Patient safety in the NHS – what we can learn from the recent IPPR report into injury prevention

The NHS has seen some incredibly challenging months recently, with staff treating patients under very difficult circumstances and the ever-looming threat of a second wave of coronavirus cases. It is no surprise that there has been a knock-on effect to waiting times for NHS care. The unprecedented circumstances mean that many of the delays to treatment may not in fact be negligent.

However, negligence does occur and these cases represent valuable patient safety learning opportunities for the NHS. Whilst things have improved - with the introduction of the duty of candour and harm-free care remaining at a rate of 94% since 2012 - there is still room for improvement in how the NHS learns from patient safety incidents, including positive use of the information it obtains from claims against it to prevent the same harm from occurring again.

Learning needs to improve, but is impacted by significant challenges

The recent IPPR report cites a lack of learning as a ‘huge area for improvement’, giving the example of the scandal-hit East Kent Hospitals University Trust having acted on only two of 23 recommendations from a 2016 maternity care review. According to the report, patients’ voices are often disregarded and this has been a common factor in many of the patient safety scandals of the last 20 years. Unfortunately, patients are often not invited to contribute, are ignored, or have even had their views discounted, despite evidence saying this compromises investigations.

All too often funding and staffing pressures are used to excuse the lack of patient safety learning and this is cited in the report. However, structural issues in the NHS, namely multiple independent Trusts resulting in a lack of consistency across the NHS as a whole organisation and multiple, overlapping Government agencies with responsibility for various aspects of the operation of the NHS, is likely to be a more significant problem.

There is no doubt that understaffing of nurses is a chronic issue in the NHS though, with 40,000 vacancies in Q4 of 2018/19 alone. Unfortunately, poor morale is also causing significant staff turnover, with 92% of nursing staff citing this as the reason for leaving their job.

According to the report these issues, alongside what the report describes as an atmosphere of fear from a hierarchical structure, can be linked to the following barriers to learning:

• staff are not trained in effective safety investigations, because they do not have the time and funding needed;
• it is challenging to introduce new ways of working, again because staff don’t have the time to learn them due to understaffing;
• patient safety skills are not valued when it comes to considering pay increases and promotion;
• metrics of success are geared towards waiting times rather than outcomes, which could be tracked back to general Government policy on funding which emphasises efficiencies over effective care;
• budgets tend to be siloed, and don’t include the resources for long-term patient safety learning.

Medical negligence solicitors as patient safety partners

The portrayal of clinical negligence claims as a ‘burden’ instead of as a learning opportunity in themselves means that the NHS’s improvement will stall unless action is taken. Complaints to the NHS, for example, remain an ‘untapped resource’ according to the report, and this is something we have often found when people come to make a claim - they feel their concerns have been ignored and that bringing legal action is the only way to get answers.

The IPPR report has a couple of key recommendations, which echo our call for a patient-centric NHS:

• set up patient safety networks to share best practice and avoid harm;
• encourage the Government to commit to a long-term safe-staffing level, with a legal duty placed upon the Secretary of State for Health & Social Care to maintain this level.

We hope that the Government does heed these suggestions, and takes notes of the concerns raised in the report. Furthermore, should patient safety networks be instituted as part of future reform, we believe that clinical negligence solicitors have an important part to play and so should be included in discussions on patient safety.