Everything you need to stay up to date on patient safety and workforce, plus my take on the most important under-the-radar stories. From patient safety correspondent Shaun Lintern.
Introducing Lintern’s Risk Register
Welcome to HSJ’s first dedicated patient safety and workforce email briefing. Every week I will summarise my selection of the big developments in these important areas, direct to your inbox. I will also signpost you to must-read articles and other links to help you keep up to speed.
Most importantly, I will keep highlighting the big issues and running stories which are not getting the attention they deserve elsewhere.
I’m really keen to hear feedback – particularly things I’ve missed and things you want to see highlighted – so don’t hesitate to contact me.
This email replaces the previous Workforce newsletter. You can update your preferences here.
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Shaun Lintern, patient safety correspondent
Dawn of the Healthcare Safety Investigation Branch
First out of the gate is the painfully slow birth of the new Healthcare Safety Investigation Branch (formerly known as IPSIS). It has had a long gestation but now finally we can see the head, thanks to an HSJ interview with national patient safety director Dr Mike Durkin. He explains that HSIB will be given a “safe space” for it to receive evidence from NHS staff and organisations without fear of it being used against them later.
The idea behind HSIB – a no-blame, fact-finding investigation service to prevent errors being repeated – is a sound one. The implementation, however, could be tricky. It will be hosted by NHS Improvement. This was something the expert panel behind its design was adamant should not happen (the panel wanted it to be fully independent) but has been forced to accept because of Jeremy Hunt’s refusal to create any new arm’s length bodies. It will also investigate only 30 cases a year and be likely to reject unresolved historical cases.
Whoever is brave enough to take on the new chief investigator role at HSIB will have an uphill struggle to win the confidence of the public and NHS staff and leaders. Dr Durkin told me one of HSIB’s first tasks would be to set out an “exemplar model” for local incident investigation which would set standards local organisations should follow to really get to the heart of errors locally and prevent them happening again.
This could be a game changer and is definitely a development to watch.
Call in the medical examiner
Desperate to shift the focus back to his own ‘safe space’ of patient safety and away from striking junior doctors, Jeremy Hunt is expected on Thursday to announce that the government will finally roll out an independent medical examiner service across England from April 2018.
For those who think this only matters to the dead, think again. Pilots for the medical examiner role, which will investigate all deaths, have shown that they can have a very real impact on the safety of living patients on NHS wards and could lead to substantial work for NHS trusts in tackling the concerns they may expose. See my article on this.
Medical examiners were originally recommended by Dame Janet Smith’s inquiry into Harold Shipman, and have been supported by further recommendations from Sir Robert Francis’ Mid Staffs inquiry and Bill Kirkup’s investigation into failures at Morecambe Bay. Although legislation was passed in 2009, Andrew Lansley’s 2010-13 NHS reorganisation, and fears over a “death tax” charge levied on families to pay for it, have delayed this important development until now.
Mr Hunt deserves praise for pressing the button on this long overdue reform as does the president of the Royal College of Pathologists, Suzy Lishman, who has been quietly lobbying for it behind the scenes.
Carter vs Willis
Reform of the NHS workforce and particularly nursing continues to be controversial – but some significant risks are not attracting the attention they deserve. Notable among these is the “care hours metric” proposed as part of Lord Carter’s efficiency and procurement review. Its method counts healthcare assistants as equivalent to nurses – and it has therefore been dismissed as “too blunt a tool” and “meaningless” for workforce planning by fellow peer Lord Willis, who led a recent review into nursing workforce for Health Education England. Embarrassingly, the Department of Health has had to accept that a number of claims in the Carter review don’t stand up to scrutiny.
But Lord Willis doesn’t escape controversy himself. His proposal for a nursing associate band 4 role continues to draw concerns – the principal one being the fear that it will be used as a substitute for qualified nurses, something Health Education England’s director of nursing says should not happen.
Health ombudsman under fire
But at least the Parliamentary and Health Service Ombudsman can be relied on to avoid controversy and act with integrity. Oh wait… it appears the deputy ombudsman Mick Martin is having some time away from the office after HSJ exposed his role in covering up the sexual harassment of a former NHS director. Ombudsman Dame Julie Mellor knew about this seven months ago and has not explained why she didn’t act sooner. HSJ editor Alastair McLellan summed up the situation here and called for the ombudsman’s leadership to step down.