to staff” in sharing information with patients, and “to remove fear from reporting”.