Everything you need to stay up to date on patient safety and workforce, plus my take on the most important under-the-radar stories. From patient safety correspondent Shaun Lintern
Does the NHS utilise the skills of its staff effectively? The first public outing for the new chief investigator, and yet another report highlights the health service’s failure to investigate errors. Contact me in confidence here.
Shaun Lintern, patient safety correspondent
Internal expertise trumps expensive consultants
Last week I enjoyed a day visiting Nottingham University Hospitals Trust to see some of the brilliant projects being led by the staff there to improve patient safety and the organisation’s efficiency and processes.
What struck me throughout the day was the commitment to improvement among the staff I met and also the complete absence of expensive external consultancies. The solutions were being self-generated with remarkable results. I hope to highlight some in the coming weeks.
One example was the trust’s revival of its performance against the national two week waiting time target for cancer patients. Having not achieved the target since February 2015, the trust brought together a team of senior admin support staff who examined the processes being used to book patient appointments. Within three weeks they turned around the trust’s performance against the target using new tools and a system dashboard to help plan capacity. The standard has now been consistently met since October.
This success is one of a number since the trust identified a concept of “essential support” staff, who have been used to improve the smooth running of services that directly impact patients’ care. The trust has even shared its expertise with neighbouring trusts to help spread improvements.
In contrast, NHS Improvement continues to pour millions of pounds into management consultancy organisations and critics continue to question the value for money of these arrangements.
It is inconceivable to me that in a workforce of 1.4 million, someone, somewhere does not already know the answer to many of the problems the NHS faces, even if this learning has not yet been shared across the system. We devalue the skills and expertise of in-house staff, and the NHS is certainly poorer for it.
Chief investigator flies in
The new chief investigator of the Healthcare Safety Investigation Branch, Keith Conradi, showed no hesitation in making clear he will be his own man as head of the new independent patient safety body.
During a grilling by MPs last week, the former head of the Air Accident Investigation Branch made clear he believed health secretary Jeremy Hunt had made the wrong call in not establishing the new body with primary legislation. He went further, telling the public administration and constitutional affairs committee this could well affect public confidence and that the HSIB would probably seek a review of the situation.
His openness before MPs is welcome and he has repeated much of what other critics of the HSIB structure have said themselves. Having NHS Improvement host HSIB – a supposedly independent body – is nonsensical, and only necessary because of the government’s aversion to primary legislation in the House of Commons. The ghost of the Health and Social Care Act still looms large over the Conservatives.
Mr Conradi is likely to have his eyes opened by the culture in the NHS which is significantly someway behind aviation in its focus on safety and learning. He also faces a significant challenge to convince staff and patients that the new body can do what is required. The task has unnecessarily been made all the more difficult by the government.
Another warning sign
One of the key tasks facing Mr Conradi and the HSIB will be to develop an “exemplar model” of trust investigations to improve the woeful inadequacy of NHS organisations to identify and learn from mistakes.
This has been highlighted by multiple inquiries, the Parliamentary and Health Service Ombudsman, MPs on the Public Administration and Constitutional Affairs Committee and most recently by experts convened to offer advice on the creation of HSIB itself.
Underlining this was a new report on 10 June from the Royal College of Obstetricians and Gynaecologists which revealed over a quarter of local investigations into stillbirths, neonatal deaths and severe brain injuries are not good enough.
Worse still, in a quarter of local reviews, parents were not made aware that an investigation was taking place. In 47 per cent of the reviews, parents were made aware that an investigation was taking place and were informed of its outcomes, but in only 28 per cent were they involved in the actual investigation.
According to the college 39 per cent of investigations had no actions or learning to improve care and only 7 per cent included an external expert.
There is plenty of scope for improvement it seems and no doubt these findings would be replicated in other specialties. You can read more about this report here.