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How effective will the Healthcare Safety Investigation Branch be?

Maria Panteli, Partner in the Clinical Negligence Department of Leigh Day, considers whether the NHS’s new Healthcare Safety Investigation Branch be able to reduce the number of mistakes in healthcare and increase patient safety.

Posted on 13 September 2016

The NHS Digital figures, which are released annually, show that between 2005 and 2015, the number of patient hospital attendances caused by an ‘unintentional cut, puncture, perforation or haemorrhage during surgical and medical care’ increased from 2,193 to 6,082.

The figures include patients whose unintentional cut, puncture, perforation or haemorrhage was at a private hospital and who had later been cared for by the NHS. They also include readmissions for ongoing complications related to the damage sustained.

Commenting on the NHS Digital figures, Peter Walsh of the charity Action Against Medical Accidents, told the Daily Mail that more complex procedures and better reporting of incidents may also partly explain the rise, but would not account for the figures trebling.

Mr Walsh said: "I suspect inadequate staffing and increased pressure at work are also factors. "I also know there is a lot of concern among surgeons that the training they get is not as thorough and adequate as used to be the case. There is not as much time spent on technical skills.

"The increase in incidents is very worrying and there needs to be an investigation to get to the bottom of it."

A Department of Health spokesman said: "NHS mistakes can lead to human suffering and tragedy. That's why this government has focused relentlessly on driving up standards through a safer, seven-day NHS, with extra support for staff to speak out honestly when things go wrong, and a tough new watchdog to probe patient incidents - the Healthcare Safety Investigation Branch."

The recommendation for an independent patient safety investigation body - the Healthcare Safety Investigation Branch - was put forward by Parliament’s Public Administration Select Committee (the predecessor to the current Public Administration and Constitutional Affairs Committee) in its March 2015 report ‘Investigating clinical incidents in the NHS’.

The Committee called for ‘a new, single, independent and accountable investigative body to provide national leadership, to serve as a resource of skills and expertise for the conduct of patient safety incident investigations, and to act as a catalyst to promote a just and open culture across the whole health system.

In June 2016, Keith Conradi was appointed the Chief Investigator of the Healthcare Safety Investigation Branch (HSIB).

Mr Conradi was the Chief Executive of the Air Accidents Investigation Branch. The Chief Investigator will be responsible for setting up the HSIB and ensuring that it is capable of commencing operations by 1 April 2017.

The HSIB will be a branch of NHS Improvement and have capacity to undertake around 30 investigations a year. Many would argue that independence is of paramount importance to the HSIB’s credibility and success and so it seems odd that it has been established inside an existing NHS regulator rather than as an independent body.

The principle of openness and honesty with patients would also seem to be fundamental. Whilst few would argue that all those involved in the investigation of a clinical incident should have protection to speak openly and honestly without fear of blame, this should not outweigh or trump the responsibilities to patients/ families.

Of concern is that the principle of openness and honesty with patients and the Duty of Candour may be compromised as it does not appear to be mandatory that all relevant information about a patient’s treatment be shared with the patient/ family and that they are free to use it as they wish.

Instead the directions on how HSIB should work say that the Chief Investigator ‘may, when requested’ disclose such information to the patient ‘but such disclosure may only be made… to such extent that the Chief Investigator judges… to be consistent with the safe space principle’.

Plans to address the need to improve the quality of NHS investigations and patient safety are welcomed. However, there is much uncertainty about the principles and framework within which HSIB will work and its independence. Therefore its capacity to make significant improvements will remain to be seen.