I think everyone who works in the medicolegal world will welcome the introduction of the Health Service Safety Investigations Bill on 14th September 2017. This will establish the Health Service Safety Investigations Body (HSSIB). The purpose of this organisation is to investigate adverse incidents in the NHS and to help to improve patient safety.
Under the proposals, the HSSIB will be independent of the NHS. It has been proposed to arm it with fairly wide sweeping powers to investigate patient safety incidents.
After each investigation is completed, the HSSIB will publish detailed reports which will:
- make recommendations for system-wide learning across the NHS
- help develop national standards on investigations
- provide advice, guidance and training to improve investigative practice across the health service
I think this is an admirable development and one that everyone in the NHS should welcome.
The draft bill allows the HSSIB to conduct investigations using ‘safe space’. ‘Safe space’ is a set of legal powers that prevent the HSSIB from disclosing the information it gathers in the course of an investigation. This will hopefully enable NHS staff to talk freely to investigators without the thought that their career might be ruined for making comments about their colleagues or management.
The proposed Health Service Safety Investigations Body HSSIB team will investigate up to 30 serious safety incidents a year in the NHS in England. The HSSIB will have an annual budget of £3.8 million.
My only concern is that in comparison with other peer group organisations the HSSIB looks very under resourced.
The Marine Accident Investigation Branch (MAIB) has 35 members of staff comprising of 4 experienced accident investigation teams and a budget of £4million. They have 15 investigations ongoing at present.
The Air Accidents Investigation Branch (AAIB) has a budget of approximately £7 million per annum and has 34 investigations currently in hand. It has approximately 50 employees.
My issue with the Health Service Safety Investigations Body (HSSIB) is that whilst the AAIB and the MAIB actually do have the ability to investigate every fatal and serious injury marine or air accident, the HSSIB clearly will not.
It would be unheard of for MAIB or the AAIB not to investigate a fatality which falls within their remit of investigations.
Meanwhile, according to the NHS’s own figures “There are around 24,000 serious incidents a year in the NHS”.
Also, a study by Researchers at the London School of Hygiene and Tropical Medicine in 2015 said; “one in 28 deaths could be attributed to poor care such as inattentive monitoring of the patient’s condition, doctors making the wrong diagnosis or patients being prescribed the wrong medicine.”
This is the equivalent of 750 deaths per month across the NHS, or 9000 per annum.
So whilst I welcome the Health Service Safety Investigations Body (HSSIB) as an aid to improving patient safety it is very concerning that they only be able to investigate 30 of the 24,000 adverse incidents that occur each year in the NHS.