Following Jeremy Hunt’s appointment as chancellor, HSJ is now hosting the Patient Safety Watch newsletter. This week features a guest column from HSJ editor Alastair McLellan.

Good afternoon and welcome to this fortnight’s Patient Safety Watch Newsletter. In this edition, we are sharing the first of a new series of guest blogs, kicking off with Alastair McLellan, HSJ’s editor. He argues that, despite the growing number of national patient safety roles and organisations, patient safety still isn’t at the top of the health service agenda.

We will be including more guest blogs/opinion pieces in future editions.

A few updates to share…

The usual patient safety news roundup will be in our next edition in two weeks’ time, but before reading our guest blog, here are a few patient safety updates from the last fortnight.

PHSO publishes updated complaints standards

This week, the Parliamentary and Health Service Ombudsman published updated NHS complaints standards and guidance, which have been revised based on feedback from organisations taking part in the PHSO pilot programme. 

CQC launches 2023 Maternity Experience Survey

The Care Quality Commission has launched its 2023 survey of mothers and other people’s experience of maternity care this week. The survey is a key part of how CQC assesses the quality and safety of maternity services in England and is open to anyone whose baby is born in January, February, or March this year. 

NHS chief executive Nick Hulme on ‘awful’ hospitals

One of the most stark news articles I came across this fortnight was this account of the current conditions in hospitals from East Suffolk and North Essex Foundation Trust chief executive Nick Hulme. Speaking at an integrated care board meeting, Mr Hulme said: “We have sadly come to accept the totally unacceptable… the worst place you can possibly be in the health system is a hospital, unless you need to be there.” 

Mr Hulme has since apologised “if the language that I’ve used has offended anybody, particularly our staff – perhaps I was a bit clumsy”. However, it’s not always the case that NHS chief executives speak about problems with such candour. As a senior NHS leader, Mr Hulme sets a great example. 

New national adverse events policy published in New Zealand

A new national adverse events policy for New Zealand has been published this week. The policy aims to improve service user and health care worker safety by supporting organisations to heal, learn and improve if harm has occurred in health and disability services. Of particular note, the policy has a strong focus on restorative practice, something I hope policymakers here will look at with interest. 

A deeper understanding of human factors in anaesthesia

A final share for this edition – readers interested in human factors thinking will enjoy this paper in journal Anaesthesia from Stuart Marshall. It’s a brilliant piece that deserves to be read by everyone working in patient safety, not only in anaesthesia.

That’s all for this edition. Do read our guest blog from Alastair below, and watch out for our next edition in two weeks’ time. Thank you for reading and stay safe.

James Titcombe

Too many patient safety cooks by Alastair McLellan

The profile of patient safety as a NHS priority is much lower than it was pre-pandemic. This is, on the face of it, surprising, as the danger of harm to patients undergoing NHS care is growing. Lengthy waits, stressed staff, and crumbling infrastructure all raise the chances of mistakes being made and best practice being neglected.

This decline in importance is despite the fact the NHS’s national patient leadership roster has never been so well-staffed.

That roster includes (in alphabetical order by surname): interim chief inspector of the Healthcare Safety Investigation Branch Rosie Benneyworth, national director of patient safety Aidan Fowler, and patient safety commissioner Henrietta Hughes.

The new body to takeover HSIB’s work on maternity investigations, along with its leader, is due to be established soon.

There are also many senior figures for whom patient safety issues provide the majority of their workload. They include national freedom to speak up guardian Jayne Chidgey-Clark, and Parliamentary health ombudsman Rob Behrens.

Then, of course, there is the CQC – one of the five “domains” it inspects within is “safe” – and NHS Resolution, part of whose role is to reduce the service’s liability arising from unsafe care. The Medicines and Healthcare products Regulatory Agency, the National Institute for Health and Care Excellence, and the Royal Colleges all have some patient safety related responsibility.

Readers will be able to add more names and organisations.

This level of resource should mean patient safety is at the top of the health service agenda, but it is not.

There are plenty of reasons for this – good and bad. Patient safety is not something politicians (with the exception of Jeremy Hunt) want to talk about at the best of times, and especially not in the middle of a full blown crisis. National and local healthcare leaders also have plenty else on their mind – and are loathe to tell overworked staff “you need to be safer”.

To be fair to the patient safety organisations mentioned above, some are very new (or even yet unformed). They also have few resources to call on. The PSC’s office, for example, is little more than Dr Hughes and a few Department of Health and Social Care secondees.

As a result of all of the above, the patient safety voice in the NHS is fractured and weak. For those who want to downplay the importance of patient safety matters, and their implications for finances and workforce, it is too easy to ignore pleas for action.

Witness the first report from the PSC. It was hard hitting and clear sighted about how the NHS was regressing on patient safety. It was covered in HSJ and the Independent alone.

Those who champion the current set up argue the sheer number of voices will – in time – coalesce into a lobby that will be hard to ignore. The PSC sees herself as a convener of the various groups.

This could work – the influence of the health and care charitable sector has increased thanks to the work of the umbrella body, the Richmond Group. Focussed interventions might get cut through better than grand plans and high profile strategies.

But one of the lessons of the last two decades is that patient safety needs a flag to rally round. In the noughties, it was the National Patient Safety Agency and, in the next decade, it was Mr Hunt’s personal crusade in the wake of the Francis report.

There was plenty wrong with the NPSA, and few mourn it. Mr Hunt’s tenure as health secretary also saw the emergence of the workforce shortage that underlies much of today’s patient safety problems. Many grand plans and strategies developed during these times made little difference at the front line.

But, in both cases, the profile of patient safety as something the NHS needed to take more seriously gained some momentum.

It is to be hoped the many patient safety bodies active now can form an effective operation – and they should be allowed the time to try.

But not too much time… as Dr Hughes said in her report, the next Mid Staffs is not too far away.

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