Sadly, in recent months stories in the media have continued to raise the issue of falling public trust and confidence in care delivery. A colleague recently shared with me that, in one area, the cumulative number of local and national actions required to be delivered and monitored for one service numbered upwards of 700. So the key question that we need answered is this: do all these recommendations and actions result in learning and helping to make the necessary improvements to raise the quality of care delivered and keep patients safe?
I was recently asked to join a House of Commons Health and Social Care Committee Expert Panel roundtable discussion on the government's progress with regard to patient safety. The focus of the discussion was the ‘Evaluation of government progress on meeting patient safety recommendations’, and the findings have just been published (House of Commons Health and Social Care Committee, 2024).
When a major patient safety incident occurs, the government may set up an independent inquiry or review, with the purpose of determining the facts, highlighting where failings have occurred and making recommendations about how systems can avoid similar incidents recurring. Such reviews allow those responsible for the implementation of recommendations to critically appraise their own progress, identify areas for future focus and foster a culture of learning and improvement.
The Expert Panel's discussion centred on three key areas:
- Maternity care and leadership
- Training of staff in health and social care
- Culture around patient safety and whistleblowing.
The key message from the panel's evaluation, and highlighted in the report, is this: The government is still to fully implement agreed actions to improve patient safety after 9 years. The report concludes that, overall, a ‘requires improvement’ rating applies to recommendations made by independent inquiries and reviews into major patient safety issues going back to 2013. The Health and Social Care Committee has now launched its inquiry into leadership, performance and patient safety in the NHS.
Poor culture
Outgoing Parliamentary and Health Service Ombudsman Rob Behrens, in an interview with The Guardian (Campbell, 2024), said that there were still ‘too many examples of care not being safe’ and suggested that NHS hospitals are covering up evidence of poor care.
The ombudsman repeatedly referenced the poor culture within the NHS for both staff and patients, arguing there was a culture of cover-up and obscuring the truth. He stressed that his successor should be able to investigate things, even when, as he suggested, a formal complaint has not been received. Behrens recalled cases of insiders calling him directly to raise issues of patient safety, who had been warned off when they tried to make a complaint:
‘The people least likely to complain are the ones who most need the ombudsman – people with mental health challenges, who are elderly or are from ethnic minority backgrounds or are poor,’ he said.
When asked, ‘How can the “cover-up culture” be ended?’, Behrens replied: ‘First of all, you have to recognise that it exists and secondly you have to make leaders accountable for how the culture operates.’ Powerfully, he quoted Nye Bevan's observation from his book In Place of Fear: ‘Silent pain evokes no response.’
Behrens uses Bevan's words to highlight that suffering, which is clearly ‘worryingly common’, has not provoked necessary changes in culture. The ombudsman also refers to the heavy price many whistleblowers pay for their candour.
Key driver
The National Patient Safety Incident Response Framework (NHS England, 2022) has been described by NHS England National Director of Patient Safety Aidan Fowler as:
‘… a significant shift in the way the NHS responds to patient safety incidents, increasing focus on understanding how incidents happen – including the factors which contribute to them.’
The NHS England Patient Safety Incident Response Framework is expected to be a key driver for how the NHS learns. However, the House of Commons Health and Social Care Committee Expert Panel rated progress as ‘requires improvement’, detailing some of the reasons for this in its report. As nurses, we all need to consider the part we play in patient safety and learning, and how collectively we can improve the delivery of consistently safe care and environments to rapidly improve the national position on this key issue.