New NHSE chair seeks ‘clear accountability and responsibility’

Penny Dash – who on Monday was confirmed as the new chair of NHS England – told a patient safety conference that accountability and responsibility for delivery were much clearer in many other industries.

“It is not like this in other industries,” she said. “They have very clear lines of accountability and responsibility, particularly through boards. It is usually much clearer who is responsible for delivering and who is responsible for regulating. That does not just stop at the board but throughout the organisation. It’s very clear what people’s jobs are.”

Dr Dash completed a review of the Care Quality Commission last year, and a second review covering wider quality and safety oversight is expected within the next three weeks.

It is looking at six organisations in particular: the National Guardian’s Office; the Patient Safety Commissioner; NHS Resolution’s quality and safety functions; the Health Services Safety Investigations Body; the Care Quality Commission; and Healthwatch.

“It is indeed a very busy landscape,” she said, adding there had also been many inquiries on quality and safety which had cost a lot of money and produced a lot of recommendations.

“The Thirlwall Inquiry [into Lucy Letby’s murders] referred to 1,400 recommendations,” she added. “There are 450 recommendations from the inquiries into maternity care. There’s all these recommendations from different bodies to ‘do this, don’t do that’.”

She added that her report would have “recommendations on recommendations”, and said the HSSIB’s purpose was to reduce the need for additional inquiries.

Dr Dash told the HSJ podcast last month that her review would emphasise the role of boards, and that quality should encompass productivity and efficiency as well as safety and effectiveness, messages she also addressed at the Patient Safety Forum conference, organised by Public Policy Projects with Patient Safety Learning.

She said: “We know that well-managed services lead to more efficient use of resources – that in itself is a big quality opportunity. We can actually do things for less that frees up money for more care.”

Looking forward, she said she hoped the NHS would be given a “balanced scorecard” to measure quality, alongside the priorities in its annual planning guidance.

She said there were many metrics available, but they could be “presented and brought into board papers” better than they were, she said.

The current North West London Integrated Care Board chair pointed to the difficulty of accessing data on the number of patients harmed. One commonly used figure was 11,700 deaths from harm in hospital a year but this was more than a decade out of date, she said, and more recent analysis suggested a figure closer to 800 deaths a year from unsafe care.

But, she indicated, there is big variation in care effectiveness; there are 4.4 million people with diabetes in the country, but the rate for getting the right package of primary care varied from 2 per cent in some areas to an average of 50 per cent. The same was true of other categories such as heart disease, undiagnosed hypertension and HPV vaccinations.