Managers must eliminate the blame culture in the NHS to prevent under-reporting of safety breaches, the chief executive of the National Patient Safety Agency has warned.

Managers must eliminate the blame culture in the NHS to prevent under-reporting of safety breaches, the chief executive of the National Patient Safety Agency has warned.

In an interview with HSJ, Martin Fletcher said staff fears of being blamed for mistakes drove problems underground. He called for a more systematic approach.

Mr Fletcher, who took over in May, said that while the NPSA has a good idea of the trends in patient safety, incidents were being under-reported.

The former World Health Organisation patient safety lead said: 'We can't make healthcare safer if we don't know where the problems are. Reporting and having a way of finding out where things go wrong is the absolute foundation of building safer healthcare.

'If you're leading an organisation where staff are concerned about reporting, scared of being blamed, there is a huge risk you are not going to find out about things going wrong.'

Managers should make it easier for people to raise concerns by making it part of the organisation's culture, he said. They should also give staff feedback when a patient safety issue has been raised.

Royal College of Nursing head of policy Howard Catton commented: 'If someone makes an unintended mistake, why can't we have a commitment that there won't be any punitive action, instead of people having the very real possibility of losing their job?'

He cited work carried out in the US by healthcare reformer Rosemary Gibson showing that for every error reported, 50 mistakes had been made along the way. Unless staff and managers looked back down the system, the root of the problem would be missed, he said.

Paul Holt, director of operations and facilities and chief nurse at Wirral University Teaching Hospital foundation trust, which scored highly in incident-reporting in the Healthcare Commission staff survey in 2006, said trusts had to get the balance right. 'We don't go in heavy unless there has been completely irresponsible behaviour,' he said. 'We have moved from blaming people to looking at the cause of errors.

'We have on average 6,000 incident forms filled in every year as the staff feel confident that they can raise concerns and we respond to each of those.'

Overall, the commission's survey revealed that 57 per cent of staff had reported errors but 5 per cent had not. While 38 per cent felt that staff involved in an error, a near miss or an incident had been treated fairly, 4 per cent did not.

Mr Fletcher also said the NPSA would focus on developing a national campaign for patient safety (see 'NPSA prepares awareness campaign').

'It's a big project for us. We are planning to have it running for next year. It's not something trusts will have to do but something so appealing they will be knocking down our door wanting to get on board.'