Taking a ‘whole systems’ approach to improving patient safety

When Matt Hancock announced the development of a national patient safety strategy to go alongside the NHS long-term plan, ensuring that safety is the “golden thread” running through the health system, this was an encouraging signal that patient safety would rightly continue to be a core government priority.

And indeed, the publication of the strategy at HSJ’s Patient Safety Congress last year was a landmark moment with widespread approval for its emphasis on taking a “whole systems” approach to improving patient safety.

“Whole system” means looking across both NHS and independent provision, recognising that patients everywhere deserve the safest possible care. In many places the divide between the NHS and independent health sector is blurred as many independent healthcare providers deliver care to both NHS and private patients. In this environment it makes no sense to look at safety in “NHS” or “independent sector” silos – patients and staff move between NHS and private care, and our safety systems need to reflect this.

By including independent healthcare provision in the bill, this would ensure that all patients, regardless of how they access their healthcare, are able to benefit from shared system learning, with best practice shared between clinicians and providers across the whole of the healthcare system

This is increasingly the case – the NRLS (National Reporting and Learning System) and its successor PSIMS (the Patient Safety Incident Management System) cover patient safety incidents across NHS and private care with learning shared across the healthcare system. More recently independent sector providers have begun contributing to the Getting It Right First Time programme and working within the HQIP National Audit programme, both of which play a key role in improving quality and safety in the healthcare system.

There is one important exception to this story of whole-system working on safety. The government’s key legislation on patient safety – the Health Service Safety Investigations Bill – takes an “NHS only” approach. The HSSIB aims to give greater power and independence to the current Healthcare Safety Investigation Branch and ensure best practice and learning is shared. But despite IHPN calling on the government to expand the remit of HSSIB to the whole health system when the bill was first presented and scrutinised by a Joint Committee of the Commons and Lords, as currently drafted the bill just applies to the provision of NHS funded care.

By including independent healthcare provision in the bill (a sector which delivers almost 2 million private acute procedures every year, in addition to over 500,000 NHS operations) this would ensure that all patients, regardless of how they access their healthcare, are able to benefit from shared system learning, with best practice shared between clinicians and providers across the whole of the healthcare system.

Expanding the remit to all healthcare provision would also help clarify that NHS Private Patient Units are covered by with the scope of the new body. And equally a “whole systems” approach would also benefit the proposed new Medical Examiners contained in the bill, allowing them to have oversight of all deaths in their areas, including in the independent sector, something the recent NHS Patient Safety Strategy has also committed to.

The Joint Committee of the Commons and Lords on the HSSIB, stated in its final report that “Our evidence was clear that HSSIB’s remit should extend beyond just NHS-funded services to the whole healthcare system”. And in its second reading in the Lords last autumn peers from across the House echoed our calls on this, with key healthcare bodies such as the Royal College of Surgeons, Royal College of Nursing and the British Medical Association also calling for the bill to cover privately funded care.

The health service has made huge strides in recent years in taking a more systems-based approach to safety and we urge the government to amend the bill and bring it into line so that all patients and clinicians can reap its benefits and ensure there’s no Berlin Wall in safety, with NHS patients on one side and private patients on another.