‘Safe spaces’ in adverse health incident investigation and patient complaints

By John Tingle

Two new reports, one by Action against Medical Accidents,(AvMA),the charity for patient safety and justice and the other by the Patient’s Association charity, (PA), highlight once again significant  problems with NHS (National Health Service) patient safety investigative and complaints structures and procedures.

The Department of Health, (DH) in 2016 produced a consultation paper which closed on 16th December 2016 on providing a ‘safe space’ in healthcare safety investigations.

This is linked to the new NHS, Healthcare Safety Investigation Branch (HSIB),operational from April 2016, and when fully functional will  offer support and guidance to NHS organizations on investigations, and carry out certain investigations itself.Current Government policy is to consider the development of a ‘safe space’ in serious adverse health incident investigations. The Consultation paper stated:

“…many believe that the creation of a type of ‘strong wall’ around certain health service investigations, so that information given as part of an investigation would only rarely be passed on, would provide a measure of ‘psychological safety’ to those involved in investigation, allowing them to speak freely. This will enable lessons to be learned, driving improvement and ultimately saving lives.” (p.8).

The proposal is to create a statutory prohibition on the disclosure of material obtained during certain health service investigations unless the High Court makes an order permitting disclosure, or in a limited number of other circumstances. This broadly mirrors the regime followed in the area of air accidents investigations.

There is a clear recognition that there is going to be a very difficult balance to achieve here between the interests of patients and their carers and those more broadly of the doctors, nurses, investigators and the NHS.

AvMA are concerned that there is now a distinct possibility that patients and their families will have information relevant to their treatment withheld from them. Also that this, ‘safe space’ will be extended to local patient safety adverse incident investigations under the proposals  as well as HSIB  investigations.Hospitals investigating themselves will be able to use the ‘safe space’ which raises conflicts of interest issues.

The Patients Association

The PA have been campaigning for improvements in patient’s experiences with the Parliamentary and Health Services Ombudsman (PHSO) and have highlighted a number of important failings with how the PHSO handle patient complaints. They feel that the situation with the PHSO is getting worse, not better,judging from the patients calls to their office. The PA report paints a very worrying picture of how NHS patient complaints are dealt with at this final stage of the NHS complaints system. Patients who contacted them about the PHSO related their experiences.

Their experience is that the PHSO:

  • Does not investigate complaints fairly – Evidence is ignored
  • Takes sides with the organisation they are supposed to be investigating – Failing to meet the commitment to make decisions impartially.
  • Does not make the process straightforward – They ask many questions that the person complaining has already answered or cannot answer.
  • Produces reports that are neither thorough nor the product of comprehensive investigation.
  • Fails to use the complaints process to ensure that lessons are learned at local level.
  • Does not put patients central to the process – Patients are made to feel like they are nuisance for complaining and that they are wasting the PHSO’s time.


There is as always a lot happening in the NHS with patient safety. The systems here in England always seem to be in a state of flux and over the years not much seems to have been achieved in remedying matters and developing an ingrained patient safety culture. The same patient safety problems and complaints seem to be repeated without any lessons of past failures being learned.

John Tingle

John Tingle is a regular contributor to the Bill of Health blog. I am a Lecturer in Law, Birmingham Law School, University of Birmingham, UK; and a Visiting Professor of Law, Loyola University Chicago, School of Law. I was a Visiting Scholar at Harvard Law School in November 2018 and formerly Associate Professor at Nottingham Law School, Nottingham Trent University in the UK. I have a fortnightly magazine column in the British Journal of Nursing where I focus on patient safety and the legal aspects of nursing and medicine. I have published over 500 articles and a number of leading texts in patient safety and nursing law. My current research interests are in global patient safety, policy and practice, particularly in African health care systems. My most recent publication is: "Global Patient-Safety Law Policy and Practice," edited by John Tingle, Clayton O'Neill, and Morgan Shimwell, Routledge 2018.

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