Given the size of the NHS, its mission and complexity of structure, developing a proper patient safety culture is always going to be fraught with problems. These include the failure of some NHS staff to learn from patient safety incidents and to change practices. In some places there is a focus more on reputation management than on the interests of patients.
We can also add into the mix the complexity and overlap of NHS organisations that have a patient safety remit, now subject to the Dash Review (Department of Health and Social Care (DHSC), 2024). Allied to this is the fact that a veritable plethora of patient safety reports, policies, guidelines and recommendations is published at regular intervals. The sheer volume of patient safety information produced can cause problems.
It can be difficult for busy NHS staff, often working in resource-constrained environments, to work out which reports, policies, guidelines and recommendations to read and follow. Some documents may even duplicate or conflict each other in terms of content and messaging. Also, what about costing and the research base?
Consideration needs to be given to impact on the patient and on the institution. The Recommendations to Impact Collaborative Group (2024) took a deep dive into these issues and produced an excellent report with helpful recommendations. These include further work to develop guidance on the creation and implementation of recommendations, and a proposal for a repository for recommendations. The report concluded with a stark message:
‘The current situation in relation to recommendations is untenable. The lack of structure around the creation and implementation of recommendations as well as the lack of monitoring of actions means that many are not improving patient care while continuing to burden providers.’
The need to better manage the patient safety information flow
We will never be able to stop the regular swathe of patient safety reports, policies, guidelines, recommendations etc – and nor should we. Health care is also everybody's business. We are all touched by it in some way, it is vital to us, and therefore will always attract a great deal of attention and discussion.
Keeping up to date with relevant publications, reports and recommendations is a key professional and legal responsibility for all healthcare staff. It is a signature mark of being a professional. There have also been past clinical negligence cases where professional updating has been an issue.
However, we can and do need to manage the NHS patient safety information flow better. A good starting point on information management is that given by the Recommendations to Impact Collaborative Group (2024). The Dash Review will also hopefully provide some rationalisation and reform of DHSC arm's length bodies that have a patient safety remit, providing a clearer, less complex focus on NHS patient safety information messaging.
I want to pick out some recent publications for particular attention.
Patient Safety Principles Toolkit
The Patient Safety Commissioner (PSC) (2024) has recently produced a Patient Safety Principles Toolkit. These are:
The PSC sets out the purpose of the principles, which is to:
‘…act as a guide for leaders at all levels on how to design and deliver safer care for patients and reduce avoidable harm, in a just and learning culture. The principles provide a clear framework for planning, decision-making, and working collaboratively with patients as partners.’
These are not new insights into how to avoid patient safety crises or new prerequisite steps to develop a proper NHS patient safety culture. They have been around for a long time in some form or other, in investigation reports into patient safety crises, in academic literature and international guidelines such as the World Health Organization (WHO) (2021)Global Patient Safety Action Plan 2021‑2030, guiding principles, which include:
The PSC (2024) toolkit suggests, among other matters, discussing the patient safety principles at team meetings and what they mean to the team. Advice also includes inviting other people to team meetings such as human factors experts, head of patient experience, people with lived experience, patient/community panels and so on. In Annex 1 there is also a patient safety principle structured reflective template to use in revalidation.
Message overlap: PSC, WHO and AvMA/HPA
There is clear overlap of messaging between the PSC (2024) toolkit and the WHO (2021) action plan. This not necessarily a problem: the Patient Safety Principles Toolkit is only 5 pages long and designed more as a quick reference guide for leadership, whereas the Global Patient Safety Action Plan 2021‑2030 is a full-blown analytical report running to 96 pages. However, both documents require unpacking, analysis and decisions made about appropriateness of implementation.
Another recent publication also needs to be considered here: the joint consultation document put out by Action against Medical Accidents (AvMA) and the Harmed Patients Alliance (HPA) on The Harmed Patient Pathway. This document is more detailed than the PSC toolkit and differs again from the WHO action plan, but still shares similar primary aims. The pathway (AvMA and HPA, 2024) is built around six commitments:
The key for all three publications is how well they are greeted and implemented in the NHS. They are all, in a real sense, competing for attention in a crowded field. Paul Whiteing, Chief Executive of AvMA, discussed the PSC patient safety principles in a recent blog post:
‘They make good sense but beg the question about their implementation, which is always the really hard part.’
Learning from workplace violence claims within the NHS
To plot a way forward in NHS patient safety culture development you must know the current problems, where you are with them and where you have been. NHS Resolution thematic reviews help with this and they are always valuable patient safety resources. They illustrate, in real time, acute patient safety issues and themes from litigation cases and give suggestions as to the way forward.
Adverse patient safety incidents have emotional costs for all those affected, both patients and the NHS staff involved in their care. Patients can suffer physical harm with long-term impacts on their quality of life and working ability. There are personal financial consequences to factor in and a cost to the NHS in terms of the amount of compensation paid. These financial costs to the NHS of specific types of adverse events are given in thematic reports from NHS Resolution, along with discussions of the other harms.
Adverse safety events can also happen to NHS staff. NHS Resolution (2024) looked at themes from an analysis of claims brought by healthcare staff who experienced workplace violence exhibited by patients in their care between 2010/11 and 2019/20.
In terms of financial cost to the NHS:
‘Of the 5,287 claims included in the quantitative analysis, 4,674 were closed. We found the total cost of the closed claims to be £61.4 million. We found 2,941 (63%) to be unsuccessful with no damages paid and 1,733 (37%) to be successful with damages paid. The total amount of damages paid for the closed successful claims was £31,250,887.83.’
Other findings include that 65% of those pursuing a claim for workplace violence were female and 35% were male; 41% of those pursuing a claim for workplace violence worked in a healthcare support role. The report discusses several matters including current policy and legislation, workforce analysis and future areas of focus. These include ensuring suitable and sufficient risk assessments, training, staff support and leadership. The report states that providers of NHS-funded care should give further attention to the prevention and reduction of workplace violence to ensure compliance with legislation and the NHS England (2021) Violence Prevention Reduction Standard (VPR).
Conclusion
NHS staff need to brace themselves for the inevitable swell of increasing patient safety reports, policies, guidelines and recommendations produced at regular intervals by a plethora of organisations, nationally and across the world. It is good to see that the patient safety discipline is a thriving one, but the information flow from it into the NHS could be more effectively managed, as pointed out by the Recommendations to Impact Collaborative Group (2024).
The PSC (2024), WHO (2021) and AvMA and HPA (2024) publications could all well advance the development of an NHS patient safety culture but, taken together, they show how overlapping the NHS patient safety information flow can be. NHS Resolution (2024) has provided a deep dive into NHS workplace staff safety in relation to violence and its findings and recommendations can well inform future policy development in the area.