This blog post was published by the Healthcare Safety Investigation Branch (HSIB). Find out more about HSIB legacy.
Full independence for HSSIB is essential for ensuring that patients, public, healthcare staff and organisations can feel equally confident that the HSSIB’s investigations will remain focused on learning to improve patient safety.
‘Safe space’ in investigations
HSSIB’s safety investigations will have legal privilege, also often referred to as ‘safe space’. This means that our investigation evidence and findings are subject to special protections. They cannot be disclosed without the HSSIB chief investigator’s consent, or without a High Court order that has assessed the public benefit of that disclosure. This protection already exists for other safety critical industry investigations, such as those undertaken by the UK’s transport investigation branches.
The purpose of safe space is to ensure that all participants can speak to HSSIB investigators without fear that their evidence could be used against them in some way. HSSIB investigations do not seek to assess or attribute responsibility for what went wrong. System-level safety investigations, which is how HSIB operates, seek to determine why the same incidents keep happening across the healthcare system. Our investigations are interested in the most important safety information, so we can make effective recommendations. Healthcare staff need to feel safe to speak freely about the problems they faced – practical, cultural, managerial – in delivering safe care.
Safe space does not hide important information from patients, families and the public. Other investigations including court processes are not impeded by HSSIB’s work. All safety relevant information HSSIB obtains will be published in our report – we just won’t attribute the evidence to individuals who shared it. HSSIB must ensure that any ongoing safety risks identified in our investigations are quickly addressed, and that we share any necessary information to support such action by other organisations including professional or sector regulators if appropriate. HSSIB will, as HSIB does, value transparency and the sharing of detail – this is important so that all people who’ve been affected by an incident we investigate feel that the full story of what happened has been told, and the findings and recommendations will be effective at reducing the chance it can happen again.
Powers to require participation, and to obtain evidence
One challenge for healthcare staff who participate in HSIB investigations is that there is often a long delay between when an incident happens and when HSIB investigators can interview them about it. This is because we need patient and/or family consent to access care records. With the Act, HSSIB will not need to obtain prior consent, so we can speak to staff more quickly and capture the nuances and details of what happened during an incident.
We will also have power to require staff to speak to us. Over the last five years, very few staff have refused to speak to HSIB investigators, but we hope that with safe space protections, all staff will feel confident that they can speak openly with us about their work without fear of blame or punishment.
HSSIB investigators will also have the authority to enter healthcare premises, inspect any equipment or documents and take copies or remove any item as long as doing so does not pose a risk to the safety of any patient.
HSSIB’s powers will also extend to investigations for care received in private and independent healthcare providers – not just care that is paid for or provided by the NHS.
HSIB’s maternity investigations
Our maternity investigations programme is vitally important. It is also the way in which many people – patients, staff and healthcare providers – know about HSIB’s role and our work. We are very proud of how HSIB’s maternity programme has demonstrated the benefits of independent investigations for families, and of local investigations designed to support system-level safety learning. After April 2023, maternity investigations will continue with a new body – the Maternity and Newborn Safety Investigations special health authority (MNSI). MNSI’s work will, at least initially, be very similar in scope and approach to what the HSIB maternity programme currently does – local investigations that meet certain criteria, and not with the HSSIB’s powers discussed in this article. Over time and working in partnership with the rest of the maternity system in England, MNSI’s approach may adapt to ensure that its investigations support safer maternity care in the best possible way.
As HSIB evolves into HSSIB and MNSI over the coming months to April 2023, we will share more about how we are changing, as well as how we will continue to work together and build on our successes to date. What will not change, is our commitment to involving patients, families and healthcare staff meaningfully in our investigations, the learning focus we bring to investigations, and our efforts to share this learning for the benefit of patient safety and those with the responsibility to protect it.
Dr Sean Weaver is Deputy Medical Director at HSIB and Consultant Gastroenterologist at University Hospitals Dorset NHS Foundation Trust.