• Aidan Fowler says design solutions are key to solving never events
  • He wants a just culture in the NHS, but those guilty of wilful neglect should be held accountable
  • NHS culture and openness after mistakes is variable but improving, he adds

The NHS must do more to prevent patient harm by working with industry to design out human error, according to the new national patient safety director.

Setting out his vision for the future of safety, Aidan Fowler said he believed the NHS was more open and transparent than in the past but there was still a long way to go.

He accepted regulators sometimes approached errors like never events in ways which can have negative consequences. When asked about the Care Quality Commission’s tougher stance on criminal prosecutions, Mr Fowler said he was concerned about anything that might hinder the development of a just culture.

He said: “I have come in at a moment of time where there is an opportunity to pause and reflect. To see where we are at. What I don’t think the system needs is revolution. What we have got is great foundations in safety but there is more to be done.

“What I want to see is a strategy that says we are not throwing anything out and starting again. We are looking at what has been achieved and saying what more can be done and how.”

On the issue of never events – avoidable incidents which should never happen – Mr Fowler said he had worked closely with the CQC on its forthcoming report examining why the number of never events has not reduced. 

He said: “I would love to get to a place [where] we have a design idea for every single never event. Whatever the idea is I would love to have something that says more about designing safety into the system, which is what they have done in other industries.”

Mr Fowler accepted the NHS culture and openness after errors was “variable”, but added he was focused on encouraging a just culture approach, where people are supported to improve but held accountable for wilful or deliberate failures.

“It’s very difficult to look someone in the eye and say we did the wrong thing,” he said. “In my experience of it, and I have had to do it, people do understand. It is quite a surprising experience.

“What are the things that incentivise people to cover up? Is it fear of litigation and cost? Is it fear of the coronial system? Is it fear of reputational damage? They are all influential and, the more we can do to develop a just and open culture, the better.

“We are on a journey on that one. Those who do it well, do it really well but it’s not uniform across the piste.”

Asked whether he supported the stance of the CQC chief executive, Mr Fowler said: “My primary concern is the development of a just culture within the NHS. That means people feel able to speak up about what is going on and be open and transparent. Anything that hampers that concerns me.

“But I am equally aware there is sometimes a need for a deterrent and, very rarely, a need to intervene stronger. If people wilfully neglect patient safety then it is appropriate they are held to account for that. If it’s a pressurised system where it’s just plain difficult and people are doing their best, prosecution, in my view, is not helpful in that situation.”

On the approach to errors by regulators, Mr Fowler said he recognised the anxiety it can cause for providers: “I don’t recognise that’s the intent but it may be the impact sometimes from regulators going in and the regulators desire to see things get better. Sometimes that is done in a way that adversely and in an unintended way may influence people’s desire to put their head above the parapet.”

He said he had specifically supported some trusts already over high levels of never events and that he had been clear with other parts of the system that he did not want them to intervene.

“I still recognise there are people who would punish trusts for errors,” he said. “But that is decreasing.”

Trusts expected to create new patient safety director role