Analysis

NHS set to save lives and money in new safety era

Strategy aimed at pulling existing NHS safety systems together to improve care over coming decade

Strategy aimed at pulling existing NHS safety systems together to improve care over coming decade

  • Safety and training framework to cover 1.3 million staff across 350 different roles
  • Maternity, neonatal, mental health, falls prevention and medicines safety targeted
  • Strategy could save around 1,000 lives and £100 million in care costs a year

Improvement is to be focused on areas, such as falls, where most harm is seen.
Picture: Science Photo Library

Better patient safety has been a major concern for the NHS and the government for years.

The focus on the issue has led to new safety alert systems, detailed guidance on everything from sepsis to falls prevention and dedicated campaigns in high-risk areas such as maternity care.

£1 billion

a year is spent on treatment relating to mistakes

Source: NHS Patient Safety Strategy

But a new strategy, published by NHS England and NHS Improvement, is aimed at pulling everything together in a move to make significant improvements over the coming decade.

Time to go further

NHS Improvement national director of patient safety Aidan Fowler says the NHS is already a ‘pioneer for safety’ but it is time to go further.

‘The NHS has tough protections to deal with deliberate wrongdoing by staff, but in the vast majority of cases it is honest mistakes or problems with systems that are at fault, so we need to help staff to speak up when they see things going wrong.’

The strategy predicts that 1,000 lives and £100 million in care costs could be saved each year if the NHS gets it right. To achieve this, the Patient Safety Strategy suggests that the foundation for success will be creating the right systems and culture.

Initiatives need to evolve

The strategy recommits the two national bodies, NHS England and NHS Improvement, to the continuation of several national safety improvement programmes set up in recent years, covering maternity and neonatal care, mental health, falls prevention and medicines safety.

‘We need to see safety become everyone’s business – it’s not just for managers, doctors and nurses’

Pippa Bagnall, sepsis campaigner


Pippa Bagnall

It also sets out how existing initiatives need to evolve. It states that the 15-year-old National Reporting and Learning System database, which handles 2 million patient safety incident reports a year, is outdated and proposes replacing it with a digital, easy-to-use portal for front-line staff to record problems on everything from errors in medicines administration to difficulties spotting patient deterioration.

There will also be a national patient safety improvement programme to support and encourage innovation and best practice.

New systems

A new framework setting out when and how the NHS should investigate serious incidents will also be drawn up, because the existing one, the Serious Incident Framework, has done too little to encourage openness or provide reassurance that inappropriate sanctions will not be taken.

There are also plans for entirely new systems. A medical examiner system is being developed to scrutinise deaths, and every NHS organisation is being asked to appoint a patient safety specialist to lead on improvement.

The strategy accepts that these posts may be like roles, such as that of head of quality or infection and prevention control, that already exist but it suggests that by formalising arrangements and creating a network of specialists it will be easier to coordinate improvements and learn from each other. Dedicated training and professional standards could be developed.

Nurses a perfect fit

NHS Improvement says these roles could be filled by clinical or non-clinical staff.

But sepsis campaigner Pippa Bagnall, who has worked in senior nursing positions and as a chief executive in the NHS, says nurses would be a perfect fit for them.

‘Without a law for safe staffing, patients will still face unacceptable risk’

RCN England director Patricia Marquis

‘They’re the ones who are closest to care and can really make a difference. Many are already championing safety, so this will give that more weight.


Patricia Marquis

‘But we need to see safety become everyone’s business. It’s not just for managers, doctors and nurses – whether it is a GP receptionist or hospital porter, they all have a role to play.’

This seems to have been recognised by the strategy, which also proposes the first-ever system-wide patient safety syllabus and training programme. Health Education England (HEE) has been tasked with developing it, the idea being to create a framework for all 1.3 million staff across 350 different roles.

HEE describes this as an enormous task that will require concerted effort over several years, but it has already indicated that it expects this training to be delivered in multidisciplinary teams. Training is just one element of creating the right culture, the strategy states. Good leadership will also be critical.

Compassionate leadership

The strategy advocates what is described as compassionate leadership to create working environments where staff feel psychologically safe, diversity is respected and valued, and teamwork and an openness to learning are emphasised.

But no drive to improve safety would be complete without addressing the issue of staffing. The strategy highlights this, stating that ‘workforce challenges clearly create pressures’.

RCN England director Patricia Marquis says this adds to the case for safe-staffing legislation in England: ‘Keeping patients safe is about more than avoiding unintended harm. It’s about taking actions that will mitigate harm in future. Without a law for safe staffing, patients will still face unacceptable risk.’

2 million

incidents a year are reported in National Reporting and Learning System database

Source: NHS Patient Safety Strategy

What happens now?

  • Replacement for National Reporting and Learning System to go live in 2020 with a view to allowing patients and carers to report via smartphones.
  • National Patient Safety Improvement Programme to take on work of National Patient Safety Collaborative, with priority areas to include sepsis, maternity care and medicines safety.
  • Patient Safety Incident Response Framework to set out when and how serious incidents should be investigated.
  • Medical examiner system to scrutinise deaths to be up and running in hospitals by April 2020 with rest of NHS to follow by April 2021.
  • Digital innovation to continue to be explored, building on progress made in areas such as electronic prescribing and medicines administration.
  • Every NHS organisation to appoint a patient safety specialist by April.
  • Patient safety syllabus and training programme to be developed.
  • Primary care networks to lead on safety in the community.

Cost of mistakes

The strategy points to research suggesting that 11,000 lives are lost each year due to safety issues, with at least £1 billion worth of extra treatment required because of mistakes. It predicts nearly one tenth of this could be saved from 2023, equating to around 1,000 lives and £100 million in care costs.

But the strategy acknowledges that quantifying savings is tricky, so it offers conservative estimates for just a selection of initiatives. It estimates, for example, that better incident reporting and responses could save 160 lives and £13.5 million a year. This is based on research showing that implementation of patient safety alerts is only 50% effective because providers find it difficult to translate warnings into practical changes.

Understanding and capability

But the biggest area for savings, accounting for more than half the estimate, is from focused improvement in areas such as falls, adverse drug reactions and neonatal and maternity care, where most harm is seen.

This could also save the NHS money in terms of litigation – halving neonatal brain injuries alone would reduce claims by £750 million a year by 2025.

Nick Evans is a health writer

Find out more

NHS England and NHS Improvement (2019) The NHS Patient Safety Strategy

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