On July 2, 2019 a new National Health Service (NHS) patient safety strategy was launched in England. The strategy promises many things and lays out the future trajectory of NHS patient safety policy making.
Aidan Fowler, the NHS National Director of Patient Safety highlights the scale of the NHS patient safety problem in the foreword to the strategy:
Too often in healthcare we have sought to blame individuals, and individuals have not felt safe to admit errors and learn from them or act to prevent recurrence…The opportunity is huge. Hogan et al’s research from 2015 suggests we may fail to save around 11,000 lives a year due to safety concerns, with older patients the most affected. The extra treatment needed following incidents may cost at least £1 billion (p3).
The strategy builds on a previous public consultation paper and is to be built on two foundations: a patient safety culture and a patient safety system. Three strategic aims will support the development of both:
- Insight: improving understanding of safety by drawing intelligence from multiple sources of patient safety information;
- Involvement: equipping patients, staff and partners with the skills and opportunities to improve patient safety throughout the whole system;
- Improvement: designing and supporting programmes that deliver effective and sustainable change in the most important areas (p4).
There is a discussion in the strategy on how each of these three strategic aims will be actioned.
Involvement actions will include:
- establishing principles and expectations for the involvement of patients, family’s carers, and other lay people in providing safer care;
- creating the first system-wide and consistent patient safety syllabus, training and education framework for the NHS;
- establishing patient safety specialists to lead safety improvement across the system;
- ensuring people are equipped to learn from what goes well, as well as to responding appropriately to things going wrong;
- ensuring the whole health care system is involved in providing care (p5).
A vision for patient safety
Safety is not seen in the strategy as an absolute, immovable concept with a single objective or a defined point. The vision sees NHS patient safety as being flexible and responsive to patient and NHS system priorities and:
The gold standard for safety will continue to be refined by new research and innovations; providing definite benchmarks on a never ending mission (p6).
Culture change — the strategy states — cannot be mandated by strategy, but you cannot ignore its role in determining safety.
The strategy is to be welcomed
The strategy is detailed and there is a helpful resource section attached on the strategy website. It reflects deep, fresh thinking and refers to significant amounts of academic writing and research. This is not a case of old wine in new bottles. There is also a conceptual underpinning as to what is proposed and a clear route forward. We now have a good and promising NHS patient safety strategy. The question remains: Can it be effectively delivered, or will it be consigned to the history books and eclipsed by further NHS patient safety crisis reports? Successful implementation will depend on how well the NHS funds the strategy and whether endemic problems are addressed. These problems include workload pressures, as well as the persistence of a NHS culture of blame and fear when errors are made.