NHS boards are devolving vital decisions on safety and failing to report serious incidents such as radiation overdoses, preliminary Healthcare Commission findings have revealed.

An upcoming review looking at governance systems and how NHS trust boards respond to information will show that the monitoring of safety issues is often poor.

The early analysis, due to be released in full next year, is contained in the commission's annual State of Healthcare report, published today.

It says boards vary in their approach to safety, but targets and finances still dominate their priorities. "In many cases, decision-making and acting on safety is devolved to local services or departments."

Detailed scrutiny of the safety of care often takes place at committee level, "with only key facts and exceptions reported to the board". While it is good to encourage local solutions to problems, the monitoring and auditing of safety improvements at senior level is "often poor".

Acute trusts, especially foundation trusts, are best when it comes to acting on incident reports, but primary care trusts are weaker.

The commission found little evidence that PCTs are systematically monitoring the safety of providers.

Failure to report

In addition, the report says many trusts are failing to report serious safety incidents.

Between April and June this year, 7 per cent of acute trusts, 14 per cent of mental health trusts and 13 per cent of PCTs did not report a single incident. In the past two years, there have only been around 600 reports of radiation overdoses - out of about 25 million procedures.

The commission concludes: "The safety of care is improving as its fundamental impact on the quality of services and outcomes for patients is increasingly recognised. But the NHS has some way to go to ensure it properly learns lessons when things go wrong, anticipates and prevents harm where possible and has systems that ensure safe practice is followed every time, for every patient."

The report also shows health inequalities appear to be narrowing, but progress in reducing the gap has slowed in the past two years.

This is based on a comparison of patients' blood pressure and cholesterol in GP practices serving the fifth least deprived areas with those in the fifth most deprived areas, using quality and outcomes framework data.

Summarising the report, commission chair Sir Ian Kennedy praised improvements but highlighted the "small number of trusts which are trapped at a level of performance that is unacceptably poor". The commission has "changed the face of whole areas of care", such as infection control, over its lifetime, he said.

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