Established by the Health and Care Act 2022, the Health Services Safety Investigations Body (HSSIB) has been in operation since 1 October 2023.
Here we provide an overview of key areas of discussion at the recent launch of HSSIB, “a fully independent arm’s length body of the Department of Health and Social Care”. The core role of HSSIB being “to carry out independent patient safety investigations that do not find blame or liability with individuals or organisations”.
Implementation of recommendations
During the launch, discussion was held as to how best HSSIB would be able to (i) make change; and (ii) promote a culture of safety.
The clear message from HSSIB is that it intends to make less, but more meaningful, recommendations. Legislation in support of HSSIB, and the new Board at HSSIB, will add force to recommendations. In particular, the intention is to link recommendations to Chief Financial Officers and Boards at NHS Trusts. A desire to collaborate.
Work is being undertaken with a similar set up in Finland, as to how HSSIB can develop a strategy to evaluate the adoption and impact of recommendations. Plus, develop an ability to escalate in the event of recommendations not being responded to.
Maternity investigation and non-maternity investigation split
During the discussion, various challenges were touched upon, which included the potential risk of the following:
- Loss of maternity learning (points previously secured via HSIB (Healthcare Safety Investigation Branch)).
- Loss of connection between those investigating safety in maternity and those investigating safety in a non-maternity health care setting.
- Women’s health, such as Gynaecology, sitting within both the areas of maternity and non-maternity, causing confusion and/or loss of valuable information.
In response to these challenges, those speaking on behalf of HSSIB stressed that care had been taken to ensure all learning points had been transferred from HSIB to MNSI (the Maternity and Newborn Safety Investigations programme), which is being hosted by the Care Quality Commission.
HSSIB stated an intention to remain in regular communication with MNSI for the benefit of patients. Further, HSSIB confirmed that women’s health is being focused on. Investigations relating to gynaecological care, and where maternity is not an issue, would sit with HSSIB.
'Safety management system'
For HSSIB the term ‘safety management system’ presents an opportunity to build safety into the core of the healthcare system. Safety management systems being an organised approach to managing safety, which is already widely used in other industries, where safety is critical.
Adoption of such an approach would strike at the core of how the system works by linking with the Chief Financial Officer and those in Corporate Governance at the relevant NHS Trust.
Mental health care
HSSIB recognise that wider socio-economic elements feed into the provision of safe patient care. These elements result in inequalities and HSSIB were keen to stress that this is particularly apparent in the provision of mental health care. They are mindful of this and will seek to bring about improvements.
Investigations will be conducted using 'safe space', which will prohibit the disclosure of any information, document, equipment, or other item held by HSSIB in connection with an investigation. To secure information of value, HSSIB are of the view that ‘safe space’ is required.
HSSIB’s view is that there needs to be a change from a defensive response by healthcare professionals to investigations. The fear of blame when NHS staff have been faced with safety investigations has remained widespread. Although, increasingly staff have felt more secure about raising concerns in relation to unsafe clinical practice, there remains a substantial number who do not feel secure.
This approach seems to fit with the new landscape of PSIRF. The Patient Safety Incident Response Framework (PSIRF) is the NHS’s new system-based approach to patient safety.
Central to the PSIRF process is understanding that patient safety incidents do not arise from a single action but as a result of many components. These components include people, technology, resources, the environment and their interaction.
HSSIB keen to emphasise an ongoing move away from blame. Human fallibility being the evidence of an unsafe system and not the cause of the unsafe event(s).
HSSIB spoke of a desire to widen ‘safe space’ so as to encourage patients to speak up and feel comfortable, and not concerned with regard to future care, when doing so.
Speaking at the launch, the Patient Safety Commissioner highlighted work being undertaken on whether adoption of ‘Martha’s Rule’ would be effective in the UK.
Martha’s Rule being a further safeguard for patients and their loved ones. It facilitates a second opinion concerning treatment options being obtained, in circumstances where there has been a suspected deterioration or serious concern raised on the part of a patient on a hospital ward.
The Secretary of State for Health and Social Care has previously indicated support for the introduction of such a Rule to hospitals in England.
It was speculated that adopting such an approach would link with HSSIB’s desire for earlier detection of harm to take place i.e. not at the point of harm occurring, but at the point of ‘some harm’ occurring.
Emergency care and winter pressures
HSSIB confirmed they have the ability to release interim reports and welcome the opportunity to explore further areas of immediate concern. Such areas might include emergency care or winter pressures.
The above correlating with NHS England’s belief that patient safety should flex and respond in real time so as to mitigate immediate risks.