Safety recommendation
In interim report 2 a safety observation was made, following the collection of further evidence this has now been escalated to a safety recommendation.
HSIB recommends that the Department of Health and Social Care develops and implements a patient safety accountability framework that spans the health and social care system. This is to help address the lack of accountability relating to patient safety risks spanning health and social care.
Response:
Accountability is central to patient safety in the NHS. It guides expectations and judgements about the performance of providers delivering health and care services.
The Department of Health and Social Care considers that regulators and oversight bodies should work to ensure that current accountability frameworks enhance regulatory and oversight arrangements in ways that achieve cross-agency and cross-sector working to improve patient safety and other outcomes that matter to the public.
Integrated Care Systems (ICSs) are partnerships of organisations that come together to plan and deliver joined up health and care services, and to improve the lives of people who live and work in their area. The Department considers that systems and the organisations within them should ensure that the right processes and improvement support are available to further improve patient safety and address any risks and issues as they are identified.
Forthcoming assessments of ICSs by the Care Quality Commission (CQC) will provide independent assurance to the system and to Parliament of how well different partners of the system are coming together to focus on the needs of their populations. This includes assessments of whether each ICS is performing well against statements of what good looks like under the theme of ‘quality and safety’. In addition, the Secretary of State’s priorities[1] for the assessments include ‘To understand how effectively each integrated care system drives improvement of quality and safety at a system level.’ Following the report, system partners (integrated care boards, local authorities, and providers) are expected to come together through a local system improvement summit to review assessment findings and publish action plans, which the CQC will monitor.
The Department will utilise CQC’s assessment of ICSs’ performance to inform itself of any specific patient safety risks and issues that span health and social care.
Response received on 22 November 2023, however HSSIB noted that the response did not meet the intent of the safety recommendation and requested further clarification. HSSIB will continue to work collaboratively with partners to support the development of Safety Management Systems in healthcare which provide a proactive approach to managing safety and set out the necessary organisational structures and accountabilities.
Updated response received on 1 October 2024:
Clear lines of accountability and responsibility are needed for effective patient safety management in the health and care system.
The Department of Health and Social Care maintains its position that regulators and oversight bodies should work to ensure that current accountability frameworks for providers enhance regulatory and oversight arrangements in ways that achieve cross-agency and cross-sector working to improve patient safety and other outcomes that matter to the public. On 26 July 2024, the Secretary of State for Health and Social Care stated that he would ask Dr Penny Dash (pending completion of her final report into the operational effectiveness of the Care Quality Commission in autumn) to review and make recommendations on how to maximise the effectiveness of key organisations with oversight responsibility for patient safety. The Department will consider any recommendations relating to accountabilities for patient safety.
The Department acknowledges that patient safety accountability and delivery could be comprehensively enhanced by taking a safety management systems (SMS) approach across the health system. NHS England are currently working with partners from across the healthcare system (including the Health Services Safety Investigations Body), academia and other safety critical industries to explore how the principles of SMSs may be translated within a healthcare context. The Department will continue to work with NHS England and the Health Services Safety Investigations Body to understand how SMSs could be employed in the NHS.