Healthcare workers to be given legally protected ‘safe space’ to report errors
Doctors, nurses and other healthcare professionals will be given a legally protected “safe space” to report concerns and mistakes to a new independent NHS investigation branch, Jeremy Hunt has said.
The Health Secretary said the Healthcare Safety Investigation Branch will conduct “timely, no blame” investigations while legal protections will be given to those who speak out honestly.
This will reduce the “defensive culture” patients often come across, give families the truth more quickly and allow healthcare professionals more support and protection to speak out, Mr Hunt said.
In a Commons statement on new plans to improve the health service’s ability to learn from mistakes, Mr Hunt said: “As with the Air Accident Investigation Branch, I can today announce that we will bring forward measures to give legal protection to those who speak honestly to investigators.
“The results of such investigations will be shared with patients and families who will therefore get to the truth of what happened much more quickly.
“But unlike at present, those investigations will not normally be able to be used in litigation or disciplinary proceedings, for which the normal rules and processes will apply.
“The safe space they therefore create will reduce the defensive culture patients and families too often find, meaning the NHS can learn and disseminate any lessons more quickly so we avoid repeating mistakes.
“My intention is to use this reform to encourage much more openness in the way the NHS responds to tragic mistakes.
“Families will get the truth faster, doctors will get support and protection to speak out, and the NHS as a whole will become better at learning when things go wrong.
“What patients and families who suffer want more than anything else is a guarantee that no one else will have to relive their agony, this new legal protection will help us to promise them never again.”
Other measures include introducing medical examiners to review death certificates and confirm the cause of all deaths, bringing a “profound change in our ability to learn from unexpected or avoidable deaths”, Mr Hunt said.
“Grieving relatives will be at the heart of the process and will have the chance to flag any concerns about the quality of care and the cause of death to an independent clinician, meaning we get to the bottom of any systemic failings much more quickly”, the Health Secretary added.
In addition, doctors and nurses who admit mistakes will also be given “credit” if their cases are heard by tribunal panels.
England will also become the first country in the world to publish estimates by every hospital trust of their own avoidable mortality rates.
Mr Hunt added: “An NHS that learns from mistakes, one of the largest organisations in the world becoming the world’s largest learning organisation.
“That is how we will offer the safest, highest quality standards of care in the NHS.”
Shadow health secretary Heidi Alexander said Labour welcomed the measures but would strongly challenge Mr Hunt if the moves had the reverse effect to that intended.
She said: “Let me say at the outset that the Opposition supports any measures that will improve safety in our NHS and make the NHS more open to learning from mistakes.
“However, we will also provide robust opposition and scrutiny when we think your actions are having the reverse effect.”
Ms Alexander told MPs that Mr Hunt needs to “do much more to develop a positive learning culture” in the NHS.
“How in practical terms will he support clinicians and managers to improve services?” she asked.
“Go to any health trust and you will find a director of finance and non-executive directors with financial expertise but you’ll rarely see the same attention paid to quality.
“Does the Health Secretary not agree that every trust board needs someone whose focus isn’t short-term fire-fighting but to coordinate and bring together staff to drive improvements in quality?”
Ms Alexander said she will “always support sensible steps to improve safety and transparency” in the NHS.
“But what I can’t do is stand here today and pretend that other actions taken by this government won’t have a detrimental effect on patient care,” she said.
“The Health Secretary’s kamikaze approach to the junior doctor contract means that no matter how this dispute ends, he will have lost the good will of staff on which the NHS survives.
“How can he stand here and talk about patient safety when it is him and him alone who is to blame for the current industrial action, for the destruction of staff morale and for the potential exodus of junior doctors to the southern hemisphere?”
Ms Alexander also said that measures to investigate harm are “all well and good” but action to prevent harm happening must also be taken.
“Fund the NHS adequately, staff it properly and you might just give it a fighting chance,” she said.
Mr Hunt bemoaned the tone of Ms Alexander’s response to the statement, telling MPs she “had the chance to be constructive” in her reply.
On the issue of funding, he said: “You stood on a platform to put £5.5 billion less into the NHS every year than this government.
“On the back of a strong economy, we are putting more resources into the NHS.
“A strong NHS needs a strong economy and Labour had better remember it.”
Dr Philippa Whitford, the SNP’s shadow health spokeswoman, also welcomed the measures announced by Mr Hunt but questioned why the introduction of medical examiners in England has to wait until 2018.
She suggested that the review of deaths undertaken by such examiners might have made a difference in catching the serial killer Harold Shipman.
She said: “As a doctor it was always the thing that seemed obvious to me as what might have made a difference to Shipman.”
She also stressed the need to improve staffing ratios in hospitals to reduce mistakes and to give people the time to report them when they do occur.
On the issue of increased support for whistleblowers, she suggested there should also be a “review and reconciliation” scheme for people who have been badly treated in the past.
Mr Hunt told MPs that the implementation of medical examiners has not been delayed.
He also said he will “reflect” on the reconciliation suggestion but added the new measures aim to “eliminate” the need for whistleblowers.
The Health Secretary later emphasised that the measures do not make people immune to action.
He said: “This is not about people getting off scot-free if they make a terrible mistake.
“There is no extra protection here for anyone who breaks the law, who commits gross negligence, who does something that is utterly irresponsible.”
Meanwhile, Dr Tania Mathias, the Tory MP for Twickenham, urged the Secretary of State to consider introducing exit interviews across the NHS in order to improve the learning of lessons.
She said: “Can I ask that you look into increasing the use of exit interviews in the NHS?
“I have worked in the NHS, other aid organisations, charities. The NHS is the only one where I haven’t had an exit interview.”
Mr Hunt replied: “I think you make a very good point about exit interviews and I would like to take that away if I may.”
Dr Andrew Murrison, the Tory MP for South West Wiltshire, raised the issue of clinical negligence payments.
He said: “When things go wrong it’s right that the NHS is frank about it and where necessary compensates people for what may be long-term management issues.
“However, currently negligence settlements are based upon provision in the private sector and do not anticipate necessarily that people will be treated and managed in the NHS, which means that the service effectively pays twice for mistakes.”
Mr Murrison suggested the issue should be looked at because changing the current scheme could save the NHS a lot of money.
Mr Hunt said there are things that “someone independently looking at our current system might say are difficult to understand”.
The Health Secretary then pointed out that the NHS tends “to give bigger awards to wealthier families” when it comes to settlements because family income is often taken into account.
He said the issue will be examined.
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