NHS Providers warns against 'safe space' plans

In evidence to MPs scrutinising the government’s draft legislation for the Healthcare Safety Investigation Branch, known as HSIB, the NHS Providers said safe space powers, which protect the evidence collected during an investigation, was not appropriate for NHS trusts.

NHS Providers chief executive Chris Hopson told MPs this week that there was a risk that HSIB could cut across the existing responsibilities of NHS trusts when incidents occur and he warned there were questions about HSIB’s independence with the health and social care secretary having the right to direct its investigations.

Care Quality Commission chief executive David Behan has warned extending safe space could erode public confidence while HSIB’s chief investigator Keith Conradi said in January that he rejected the government’s proposals.

In evidence to a special committee on the draft legislation that would create HSIB as a new statutory body, NHS Providers said it welcomed the creation and work of HSIB at a national level but warned “its functional independence does not yet appear to be sufficient.” It suggested HSIB be made accountable to Parliament and not the secretary of state.

On safe space powers NHS Providers said: “A legally protected safe space is necessary for the HSIB’s investigations; it is not appropriate for provider led investigations – their investigations have different purposes, contexts and tools available.”

One controversial proposal in the legislation is that local NHS trusts could be accredited to carry out a form of local safe space investigations that would be similar but separate to the national work of the HSIB investigators.

NHS Providers said: “For the HSIB to succeed in contributing to improved patient safety, any investigations associated with it must be carried out independently and without conflict of interest, and be perceived as such. Accreditation – wherein lies an inherent conflict of interest in NHS bodies investigating themselves and their peers – would seem to undermine these core requirements and risk engendering further distrust in the NHS’s capacity to learn and improve.

“The intention behind accrediting trusts, that of developing a learning culture, would be better directed towards investing in the HSIB’s role in setting standards of investigations and of training and accrediting local investigators to support its own work.”

Mr Hopson told MPs on Monday the way HSIB’s powers were set it could take over investigating an incident, at the direction of the secretary of state, which he said would deprive trusts of the ability to discharge their statutory functions.

He cited the recent example of HSIB being directed to take on approximately 1,000 maternity incident investigations from trusts.

He added: “If we are going to change the culture, there is a whole bunch of activity that needs to follow—training, education, improvement of quality of investigations—and I do not think that necessarily means that local safe space is the right answer.”

Also giving evidence, Niall Dickson, chief executive of the NHS Confederation, told the committee an element of safe space could be used locally but it needed to be done carefully: “I think there is a question mark over the whole accreditation model and how it might be rolled out.

“From our members we have not had an enthusiastic response and people wanting to come forward. We did have one trust where they already have a well trained team of investigators and so forth, but they were not rushing to say that that is something they wanted to do.”

He suggested that a “kitemark” style system with a model approved by HSIB could work but asked by MPs whether NHS hospitals would be trusted to do these investigations, he said: “If trusts are not trusted with the safe space, we might as well pack up and go home. That is the whole point: we have to change the culture.”