• Safe space powers should not be rolled out to NHS trusts until HSIB has developed it first
  • CQC chief executive and NHS Improvement medical director say HSIB should be free to link staffing levels and safety
  • Sir David Behan said ‘safe space’ must not cut across the existing duty of candour

Giving NHS trusts “safe space” powers to investigate themselves will “erode public trust and confidence”, Sir David Behan has warned MPs.

The chief executive of the Care Quality Commission told a special committee of MPs examining plans for new legislation to establish the Healthcare Safety Investigation Branch as a statutory body, that extending its powers to individual trusts should only be done where public confidence would not be damaged.

He said it “will erode public trust and confidence” and warned any extension of powers to trusts had to be done carefully.

But he also told MPs that with 24,000 serious incidents, it was not possible for HSIB to investigate them all.

“We have got to look at how trusts themselves grow the capacity and capability to do this work with HSIB doing a number in a year of the more difficult, complicated and contentious [incidents],” he said.

NHS Improvement’s medical director Kathy McLean told the committee local trusts should not be accredited to take on HSIB’s safe space powers until HSIB had developed it first.

Safe space powers allow HSIB to keep any evidence it has collected secret but the new watchdog has insisted this will not mean facts about events will be hidden from families and serious misconduct or criminal behaviour will be reported to the police and regulators.

Giving evidence yesterday, Sir David warned MPs that “safe space” must not cut across the existing NHS duty of candour.

They both also told MPs they expected HSIB’s work would highlight the link between poor staffing levels and safety incidents.

Sir David, who will leave the CQC next month, told MPs he fully supported HSIB being given independence but added: “We think there must be very great clarity on the role, purpose and powers of the new body and particularly how that new body works with other bodies and particularly the CQC.

“Having a safe space is important and we can see how that drives learning…but it needs to sit alongside a duty of candour and for patients who have experienced harm or have been subject of an accident that duty must continue to operate alongside safe space.

“The importance of the duty of candour not being fettered is absolutely essential. The evidence not just from here but other countries is that when people are told at an early stage what happened, why and what the consequences are, and that that understanding and learning will benefit others, many many people are often satisfied with that. It’s when they have had to fight to get the truth that they then want to know who is accountable for that.”

Kathy McLean told the committee she also supported independence for HSIB but urged caution on safe space, saying it needed to be developed and could only work in places where there was the right culture.

She said: “We need to be realistic. It is better to do it well than to do it fast.”

Asked by committee chairman Bernard Jenkin MP if HSIB will address issues to workforce shortages, Sir David said it was his personal view that HSIB “should have the freedom to do that,” adding: “You can’t say there are no go areas.”

Kathy McLean added: “I would be very surprised if as part of the systemic findings around safety they didn’t come up fairly soon with something related to staffing, whether that’s doctors, nurses or other staff, and they should be able to make recommendations related to that.

HSIB, which was set up in April 2017, is hosted by NHS Improvement. The Draft Health Service Safety Investigations Bill Committee is carrying out pre-legislative scrutiny on a government bill that would give HSIB statutory independence.