In June, NHS Providers submitted written evidence to the Joint Committee on the Draft Health Service Safety Investigations Bill as part of its consideration of the Bill.

Key messages

• NHS Providers welcomes the creation of the Health Service Safety Investigations Bill (HSSIB) as an opportunity to develop a just culture in the NHS and a focus on learning. It is notable though that considerable expectations appear to have been placed on the HSSIB; the complaints and safety mechanisms within the NHS are already complex; and the HSSIB is a novelty to English healthcare. It is vital that HSSIB has a clearly defined remit and that expectations are managed as to what it can, and is intended to, achieve. The HSSIB is an independent body designed to investigate systemic safety risks. It also has a role in training and educating providers and clinicians in support of developing a just culture within the NHS. The HSSIB is not, however, the sole driver of a just culture – rather, this needs to be embedded throughout the NHS.

• Key to the success of the aviation, rail and maritime accident investigation branches has been taking a systemic approach to prioritising safety and embedding a learning culture throughout the given industry. We would note that: (1) they do not accredit organisations to carry out safety investigations or otherwise delegate investigations, and (2) recommendations may be focused across the full range of industry actors, whether on local or national bodies.

• The HSSIB will need to be fully independent of political influence, and maintain consistency of purpose through periods of political change which may impact on the regulatory and commissioning environment. However, its functional independence does not yet appear to be sufficient. The NHS’ regulatory bodies – Monitor (now within NHS Improvement), the Care Quality Commission and the professional regulators – are accountable to Parliament, recognising their necessary objectivity. A similar argument could be made for underpinning the independence of the HSSIB. We would therefore suggest that the HSSIB needs to be accountable as an organisation to Parliament, rather than the Secretary of State.

• A legally protected safe space is necessary for the HSSIB’s investigations; it is not appropriate for provider-led investigations – their investigations have different purposes, contexts and tools available. The HSSIB’s safe space must be designed to build the necessary confidence and trust amongst staff and the public that the NHS is honest, open and transparent when things go wrong – and further consideration is needed as to better defining the boundaries of safe space.

• For the HSSIB to succeed in contributing to improved patient safety, any investigations associated with it must be carried out independently and without conflict of interest, and be perceived as such. Accreditation – wherein lies an inherent conflict of interest in NHS bodies investigating themselves and their peers – would seem to undermine these core requirements and risk engendering further distrust in the NHS’ capacity to learn and improve. The intention behind accrediting trusts, that of developing a learning culture, would be better directed towards investing in the HSSIB’s role in setting standards of investigations and of training and accrediting local investigators to support its own work.

• The HSSIB will be able to identify where change is needed and make recommendations for a given NHS body to take action. It will not directly effect change or have any enforcement or oversight powers, this being a necessary separation to maintain its independence. This also avoids turning the investigations function into a de-facto regulatory process with judgment and apportionment of responsibility, as well as greater potential for self-interested obfuscation.

• The HSSIB will be carrying out high-profile investigations and detailed consideration is needed to ensure those involved in an incident and its investigation are not caused further distress. The objective must be learning – any necessary redress should be dealt with through other routes, and future participants should not be dissuaded from being forthcoming because of concerns about reporting on earlier participants.

NHS Providers full written evidence submission can be viewed at the link below. 

In June, NHS Providers chief executive, Chris Hopson, wrote to the Joint Committee to further detail our concerns relating to the lack of clarity for trusts about the implications of HSIB/HSSIB replacing their local investigations into serious incidents in maternity and neonatal care. 

A transcript of NHS Providers chief executive, Chris Hopson, oral evidence session in front of the Joint Committee can be found here.