Impartial investigation or review An impartial investigator is important, especially in small jurisdictions, where particular difficulties are faced when there is a need to investigate
Unanswered complaints A backlog of unanswered complaints is a sure fire target for a diligent regulator. And the question that follows the discovery of the
Never events are rare given the huge number of treatment episodes in the NHS; 306 were reported in the year 2014-15, and a total of
Spotlight on child abuse I went to see the excellent film Spotlight the other night. The basic plot is pretty well-known – dedicated journalists track
Parliamentary and health service ombudsman This week the Parliamentary and Health Service Ombudsman (PHSO) published its review into the quality of complaints investigations where serious
Incident investigation training Hear a 3-minute audio clip of Verita’s head of training talking to Charlie de Montfort about Verita’s systematic incident investigation training course.
Department of Health Yesterday, the Department of Health published an update report providing a summary of the actions taken in response to recommendations from Kate
Clinical commissioning groups Last week Peter Killwick wrote in this blog about a number of risks associated with governance in clinical commissioning groups (CCGs). Since
Background Root cause analysis (RCA) was developed for the health services to promote a systematic approach to the investigation of serious incidents. In the past,
Investigation work As we approach our 14th year of investigation work, our methodology continues to sharpen. Each year offers the team a wealth of opportunities
Patient safety In order to improve patient safety, it is essential to learn from serious incidents. Much has been written about the need to develop
Myles Bradbury Last week Cambridge University Hospitals NHS Foundation Trust published the report of the review it had commissioned from Verita into the governance of
