• Aidan Fowler wants to see patient safety directors in every NHS trust
  • All staff will be given patient safety training under a new regional structure
  • NHS Improvement will aim to be more “directive” over the 15 patient safety collaboratives

All NHS trusts will be expected to appoint patient safety directors working at a senior level within a new national structure designed to deliver “uniformity” and help reduce patient harm.

In a wide-ranging interview, Aidan Fowler, the new national patient safety director, set out his emerging vision for patient safety policy in the NHS, which will sit alongside the NHS long-term plan.

Among his proposals is for NHS Improvement to become “more directive” over the 15 English patient safety collaboratives to deliver national programmes for improvement. Each of the new NHS regions will also have a safety structure under the national patient safety team.

The patient safety collaboratives were established five years ago and have received more than £35m in funding. Mr Fowler said he wanted to “make better use” of them. He added they had done good work but “if you plan centrally, you reduce variation, but trying to do improvement across a population of 56 million is quite difficult”.

He continued: “NHSI will be a bit more directive but we don’t want to be heavy handed or micro-managing. We don’t want to be destroying what they have already achieved or suppressing the innovation out of them.”

Mr Fowler, a former consultant surgeon, told HSJ he wanted to reduce the variability in how some trusts approached patient safety through new roles and national training in safety issues and policy.

“We can work together better at the top,” he said. “We want to work on a patient safety structure for regions. Then there is how does it work in an individual trust and, at the moment, there is a slightly variable group of people.

“If you’re putting out information to busy medical directors and nursing directors who have a huge amount on their plates, I don’t think that’s the best way.

“Some organisations already have people badged as their safety directors so it’s not new in that sense. What we are saying is let’s have uniformity but also let’s make sure they are properly trained.

“A patient safety director who knows how to respond to an alert and senior enough to get through the system and get time with people who are relevant, someone who can network with us and understand what is going on in the real world.”

On training, he said his aim would be for the same training to be delivered for all staff, not just nurses and doctors. “We all do fire training but we don’t do safety training, which seems bizarre. I’ve seen one fire in one hospital but I’ve seen lots of patient safety issues,” he said. 

Mr Fowler said a draft vision for patient safety strategy in the NHS will be published alongside the long-term plan, but will not be finalised until March, after a consultation with the NHS.

He said: “I specifically don’t want to be the author of something written from a cupboard that people have not had the chance to input into.”

Describing the strategy as an “undecorated Christmas tree, a starting point for a conversation”, he said it would have three broad areas of focus – insights, infrastructure, and initiatives.

On insights, he said this would look at the range of information and data collected in safety, such as incident reports, coroners inquests, clinical negligence claims, and concerns raised by patients and staff. He said one major development would be the launch of a new incident reporting system to replace the 15 year old national reporting and learning system, which would also make use of machine learning to understand trends in safety.

On infrastructure, he said: “The assumption that we get information in and we put information out and that’s our job done is, I think, wrong.”

He said the new national safety committee to prioritise safety alerts should become a national patient safety committee, where all the major bodies involved in safety will meet and work together.

“I would then see the next iteration of that committee being a national safety committee where we work together as different bodies with an interest in safety,” said Mr Fowler. “It’s what they do in transport – the different players in safety get together and discuss things. Once there is an issue, we want to work together to try and solve it.”

He said the new national system of medical examiners would report to him once the system was up and running via a national medical examiner role. The government has said this should be operating by April 2019.

In the final section of the strategy, Mr Fowler said this would be where the new approach to patient safety collaboratives would come into effect to ensure action is taken. “We are doing important and relevant stuff,” he said. “How do we continue that and how do we spread it? What is the mechanism for doing that?”

Mr Fowler said the whole strategy was predicated on maintaining the existing £15m spend on patient safety within NHSI but to reallocate funds to priority areas and reform how the system worked to reduce the estimated £900m cost of patient harm.

Trusts expected to create new patient safety director role