Quality and safety: The first 100 days of the new government

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Alongside the shift to focusing on NHS finances, the government wishes to continue the emphasis on quality and safety that came strongly to the fore during the second half of the last parliament.

Its ambition is that the NHS develop a culture of ‘continuous improvement’, supported by buddying with international exemplars such as the Virginia Mason Medical Centre in Seattle, United States. This will go hand in hand with a focus on ‘intelligent transparency’ to drive up quality based on the publication of performance data and a continued emphasis on inspection.

A number of actions have been taken in this area, including stronger support for whistle-blowers and the planned establishment of a new Independent Patient Safety Investigation Service (IPSIS), modelled on practice in the airline industry. However, perhaps the most high-profile change has been the transfer of work on safe staffing levels from the National Institute for Health and Care Excellence (NICE) to NHS England, raising questions about the priority now attached to this work.

In early June, Simon Stevens, Chief Executive of NHS England, announced that Chief Nursing Officer Jane Cummings will take forward work on safe staffing for those working in mental health, urgent and emergency care, learning disability and community services. NHS England intends to incorporate some of this work into existing programmes, such as the urgent and emergency care vanguards and the Mental Health Taskforce.

In line with this decision, the safe staffing programme being undertaken by the National Institute for Health and Care Excellence (NICE) has been suspended. NICE’s programme was originally set up in response to a recommendation from the Francis Inquiry and was looking at staffing across several areas. Staffing guidance already published by NICE will not be re-visited, but it does not appear that any of its complete but unpublished work will now be issued.

A further change was announced in July, when Jeremy Hunt indicated that the work on safe staffing would be taken forward by NHS Improvement, in line with the transfer of safety responsibilities from NHS England to the new body. The work will be overseen by National Patient Safety Director Mike Durkin, who is also moving to NHS Improvement. Dr Durkin will continue working with Jane Cummings and NHS England.

Jeremy Hunt indicated that the work will be independently reviewed by NICE, Sir Mike Richards, the Care Quality Commission’s Chief Inspector of Hospitals, and Sir Robert Francis.

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The government has set out its position in response to three reports relating to patient safety: The Freedom to speak up review by Sir Robert Francis; the Public Administration Select Committee’s report Investigating clinical incidents in the NHS; and the investigation into University Hospitals Morecambe Bay NHS Foundation Trust, conducted by Dr Bill Kirkup.

Responding to the findings in each report the government proposes to:

  • put in place Freedom to Speak Up Guardians at each trust – these guardians, who will be responsible for encouraging and supporting staff to raise concerns in relation to patient safety, will be appointed by trust chief executives to act as independent figures
  • ensure that all NHS providers provide training in raising and listening to concerns
  • remove the Nursing and Midwifery Council’s (NMC) current responsibility and accountability for statutory supervision of midwives in the United Kingdom, to bring arrangements for supervision of midwives into line with those in other clinical professions (the NMC will remain responsible for regulating midwifery)
  • review the Professional Codes of doctors, nurses and midwives – the intention is to ensure that the right incentives are in place to encourage people to report on and learn from mistakes
  • create a new Independent Patient Safety Investigation Service, to be fully operational from 1 April 2016.

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In July Jeremy Hunt announced new arrangements relating to patient safety.

The patient safety function led by Dr Mike Durkin, currently located within NHS England, will move to NHS Improvement, the new body jointly led by Monitor and NHS Trust Development Authority. One of NHS Improvement’s early priorities will be to support the Chief Nursing Officer in completing the work on safe staffing levels initiated by NICE.

In addition, Dr Durkin and an expert advisory group will set up a new Independent Patient Safety Investigation Service (IPSIS), modelled on the Air Accident Investigation Branch used by the airline industry. This service will be responsible for undertaking independent, expert investigations into patient safety incidents, as well as championing and supporting high-quality investigations led by local organisations.

IPSIS should be fully operational by April 2016. Initially it will be funded by central government, but in the longer term the ambition is to move to a mixed-funding model in which a significant proportion of income will come from NHS trusts.

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