NHS ‘a long way’ from being ‘proactive’ on safety, watchdog warns

Rosie Benneyworth, who was appointed as interim chief investigator last summer, said other safety-critical industries made decisions on the basis of a “triad” of operations, finances and safety. She said the NHS needed to be “more proactive” to take action before things go wrong.

Dr Benneyworth said in an interview with HSJ, ahead of the HSJ Patient Safety Congress this month, in which she is a speaker: “I think it’s fundamental that ICSs put safety at the core of everything they do. And I don’t think operational decisions or financial decisions should be made without considering the implications for safety.”

It comes amid huge pressure to cut spending at many ICSs, with 14 out of 42 which are forecasting deficits subject to NHS England’s “financial control regimes” and national rules that limit their spending on staffing.

Dr Benneyworth – a former GP and commissioner – also spoke about whistleblowing in the wake of the Lucy Letby scandal, saying national organisations should “lead the way” on being proactive over safety and supporting whistleblowers. Major cultural problems were uncovered at HSIB several years ago, while NHSE has been under the spotlight in recent weeks for implementation of the “fit and proper person” test for board members.

“I think it’s very difficult as national organisations to tell providers what they should [be] doing, if we’re not doing it ourselves,” Dr Benneyworth said.

She added: “What we need is a much more proactive approach to safety, where we actually identify those things that could go wrong and take action before they do go wrong.

“And if we did that, then actually, we might finally have less whistleblowers, because they’d be confident…  concerns were being listened to and acted upon.

“We’re quite a long way away from that and, at the moment, what we need to make sure is that people are able to speak up, that they’re listened to, that their concerns are acted upon, and that they are protected.”

Lawyers’ adverts adding to parents’ anxiety

Maternity services have been a major area of safety concerns in recent years, but Dr Benneyworth warned: “I think it’s vital for the public to have confidence in the services that they use.

“It must be a worrying time… if you’re a woman who’s pregnant at the moment and listen to some of the stories they hear, it must be difficult. And I also know that… some of these pregnant women end up with social media feeds with adverts for lawyers and legal representation if something goes wrong, which probably also adds to the anxiety.

“But we need to work hard… there is good care, as well as the poor care, we need to remember that, and we need to build on what’s happening and learn from the places that are doing good as well.”

She said some of the problems with the services were due to a shortage of staff, but there were other factors such as “culture, hierarchies… people not being able to speak out, processes that could be improved [and] environments that can be improved”. Dr Benneyworth added: “There are some things that are in a trust’s gift to be able to improve and our maternity team do see a lot of improvement with the trusts that they work with.”

Road to independence

Next month, HSIB will officially become a fully independent public body and be known as the Health Services Safety Investigations Body.

This has seen its first independent board appointed, which will be chaired by Ted Baker, former chief inspector of hospitals at the Care Quality Commission. HSIB has been the subject of much scrutiny over recent years with concerns raised over hierarchical management and poor governance.

The maternity investigations team will not be part of HSSIB and will instead be hosted by the CQC – which has its own share of pressures with staff strikes and a major organisational transformation programme to see through. Dr Benneyworth said HSIB had been working very closely with the CQC to do this.

When asked if the CQC has the capacity to host this work, Dr Benneyworth said the HSIB maternity team had already done more than 3,000 investigations since it had been set up and hosting it would not be “hugely onerous”.

Before joining HSIB, she was the CQC’s chief inspector of primary care and integrated care.

She also described HSSIB’s independence as a “massive opportunity” and said she was keen for the organisation to look at patient safety consequences of things that are out of the spotlight, such as procurement, estates, and supply chains.

“What we want to do is make sure that we don’t look at our impact by the number of investigations,” she said. 

It would engage more with other “partners” when it decides what to cover, she said, and to avoid duplicating subjects. She wants local NHS organisations to “really take note of what we’re saying” in future, and avoid “tick box” compliance. 

She added that, although it will have more new powers to issue fines and require people to give evidence, “we’re very keen to be a supportive organisation and that people see the real value in getting involved in our investigations. We don’t want to be an organisation that is having to compel people to get involved in talk[ing] to us.”