How we decide what to investigate

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Investigation criteria

The Health Services Safety Investigations Body (HSSIB) investigate patient safety concerns across the NHS in England, to understand why patients may have been harmed or be at risk of harm. We can also investigate in independent, or private, healthcare settings, where there may be safety lessons for the NHS.

We can investigate patient safety concerns that:

  • happen in healthcare services in England, and
  • have or may have an impact on the safety of patients.

Our investigations focus on learning and do not find blame with individuals or organisations. Our vision is to make healthcare safe for everyone through investigations, education, and working together.

We can also be directed to investigate a patient safety concern by the Secretary of State for Health and Social Care.

Investigation criteria

Our investigation criteria help us to make decisions about the patient safety issues we investigate.

Table setting out criteria for HSSIB investigations
Criteria Description Minor Moderate Major
Potential harm to patients and staff To what extent has the issue contributed to actual or potential harm of patients across the healthcare system? Would result in a low risk of harm including:
- minor reduction in quality of life
- minor reversible health condition
- minor infringement of a person's rights or welfare 		Would result in a risk of harm including:
- temporary disability
- reversible adverse health condition
- moderate infringement of a person's rights or welfare
- moderate reduction in quality of life 		Would result in a serious risk to any person’s life, health or wellbeing including:
- death
- permanent disability
- major reduction in quality of life
- significant infringement of a person's rights or welfare
Scale of the healthcare safety issue How widespread and systemic is the safety issue across the healthcare system? The safety issue occurs across a limited range of healthcare settings or contexts, for example an isolated issue that affects a single healthcare setting The safety issue occurs in a moderate range of care settings or contexts, for example a regional issue that affects multiple healthcare settings The safety issue occurs in a wide range of care settings or contexts nationally
Health inequalities To what extent is the safety issue associated with known health inequalities? The safety issue is not obviously associated with significant health inequalities The safety issue could be associated with health inequalities The safety issue is strongly associated with health inequalities
Potential to drive improvement To what extent could an HSSIB investigation drive improvement in relation to the patient safety issue? A HSSIB investigation would be unlikely to highlight new safety learning or help drive improvement A HSSIB investigation may support the development of existing safety learning and support existing efforts to improve safety A HSSIB investigation would likely highlight new safety learning and help drive improvements in patient safety