HSIB to stop maternity investigations by 2021

Powers to allow HSIB to continue investigating more than 1,000 serious incidents in maternity units each year were left out of legislation which was presented to the House of Lords this week, sparking criticism from former health secretary Jeremy Hunt.

The new bill gives HSIB statutory independence from the NHS alongside a range of powers, including the power to enter and seize documents and equipment that could be evidence. It also grants HSIB the power to keep information in a so-called safe space that cannot be shared, except in exceptional circumstances, with bodies like the General Medical Council.

HSIB was established in 2017 to carry out independent investigations into systemic patient safety incidents and to make recommendations on improvement using a human factors, safety systems approach to incident investigation.

Mr Hunt asked HSIB to take on maternity investigations from 2018 due to concerns they were being poorly conducted by the NHS and to help boost efforts to meet the target of halving the rates of stillbirths, neonatal and maternal deaths, and brain injuries.

However, MPs criticised the decision, arguing it confused the original purpose of HSIB and could undermine trust in its work. They argued maternity investigations should remain the NHS’ responsibility.

A Department of Health and Social Care spokeswoman told HSJ it was important the current work continued “for a time-limited period so that we get the maximum learning”.

She added HSIB would continue the work “until the new body commences operations, planned for 2021”.

‘A world first for the NHS we mustn’t throw away’

Mr Hunt welcomed the HSIB Bill’s inclusion in the Queen’s Speech but said he was “very concerned having read it that there is no provision for the maternity investigations HSIB currently does.

“These are vital given we have four neonatal deaths every single day and that maternity mistakes are about 40 per cent of the huge annual litigation bill the NHS pays. We must find a way to allow HSIB to continue spreading the learning from these tragedies by investigating every single maternity death — a world first for the NHS we mustn’t throw away.”

Maternity safety campaigner James Titcombe, who served on the original expert advisory group that directly led to HSIB’s creation, said HSIB was asked to investigate because “of repeated evidence that the local system of investigating these cases was not fit for purpose, meaning families were often left battling for answers for years and crucial learning simply didn’t happen.

“We must never go back to the system we had before, where families and staff were put through local investigations that were often inadequate and sometimes actively concealed the truth.”

NHS Providers chief executive Chris Hopson accepted “significant improvements” were needed in the way maternity incidents were investigated and HSIB was now adopting a systemic approach but he said the work should not be made permanent “without full and proper debate, including recognising the legitimate concerns raised by the joint committee”.

Safe space concerns

Away from maternity, Mr Hopson said he was concerned about powers in the bill which allowed coroners to access safe space information and could then make it public.

He said: “Safe space should be exactly that — safe. Staff have to be confident that the information they provide to HSIB will not be passed on or used inappropriately or unfairly to apportion blame or create scapegoats. Including this power directly contradicts the strong advice of the joint committee scrutinising the bill.

“It’s frustrating that the government has added this provision very late, without consultation, and without respecting the imperative for safe space.”

The DHSC spokeswoman told HSJ coroners could not automatically share information. She added the bill had a “narrow exception” for coroners to help their investigations into deaths but they would still require an application to the High Court before sharing information more widely.

In the face of widespread criticism, the government has also dropped plans to extend the safe space powers to the wider NHS and organisations.

The DHSC spokeswoman said: “We want to ensure that the new Health Service Safety Investigations Body [as it will be renamed under the new law] only focuses on a small number of national investigations, conducted using a ‘safe space’ approach, to ensure the greatest opportunity for learning for the NHS.”