Workload and lack of expertise hitting safety, says CQC

Ted Baker, the Care Quality Commission’s lead inspector, told HSJ: “Because of the systems and processes [staff] work under it is very difficult for them to actually achieve the safety level they want to and some of that is the sheer workload they face on a daily basis.

“Staff told us time and time again that safety should be their top priority but they are working so hard with the workload that sometimes it is very difficult to prioritise it the way they want to.”

He spoke to HSJ to coincide with the launch of a study by the CQC today on why the number of preventable “never event” incidents is not falling - there were 468 reported between April last year and March.

The report says the current system of national arm’s length bodies “is confused and complex, with no clear understanding of how it is organised and who is responsible for what”. It raises a number of other concerns about how NHS organisations and systems inhibit safety (see list of findings below).

Professor Baker also said there was a cultural disconnect between frontline NHS staff who experienced the high-risk reality of healthcare every day and the false belief of many others in the service that it was intrinsically safe.

“That disconnect is really very tangible because it makes it very difficult for staff to react in the right way and organisations to react in the right way when things go wrong,” he said.

“It leads to the defensive behaviour we see so much of in healthcare. There are things we can do to improve systems and process but fundamentally if we don’t address those cultural issues we won’t make the progress we want.”

The report, ordered by former health secretary Jeremy Hunt, also makes a number of recommendations about safety, including that NHS Improvement leads work to identify where processes can be standardised to reduce inconsistencies.

Professor Baker called for better training and an investment by NHS trusts in safety expertise, warning: “If we get safety right it will make us more operationally efficient and financially efficient. If we get in the mindset that we’re too busy to invest in safety training then I think that is a really dangerous place to be.”

He added: “There is an assumption that people in clinical roles understand safety but actually if you look at safety training in the clinical curricula it is not at all consistent. They may understand the clinical system very well, but they don’t understand safety like human factors.

“If you talk to other high risk industries they will say you cause more problems by not doing this sort of training.”

Other findings from the CQC’s report include:

• Due to competing pressures on staff, implementing patient safety alerts can be seen as just one more thing to do, and can lead to staff taking a mechanistic and siloed approach to implementation leading to variable adaptations of the same guidance.
• Too much reliance is placed on the individuals delegated the task of implementing alerts. Trust boards are not consistently discussing never events and safety alerts.
• Rigid hierarchical structures prevent people from speaking up about safety critical incidents.
• Trusts receive too many safety-related messages from too many different sources.
• NHSI should work to standardise clinical processes and governance while allowing for clinical judgement.
• The national patient safety alert committee should oversee a standardised process for all bodies issuing alerts.

The CQC also said it would monitor the implementation of patient safety alerts as part of its inspection process.