Review of patient safety across the health and care landscape – our response
The Association of Anaesthetists welcomes the publication of the Review of patient safety across the health and care landscape undertaken by Dr Penny Dash. Anaesthesia has always been at the forefront of patient safety and the motto of the Association of Anaesthetists is 'In somno securitas' or 'Safe in sleep'. Our mission is to keep both patients and anaesthetists safe.
We welcome much of this review, in particular we agree that a more strategic and coordinated approach to improving quality and safety in care is required and that there is a need to reduce duplication across the system. If implemented, these steps have the potential to increase accountability, promote patient confidence and improve safety outcomes.
With regards to the review’s recommendations, we welcome that the CQC will remain the independent regulator and oversight body for the health and care system. We note with interest that the CQC will have a new role related to oversight of the governance structures of larger organisations. The Association responded to the recent consultation on regulating NHS managers and highlighted that at present, unregulated NHS managers make decisions that directly impact patient safety outcomes; however, managers are not at present held to the same level of responsibility as clinicians for any failure of care. We look forward to this being addressed.
We further welcome that the Health Service Safety Investigation Branch (HSSIB) and Patient Safety Commissioner will continue to operate as part of the safety landscape. Their investigative work is crucial to patient safety, and we are clear they must retain full independence and the ability to make safety critical recommendations. The recommendation to revitalise the National Quality Board is further welcome and we believe the Association has a key role to play in this body.
The review notes that “some of the organisations under review have expanded their scope of work beyond the original remit”. It is natural that organisations with a safety remit should themselves learn and develop and at times wish to expand their remit. It would be regrettable to remove or stifle the ability to make such organic improvements. The review also points out that HSSIB was created “to look at specific cases or incidents of severe harm, but it has since broadened its work into making more systemic recommendations”. This is both understandable and laudable, because system errors contribute significantly to most harms and it would be wrong and a retrograde step to re-focus simply on individuals’ errors.
The review refers to the NHS as one of the most data-rich healthcare systems in the world and highlights the opportunities to build on this to improve safety. We would reiterate the point that we have made before, that the current NHS IT infrastructure is not even fit for its current purpose and we repeat the frustrations that clinicians confront every day: poor or no Wi-Fi, slow network speeds and sub-standard hardware running sub-optimal software. Considerable upgrades will be required to realise any patient safety improvements. It is optimistic to hope that AI will help much while we can barely support ‘ordinary’ IT. We should also reiterate a point made in the 10-year plan, that much of our imported software is predicated on capturing ‘billable’ events and not on capturing safety-related data. This must change if IT is to realise its full safety potential.
We welcome the plans to reform mandatory training and remove some of the frustrating and pointless hoops that staff have to jump through in order simply to tick a box on their appraisal paperwork. We have already commented on this in our response to the 10-year plan. The review suggests that “further work is carried out to quantify the cost-benefit of all of these”. We would go one stage further and say that it is simply the benefit that should be the prime determinant. If genuine safety improvements follow from any training, then it is worthwhile and should be mandated. Only then should the cost be considered. If no benefit can be shown, the training should be discontinued.
Finally, the Association is clear that without more anaesthetists, aspirations to improve patient safety may be unrealised. At present, the number of consultant anaesthetists is around 1,900 (15%) short of what is needed. As two-thirds of patients staying in hospital have contact with anaesthetists, this shortage is being felt by patients with roughly 1.4 million operations and procedures unable to take place each year. We will continue to advocate for a sufficient anaesthetic workforce to improve patient safety and care.