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Response to the consultation: Providing a ‘safe space’ in healthcare safety investigations

26 Jan 2017
  • Consultation Responses

The Authority's response to the Department of Health's consultation on 'providing a ‘safe space’ in healthcare safety investigations'.

Response to the Department of Health's consultation on 'providing a ‘safe space’ in healthcare safety investigations'

We welcome the opportunity to respond to this Department of Health consultation about providing a ‘safe space’ in healthcare safety investigations. We offer some general comments, detailed analysis and have responded some of the individual questions in the consultation document.

General Comments

The Authority supports the goal of creating a learning culture and an environment where professionals can openly discuss issues to improve performance and patient care. We agree with Don Berwick’s conclusion in A promise to learn – a commitment to act that patient safety depends upon a learning culture, where near misses and errors are openly discussed and learnt from. However, an open culture to share information confidentially between professionals must be consistent with the rights and needs of patients and their relatives and with the proper requirements of professional standards of conduct and effective regulation. Openness in secret is not openness.

We consider there is a fundamental contradiction between the Government’s commitment to transparency and accountability, as expressed though the duty of candour, and the proposals in this paper for anonymous and confidential reporting.

We find the term ‘safe spaces’ unattractive. The language of safe spaces has long been used in the protection of vulnerable children and adults. For this language to be applied to health professionals as though they were the victims of patient safety errors is distinctly unappealing. However, if professionals are to be viewed as ‘victims’ then it should be noted that they are ‘second victims’ to the ‘first and obvious victims’: patients.

Moreover the term ‘safe spaces’ has recently been adopted by various pressure groups claiming ‘safe spaces’ where they can be free from any public debate or challenge. We see no reason why ‘confidential enquiry’ or investigation cannot be used as it is after all what is being proposed. We use ‘confidential enquiry’ instead of ‘safe space’ in this response.

We welcome lessons that can be learned from other sectors to improve safety in healthcare. The consultation document pays particular attention to the airline industry and we note the useful lessons which Carl Macrae has drawn from that sector. He discussed the need for the UK healthcare system to develop a ‘shared accountability’ culture whereby all staff see patient safety as part of their role and responsibility.

We note the contradiction between confidential investigations and professional regulatory operations. The consultation document makes clear that if there was an ‘immediate risk to patient safety’ of any information found in a confidential investigation then the information would be referred to professional regulators or other relevant authorities. The Department of Health and the Healthcare Safety Investigation Branch (HSIB) will need to work closely with all eight professional regulators operating in England to determine reliably what constitutes a ‘public risk’.

We note also that as the powers of the HSIB apply to England only this will create operational variations for the regulators which are UK or GB wide.