Supplementary memorandum submitted by
the National Audit Office
Question 57 (Jon Trickett): Information relating
to staff incidents
— Revised figure six using the incidents
per 1,000 staff—Number of incidents per 1,000 members
of staff.
— Reported incidents per thousand members
of staff compared to star ratings.
THE TOTAL
NUMBER OF
INCIDENTS AND
NEAR MISSES
PER 1,000 MEMBERS
OF STAFF
The total number of incidents and near misses
per 1,000 members of staff for 2003-04 (based on responses from
256 trusts) and 2004-05 (based on responses from 212 trusts) are
as follows:
These figures show that there is wide variation
in the number of reported incidents and near misses between trusts.
The Comptroller and Auditor General's Report, paragraph 2.6, noted
that it is difficult to make year on year comparisons as many
trusts have changed their reporting systems. The Report also notes
that the Department of Health welcomed the evidence of an increase
in numbers of incidents reported as this showed a more complete
coverage of reports from across the NHS[10].
The statistics noted above require careful interpretation
as trust use different definitions and report under different
reporting criteria. For example we found that some trusts did
not differentiate between near misses and incidents and that overall
there were far fewer near misses reported than incidents, particularly
in mental health trusts. However, statistical analysis shows that
the more staff believed that their reporting systems were fair,
the closer the ratio of incidents to near misses reported (paragraph
2.13-2.14) 1.
We also noted that under-reporting was a problem
for some trust (35% of executive directors of patient safety told
us that under-reporting was a moderate problem and 2% that it
was a major problem for their trust. Most (93% had attempted to
estimate the level of under-reporting of incidents and near misses
(on average 22 and 39% respectively). Also certain types of incidents
are more likely to be under-reported. During our visits to trusts
managers pointed out that staff were less fearful about reporting
a patient fall, as in many cases the attributed cause was not
due to direct staff action. In contrast medication errors and
adverse drug reactions were under-reported (paragraph 2.16) 1.
We concluded that at the local level the vast
majority of trusts have developed a predominantly fair open and
fair reporting culture but with pockets of blame and scope to
improve their strategies for sharing good practice. Indeed in
our 2005 re-survey we found that local practice had continued
to improve with more trusts reporting having an open and fair
reporting culture, more trusts with open reporting systems and
improvements in the perceptions of the levels of under-reporting
(paragraph 6) 1.
Given the above, we consider that the data on
2004-05, whilst from a slightly fewer number of trusts, is the
most up to date and is also likely to be the more robust figure.
REPORTED INCIDENTS
PER THOUSAND
MEMBERS OF
STAFF COMPARED
TO STAR
RATINGS
We found no statistically significant correlation
between star ratings and reported incidents.
This is not particularly unexpected as, partly
as explained above, improvements in reporting are still developing
and a trust that currently reports a higher level of incidents
and near misses is as likely to be a high performing trust as
far as developing an open and fair reporting culture, as a poorly
performing trust in respect of the safety of patients. The lack
of correlation is also likely to be due to the fact that star
ratings are awarded following evaluation if a trusts performance
against a wide number of performance measures, which do not include
the number of reported patient safety incidents.
The ratings, for the financial year 2004-05,
assessed performance in meeting targets in areas such as waiting
times for hospital treatment, access to GPs and response times
of ambulances, as well as management of finances and handling
of patients and staff.
Patient safety is covered to a small extent
by the response to the patient survey but only as one of many
other patient issues. The staff survey also asks questions about
staff reporting, but again this is one of a number of issues covered
by the questions. The results from the Healthcare Commission's
2004-05 star ratings assessment show an improvement in the performance
of the NHS (see below). Details can be found on the Healthcare
Commision's website http://ratings2005.healthcarecommission.org.uk.
10 The Comptroller and Auditor General's report (HC
456 Session 2005-06). Back
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