Dr Penny Dash's review of patient safety has concluded that there has been: “a shift towards safety over the last 5 to 10 years, with considerable resources deployed, but relatively small improvements have been seen”.
In her report, she comments that the focus on safety has been “at the expense of other aspects of quality of care”. In addition, various new organisations and bodies have cost “at least £60 million per year”, while DHSC-sponsored reviews and inquiries into safety are estimated to have cost at least £100 million.
Commissioned by the Department of Health and Social Care, the review was asked to look at six specific organisations that were established to either assure - or contribute to improving - the safety of care, while also making reference to the wider landscape of organisations influencing quality of care. The six organisations included:
- CQC
- Health Services Safety Investigations Body (HSSIB)
- Patient Safety Commissioner
- National Guardian’s Office
- Healthwatch England and Local Healthwatch
- the patient safety learning aspects of NHS Resolution
The review was asked to consider whether there are overlaps and gaps in functions across organisations, and make recommendations as to the future roles of the organisations.
Dr Dash found that:
- There has been limited strategic thinking and planning with regard to improving quality of care.
- There is a large number of organisations carrying out reviews and investigations. A very high number of recommendations have been made to the NHS, most of which lack any cost-benefit analysis.
- A large number of organisations look at user experience or advocate on behalf of the 'voice of the user', yet few boards in the NHS have an executive director for user or customer experience.
- The current system for complaints and concerns is confusing and may lack responsiveness.
- Some of the organisations reviewed have expanded their scope of work beyond the original remit. While this is done with the admirable intention of improving the safety of care delivery, it can create further complexity, recommendations and confusion.
- A greater strategic focus on care delivery and management is needed to improve quality of care.
- The National Guardian's Office duplicates work carried out by providers.
- Insufficient use is made of the NHS's data resources to generate insights and support improvement.
- There is insufficient focus on developing a national strategy for quality of social care.
She concluded that action is needed to address some of the gaps in functions. In particular, a strategic approach is needed with regards to improvement and innovation in quality of care (including safety). There is a need to streamline, simplify and consolidate functions where considerable duplication and overlap currently exist. Furthermore, too many functions sit outside of the commissioners and providers of care who are ultimately responsible for improving quality (including safety). This results in limited impact from the very many inquiries, reviews, investigations and resulting recommendations that are made.
Within commissioners and providers, there needs to be a far greater focus on:
• building skills and capabilities
• effective governance structures
• clearer accountability for quality (including safety) of care
Lastly, she states that the CQC needs to rebuild public, professional and political confidence.
She goes on to make nine recommendations in the report:
- Revamp, revitalise and significantly enhance the role of the National Quality Board
- Continue to rebuild the Care Quality Commission (CQC) with a clear remit and responsibility
- Continue the Health Services Safety Investigation Body's role as a centre of excellence for investigations and clarify the remit of any future investigations
- Transfer the hosting arrangement of the Patient Safety Commissioner to the Medicines and Healthcare products Regulatory Agency (MHRA), and broader patient safety work to a new directorate for patient experience within NHS England, transferring to the new proposed structure within DHSC
- Bring together the work of Local Healthwatch, and the engagement functions of integrated care boards (ICBs) and providers, to ensure patient and wider community input into the planning and design of services
- Streamline functions relating to staff voice
- Reinforce the responsibility for and accountability of commissioners and providers in the delivery and assurance of high-quality care
- Technology, data and analytics should be playing a far more significant role in supporting the quality of health and social care
- There should be a national strategy for quality in adult social care, underpinned by clear evidence
Commenting on the report, Matthew Taylor, chief executive of the NHS Confederation, said: “Patient empowerment is crucial to the success of the government’s Ten-Year Health Plan. It is absolutely vital that when things do go wrong there are ways for patients to report it and for NHS organisations to learn from mistakes.
“Our members fully recognise the importance of making sure the voice of patients and their wider communities in how their services and planned and delivered is listened to, and that the feedback they give guides and shapes where improvements need to be made.
“NHS leaders will welcome Dr Penny Dash’s review, which supports the direction of the Ten-Year Health Plan in streamlining the role of the centre and devolving accountability to local leaders, while giving the public the tools to make informed choices about their care.
“The government has already announced plans to reduce costs from within the NHS, so it is understandable that some consolidation may be needed around the way national standards are set too. Any opportunity to reduce duplication should be welcomed, particularly where any money saved can be invested back into frontline care.
“However, NHS leaders would encourage the government to not forget the failings in care that led to these bodies being set up in the first place and tread carefully so as to ensure their vital missions continue in future. Staff and patients will still need safe spaces where they can speak up.
“Given the importance of patient feedback informing the design and delivery of care, and following the abolition of Healthwatch England and local Healthwatches, NHS leaders would encourage the government to ensure ICBs and local authorities taking on these functions are adequately supported and resourced to do so effectively.”
View the full report at: Review of patient safety across the health and care landscape - GOV.UK
