Last month, NHS Improvement (2019a) launched its new strategy to help the NHS to continue improving patient safety. Entitled The NHS Patient Safety Strategy. Safer culture, safer systems, safer patients, it aspires to widen approaches to improving patient safety and curtail situations that result in things going wrong in patient care. The strategy sets out the steps the NHS will need to take to achieve its vision of continuously improving patient safety, which centre on adopting a safer culture and implementing safer systems to achieve this goal.
Background
Since revelations about failings in care at Mid Staffordshire NHS Foundation Trust, where 400–1200 patients died between 2005 and 2009, the NHS has endeavoured to improve its safety record. The Mid Staffordshire scandal created a huge public outcry, and the Prime Minister was forced to launch a public inquiry, the findings of which sullied the reputation of the English NHS (Francis, 2013).
The NHS has striven subsequently to foster a culture of transparency and patient safety, much of which has been modelled on processes introduced by the Virginia Mason Hospital in Seattle, USA (https://www.virginiamason.org/safety). This hospital continues to lead the world through its endeavours to achieve the best clinical outcomes for patients based on a meticulous provision of the safest possible healthcare environment.
To help improve safety, the previous Secretary of State for Health Jeremy Hunt announced in 2016 that he was going to award substantial funding to a range of NHS trusts to develop excellence in harnessing digital technology to improve patient safety. This initiative was in direct response to the findings of the Wachter (2016) review of NHS technology.
The push for safer hospitals continues to motivate health professionals. For example, the Royal College of Paediatrics and Child Health (RCPCH) has developed its SAFE [Situation Awareness for Everyone] toolkit (RCPCH, 2019). The toolkit seeks to improve communication, build a safety-based culture and deliver better outcomes for children and young people, but especially those in hospital.
Similarly, the NHS has put significant effort into improving infection control to avoid hospital-acquired infections. As part of the drive to promote safety, it is now commonplace to see infection control information prominently displayed for both staff and visitors.
Since the Mid Staffordshire inquiry report, the impact of healthcare policy on changes to safe care delivery has been considerable. However, although policies can be a powerful weapon for improving care, it is import to highlight barriers, such as staff shortages, to implementing policy recommendations (Griffiths et al, 2018).
This latest government initiative to improve safety awareness in the NHS brings together all previous schemes to address the issue. A fundamental aspect of the NHS Long Term Plan (NHS England and NHS Improvement, 2019) is to enhance patient safety and The NHS Patient Safety Strategy illuminates this vision.
NHS Patient Safety Strategy
Although there have been great strides in patient safety over the past decade the new NHS policy points out that up to 11 000 lives a year are lost in the NHS due to safety concerns, with older patients most affected. It is not just lives that are lost—the additional financial burden of treating patients following safety incidents has been estimated as being about £1 billion a year. To prepare for the formulation of the new policy NHS managers have been attending stakeholder meetings and engagement events and holding workshops with staff, patients and senior leaders across the country. If the NHS addresses the patient safety challenges, it will enable the service to continuously improve in this area and achieve its primary objectives, which are to develop a patient safety culture and a patient safety system.
It is not possible to cover the entire content of the safety policy, but three strategic aims have been developed to support the NHS vision to improve patient safety:
Data collection
The NHS will promote the use of key safety measurement systems and metrics to better understand how safe care is. The Care Quality Commission already gathers such data when inspecting NHS trusts for safety under Regulation 12 of the Health and Social Care Act 2008. This regulation is designed to prevent people receiving unsafe care and treatment, and prevent avoidable harm or risk of harm by assessing the risks during care or treatment, and making sure staff have the qualifications, competence, skills and experience to keep people safe.
Additionally, the NHS will use new digital technologies to better learn from what does and what does not go well with patient care. To achieve this objective, the existing National Reporting and Learning System has been scheduled for replacement with a new safety learning system, which will continue to act as a central database of patient safety incident reports.
The NHS also plans to share insight from litigation to prevent harm and introduce the Patient Safety Incident Response Framework to improve the response to and investigation of incidents (https://tinyurl.com/psirf). The framework has been designed to support the NHS to operate systems that assist learning and improvement, and allow organisations to examine incidents openly, without fear of inappropriate retribution, as well as to support those affected and improve services.
Furthermore, in addition to implementing the new medical examiner system to investigate patient deaths, the safety policy will promote the new National Patient Safety Alerts Committee to enhance how the NHS responds to emerging risks to the service. This committee was established after it became known that the safety advice and guidance issued to the NHS was not always being implemented in some trusts, thus posing risks for patients. The committee now identifies more clearly which nationally issued advice and guidance is safety critical and mandatory, to ensure that healthcare providers are in no doubt about which standards they must comply with.
Equipping patients, staff and partners with skills
The second aim is to endow patients, staff and partners with the skills they need to find opportunities to improve patient safety throughout the NHS. Many nurses reading this will already have made great strides in achieving this aim. To move the safety agenda further forward the NHS is to establish the first system-wide patient safety syllabus, training and education framework for the NHS.
There are also plans to create patient safety specialist posts in organisations to lead safety improvement across the system. This strategy is intended to ensure that people are equipped to learn from what goes well, in addition to responding appropriately when things go wrong, and to ensure that the entire healthcare system is involved in the safety agenda.
Programmes to deliver effective, sustainable change
The third aim is to design and support programmes that deliver effective and sustainable change in the most important areas of patient safety, such as delivering a mental health safety programme. To achieve this, the NHS will implement the National Patient Safety Improvement Programme (NHS Improvement, 2019b), and build on the current safety drive of preventing avoidable deterioration and adopting and disseminating safety interventions.
Given the high cost of litigation related to incidents with maternity services, the policy aspires to deliver the Maternal and Neonatal Health Safety Collaborative (NHS Improvement, 2019c) to ensure measurable improvements in safety outcomes for women, their babies and families. The policy seeks to reduce the rates of maternal deaths, stillbirths, neonatal deaths and brain injuries that occur during or soon after birth.
The policy highlights the development of the National Medicines Safety Programme (NHS Improvement, 2019d), which seeks to increase the safety of those areas of medication use that are currently considered to be of highest risk. For example, there are an estimated 237 million ‘medication errors’ per year in the NHS in England. This has come in response to the World Health Organization (WHO) (2017) initiative Medication Without Harm, the aim of which is to reduce the global burden of severe and avoidable medication-related harm by 50% over 5 years.
The strategy acknowledges that mental health is an area of care prone to safety issues and reinforces the need to deliver a mental health safety improvement programme to tackle priority areas, many of which are attributable to, and exacerbated by, staff shortages (Griffiths et al 2018).
It also recognises that all personnel across the NHS must work together to support safety improvements in patient groups such older people and people with learning disabilities, and to tackle the continuing threat of antimicrobial resistance. Achieving this will to some extent depend on promoting research and innovation to underpin safety improvement in the health service.
Conclusion
The new safety policy is an integral part of the NHS Long Term Plan and nurses will be key players in its delivery. In essence, the pursuit of optimum patient safety is all about positively exploiting the lessons learnt when things go well and minimising those when things go wrong. The safety policy is an ambitious strategy that sets out what the NHS will become over the next decade: a service that fosters a safer environment for all service users and one in which nurses will be at the forefront of safety improvements.