Patient Safety: Another step forward (Joint Committee reports on Health Service safety investigation draft legislation)

Recommendation

Rationale

The 'safe space' intended to protect information given to HSSIB as proposed in the draft legislation should be preserved.

The concern was that this would generate a suspicion that information was being hidden from wider scrutiny and would undermine the effectiveness of HSSIB. The Joint Committee rejected this idea on the grounds that the 'safe space' would have no effect whatsoever on any information or evidence already available or which could be produced through other avenues.

HSSIB should have a power to compel individuals to give evidence

This is a quid pro quo for such evidence being given in a 'safe space'. Non-compliance should be a criminal offence.

HHSIB should be allowed to enter NHS premises to inspect and copy documents without a warrant where permission to do so is not given by the NHS body

HSSIB accreditation of NHS Trusts and Foundation Trusts to enable them to undertake 'safe space' investigations is "wholly misconceived" and should be dropped from the draft legislation.

This would create a conflict of interest as between the accredited Trust and the 'safe space' concept; it would make the HSSIB appear to be a part of the system it was investigating and erode its independence.

HSSIB should not be granted a power to undertake investigations which do not embrace a 'safe space'.

Although not part of the draft legislation this was a government suggestion, borne of the direction of the Secretary of State that HSSIB investigate stillbirth, neonatal death and suspected brain injury and maternal death. The Joint Committee felt this would blur the distinction between the duties of Trusts, professional regulators or the courts to establish accountability and the HSSIB requirement to focus on learning lessons without finding blame.

There should be no statutory duty on HSSIB to co-operate with other organisations undertaking a regulatory function.

While HSSIB will need to co-operate with those organisations, a statutory duty to co-operate would cast doubt on its independence from existing structures.

The remit of HSSIB should not be limited to NHS care provision. Its powers should be extended to enable analysis of the care pathway involved.

Limiting its remit in this way may reduce the effectiveness of HSSIB as it does not take into account the complex interactions of health and social care or private and public healthcare provision.

The remit of HSSIB should not be limited to England. Devolved administrations should be given the choice of participating in HSSIB if they wish.

Limiting its remit in this way would not take account of the fact that many patients cross borders within the UK.

The independence of HSSIB should be reinforced

Although the Committee accepted that the Secretary of State could not direct the HSSIB on which investigations to undertake, it felt that independence of judgement needed to be enhanced.

The appointment of Chair and Chief Investigator should be subject to pre-appointment by the Commons Health and Social Care Committee.

The effectiveness of HSSIB should be subject to a post-legislative review after 3 years.

DoHSS and HHSIB should engage with patients and families to ensure proper understanding of the meaning of 'safe space'