Safety: too little; too late?

We all know the old joke about doctors having poor handwriting: but it’s come to something when confused communication spreads across the whole NHS – and then jumps the species barrier from handwritten to computer generated copy, as is the case with recent press releases from the Department of Health. It seems that the NHS is having a drive on safety, by which they mean they want staff to stop abusing patients – but it’s difficult to work out what the NHS is actually going to do.

They will start by publishing data on safety, so that public can look at the data: apparently this, just the fact of the public looking, will “drive up competition and standards”. How? If we could make the world a safer place just by looking at statistics about it, you’d probably have a long queue of public spirited folk keen to help out. We suspect that standards will only improve if someone looks at the data and finds a way of improving the practices behind the data, even if that means spending more money. However, the link between competition and standards is nonsensical. Increasing competition in public services does not magically drive up standards. Usually quite the opposite occurs, as those in competition have to try to do more with less money until there is a disaster and everyone is sorry.

The next step that is going to be taken is that Sir Robert Francis QC will lead a review, which will be called “Freedom and Responsibility to Speak Up: An Independent Review into Creating an Open & Honest Reporting Culture in the NHS”. Yippee.  The review will consider how to make it easier for NHS staff to whistleblow on their colleagues, if and when those colleagues appear to be harming patients. Again, this is putting the cart before the horse. Yes, whistleblowers should be protected – but you cannot base your safety procedures on the hope that someone will report wrongdoers, or even on the hope that the threat of wrongdoing being reported will stop it taking place. You need safety procedures which will stop patient abuse, and then whistleblowing is your safety net when something goes wrong – not your means of enforcement.

Finally, we have a new “Sign up to Safety” campaign, to be led by Sir David Dalton, Chief Executive of Salford Royal NHS Foundation Trust. This aims to “halve avoidable harm, and in doing so save up to 6,000 lives over the next three years.” Save 6,000 lives? Excuse me?  Your existing procedures have been costing 2,000 lives a year and you have done nothing about them till now? And all you want to do now is to halve avoidable harm? Not to stop it? Just to halve it? You want to divide avoidable harm into one half of intolerable avoidable harm and another half of tolerable avoidable harm? By saving 6,000 lives in three years? Not 4,000 this year and none next year?

The Sign up to Safety campaign sounds like a bureaucratic nightmare. Although all Trusts have been invited to “sign up”, it does not appear to be compulsory. Just twelve Trusts are in the first tranche of signers, which has safety plans under development. The Trusts have to choose two national patient safety priorities and two local priorities to tackle in their plans. The plans are then reviewed by the NHS Litigation Authority and, when approved, they will receive a financial incentive to support implementation of the plan. Welcome to the NHS of the 21st century: where core funding is held back but bureaucratic plans offer additional money for special schemes. Trusts have to opt in to the plans to get the money – and so a new class of (non-productive) bureaucrats is created (and funded by the taxpayer). Perhaps, dear reader, you can begin to see why we are finding it hard to understand what the Department’s priorities are here.

Apparently it’s not just the moral issues that are driving change: the NHS is looking to save money. “A 2007 study estimated the cost of adverse events due to medication errors at £774 million per year and the NHS currently spends around £1.3 billion per year on litigation claims,” they tell us. Weird. The NHS has been spending money on litigation claims for years. Why have they waited this long to find ways of cutting down on this expenditure? If the pressure of spending money on litigation claims hasn’t ““drive[n] up competition and standards”, it is even less likely that publishing safety statistics will force improvement.

The British Medical Association (BMA) has damned the safety initiative with rather feint praise. Dr Mark Porter, Chair of BMA Council, said: “We share the Health Secretary’s commitment to greater openness and transparency. In a public service the public must have confidence in the systems that underlie patient safety.

“The challenge for us all here is to make sure that openness and transparency is understood as a good thing in itself. Leadership by example will be essential to make sure this very openness is not used to feed the blame culture that has been shown to be so damaging to the continual improvement of patient safety.

“We look forward to engaging with Sir Robert Francis’ review to ensure that we have a culture of support – not blame – to empower staff to raise concerns.

“We must not allow the undermining of the excellent care that our doctors and other NHS staff provide every day. Despite the growing financial and workload pressures on our hospitals, the Commonwealth Fund last week ranked the NHS first in the world for quality of care, including patient safety.”

Sir Robert Francis, who is to lead the review, said: “We need a culture where ‘I need to report this’ is the thought, foremost in the mind of any NHS worker that has concerns – a culture where concerns are listened to and acted upon.” Can we suggest an alternative? How about that the NHS strives for an “I am glad I have nothing to report” culture?

Safety data can be found on on www.nhs.uk/safety. Details of those organisations that have signed up to safety can be found on www.signuptosafety.nhs.uk. You can follow progress on twitter via @signuptosafety and using #signuptosafety (or you could just get a life).