This blog post was published by the Healthcare Safety Investigation Branch (HSIB). Find out more about HSIB legacy.
As part of our investigation work, HSIB has spoken with a number of NHS staff who are feeling the impact of the ongoing pressures across the NHS, including winter pressures and fatigue from fighting the coronavirus (COVID-19) pandemic.
They’ve told us how this can affect the response to patient safety incidents, if it’s not possible to support staff to be involved in investigations due to these ongoing pressures.
Missed learning opportunities
Where NHS staff are not supported to be involved in investigations of patient safety incidents, this can lead to missed opportunities for learning.
Staff are often best placed to describe the challenges, pressures and adaptations they have needed to make to deliver patient care in times of increased pressure on the NHS. This ‘work as done’ can be key to investigations understanding why patient safety incidents may occur and can support effective learning for organisations.
Without support during and after the investigation process, the psychological impact on staff involved in patient safety incidents can lead to significant effects on performance, health and wellbeing. This can include concerns such as anxiety, depression or concern about their ability to perform the job.
For organisations, the impact may lead to, amongst other things, increased levels of sickness, increased turnover of staff and reduced morale.
Support tools and programmes
It is also important to think about how we support staff who are asked to investigate patient safety incidents. At HSIB we use two key tools to help us support our staff: REACTMH and Trauma Risk Management (TRiM) peer support.
So how can we try and make sure NHS staff are supported to be involved in patient safety investigations?
We published a national learning report last year that looked at just this: ‘Support for staff following patient safety incidents’. It identifies how important it is for local NHS organisations to implement programmes to support their staff following patient safety incidents.
The report identified four themes for NHS organisations to consider when planning and providing support:
The report also considered that support programmes should include:
- Normalisation of the need for staff to be able to access and seek support. For example, leaders that role model and encourage the need for staff to access support services at times of need.
- Equality of access to support services. For example, access to general available support services should not be determined by staff group or grade.
- Identification of staff members or groups at particular risk to enable more focused intervention. For example, HSIB has heard from staff in urgent and emergency care about the specific pressures they currently face.
- Different routes for staff to access support. For example, via face to face, telephone or virtual services.
- Different types of support dependent on individual staff needs. For example, offering a variety of formal and informal support packages so that staff can choose what best suits their needs.
- Clarity on the expectations of staff involved in incident reports. For example, including a clear focus on learning, clear timelines and communication and participation of individuals in resulting service improvements, as part of incident investigations.
However, the report also found that not all organisations provide support to staff after patient safety incidents and certain staff groups may be less likely to engage with available support. There was also more limited evidence of support in areas such as primary care when compared with the secondary care sector.
The new NHS England Patient Safety Incident Response Framework (PSIRF) recognises the need to identify, inform and support staff following patient safety incidents. The framework includes specific guidance for NHS trusts to do this.
Wider support for NHS staff
We now understand the need to support NHS staff more generally (outside of patient safety incident investigation) following the COVID-19 pandemic and in light of the increased pressures being placed on the NHS.
At HSIB, we’ve particularly heard concerns from NHS staff who work in urgent and emergency care. In November we published an interim bulletin as part of our investigation into harm caused by delays in transferring patients to the right place of care which highlights these concerns.
Staff described to the investigation the negative impact work was having on their personal health and wellbeing. They reported:
- being unable to ‘switch-off’ from work
- impact on personal relationships at home
- reduced attention levels
- concerns about their ability to deliver the best service possible for their patients.
The investigation continues to work with stakeholders and a subject matter advisor to understand how deteriorating staff wellbeing can impact safe patient care. We will report further in early 2023 when this work is complete.
NHS England provides access to a range of support services for NHS staff. This includes a national support service for NHS staff that can be accessed via a confidential text message. NHS staff can text FRONTLINE to 85258 for support 24/7. This is available to all NHS staff who “have had a tough day, who are feeling worried or overwhelmed, or who have a lot on their mind and need to talk it through”.
The wellbeing of NHS staff has never been more challenged. It must be protected to the best of our ability when investigating patient safety incidents and more widely.