Patient Safety - Health Committee Contents


11  The role of the DH and Government

297. Patient safety policy since An organisation with a memory (2000) has been mainly focused on the creation of reporting and learning mechanisms together with an open safety culture. As we have seen, a formidable, and pioneering, reporting and learning system has been created; yet a safety culture apparently remains elusive in much of the NHS. As Professor Kennedy, then Chairman of the HCC, told us, "cultural changes and behavioural changes" in respect of safety "lag behind in translating ideas into reality" compared to "structural responses".[285]

298. A major factor in this seems to have been that, as Safety First (2006) noted, safety is "not always given the same priority or status as other major issues such as reducing waiting times, implementing national service frameworks and achieving financial balance".[286] As we have noted, in several cases of major lapses in patient safety, an important factor was that safety was pushed aside in the deliberations of Boards by other priorities—particularly waiting-time targets, the need to achieve financial balance and the achievement of Foundation status. Although patient safety has theoretically been among the major priorities of the NHS for the past decade, in practice the message coming from the DH, as several witnesses told us, appears to have been that all these other matters were actually greater priorities. In respect of targets in particular, the quantity of services provided has appeared to be much more important than their quality.

299. Ministers and DH officials told us rightly that many Trusts have managed to respond to targets and other imperatives from the centre, whilst also providing safe services. They accept that some Trusts have not done so, but insist that these are exceptional cases, with dysfunctional managers and Boards who must take the blame for their failure to provide safe care.

300. Two points can be made in response to this. Firstly, the Government's overwhelming emphasis on hitting targets (particularly waiting-list and A&E waiting), achieving financial balance and attaining Foundation status, clearly did not help to improve failing Trusts—rather it compounded their failure. The failing Trusts, like Mid-Staffordshire and Maidstone and Tunbridge Wells, clearly thought the Government was telling them that patient safety was a second-order priority. Secondly, the failure of the systems for commissioning, performance management and regulation to detect in a timely fashion the failings of these Trusts' managers and Boards, which we have already noted, must at least in part be laid at the door of the Government, which is responsible for those systems. Likewise, the failure of the NHS systems for handling complaints, and for patient and public involvement to bring to light those failings can also ultimately be seen as a failure of the Government policy underlying those systems.

Conclusion

301. The Government is to be praised for being the first in the world to adopt a policy which makes patient safety a priority. However, Government policy has too often given the impression that there are other priorities, notably hitting targets (particularly for waiting lists, and Accident and Emergency waiting times), achieving financial balance and attaining Foundation Trust status, which are more important than patient safety. This has undoubtedly, in a number of well documented cases, been a contributory factor in making services unsafe. We welcome Lord Darzi's statement in the Next Stage Review of the importance of quality and safety. From now on, all Government policy in respect of the NHS must be predicated on the principle that the Service's first priority, always and without exception, is to ensure that patients in its care do not suffer avoidable harm. The Government should state clearly that safety is the overriding priority of the NHS and that, if necessary, other targets should be missed where patient safety is being jeopardised; for example, A&E patients should not be moved to unsuitable wards just to meet the four-hour maximum waiting target.

302. The key tasks of the Government are to ensure that the NHS:

  • develops a culture of openness and "fair blame";
  • strengthens, clarifies and promulgates its whistleblowing policy; and
  • provides leadership which listens to and acts upon staff suggestions for service changes to improve efficiency and quality and, by the provision of examples and incentives, encourages and enables staff to implement practical and proven improvements in patient safety.

In addition, the Government should examine the contribution of deficiencies in regulation to failures in patient safety.


285   Q 691 Back

286   Department of Health, Safety First, 2006, p 6 Back


 
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