Patient safety remains at the forefront of the NHS‘s mission. From frontline staff to leadership teams, an ongoing commitment to ensuring every patient receives the highest quality of care is paramount. However, even in the most well-functioning healthcare systems, unforeseen events can occur.
This is where independent NHS investigations become invaluable. This article delves into the intricate processes involved in commissioning these investigations, explores the key factors that necessitate an independent review, and ultimately, unveils the numerous safety benefits such investigations offer for both patients and the NHS itself.
Verita is an independent investigations company providing expert advice to regulated industries in the UK. We have decades of experience as a healthcare management consultant conducting hundreds of investigations for health and social care organisations so, get in touch with us or book a free consultation if you need assistance.
What is the purpose of an independent NHS investigation?
The primary purpose of an independent NHS investigation is to conduct a thorough and impartial review of a patient’s care and treatment. This objective assessment aims to achieve several key goals.
Firstly, it seeks to identify any potential failings or areas for improvement within the care provided. Secondly, it strives to understand the root causes of the incident, preventing similar occurrences in the future. This unbiased perspective is crucial, as internal investigations, while valuable, may be susceptible to internal biases or a desire to protect the reputation of the trust involved.
As highlighted in our article on Maintaining High Professional Standards (MHPS), independent investigators bring a fresh perspective and a wealth of experience in healthcare investigations, minimising the influence of internal pressures and ensuring a truly objective review. This objectivity fosters transparency and builds public confidence in the NHS’s commitment to patient safety.
What is the independent NHS investigation process?
The independent NHS investigation process follows a structured approach designed to ensure a thorough, objective and transparent review. Here’s a breakdown of the key stages, keeping in line with the Patient Safety Incident Reporting Framework (PSIRF):
- Decision and Referral
Following an incident, the relevant NHS trust or service will determine if an independent investigation is necessary. This decision is then referred to NHS England for consideration. - Terms of Reference
NHS England, in collaboration with key stakeholders like the trust and patient representatives, will establish clear terms of reference. This crucial document outlines the scope of the investigation, its objectives, timeframe and the level of access granted to investigators. - Selection of Investigator
Based on the investigation’s complexity and focus, a qualified and independent investigator or team will be selected. These individuals possess extensive experience in healthcare investigations and a proven track record of conducting objective reviews. - Conduct of Investigation
This stage involves a meticulous examination of the incident. The investigator(s) will typically:
Review patient records: This includes medical history, treatment records and any relevant documentation.
Interview staff: Doctors, nurses and other involved personnel will be interviewed to gather first hand accounts and perspectives.
Analyse available evidence: This could include witness statements, data logs and any other relevant information.
Compliance with PSIRF: Throughout the investigation, the PSIRF framework provides a structured approach for gathering information, analysing root causes and making recommendations for improvement. - Report and Recommendations
Following the investigation, a comprehensive report will be drafted. This report should detail the findings, identify any potential failings or areas for improvement and propose concrete recommendations for the NHS trust or service involved. - Sharing Insights and Action Planning
Dissemination of the report findings and recommendations is crucial. This will involve sharing information with internal stakeholders within the trust, as well as external bodies like NHS England and potentially relevant patient groups. Sharing insights across other NHS organisations fosters a culture of learning and allows for system-wide improvements to patient safety. - Monitoring and Escalation
The independent investigator(s) may also outline a strategy for ongoing monitoring to ensure that the recommended actions are implemented effectively. This might involve setting clear timelines and milestones for progress. If necessary, the report may include provisions for escalation to NHS England or other relevant authorities in the event of delayed or inadequate implementation of the proposed improvements.
By following this structured and PSIRF-aligned process, independent NHS investigations play a vital role in ensuring transparency, accountability and ultimately, a safer NHS for patients and staff alike.
When can an independent NHS investigation be commissioned?
The Patient Safety Incident Response Framework (PSIRF) marks a positive shift in healthcare safety culture. It moves away from a blame-oriented approach towards a collaborative one, prioritising learning from incidents to prevent future occurrences. This focus on open communication and system-wide analysis unlocks deeper insights into the root causes of safety issues, ultimately leading to improved patient care.
However, in some situations, an independent investigation becomes necessary to ensure an objective and transparent review. For example, imagine a scenario where a smaller healthcare organisation, perhaps a community clinic, experiences a complex incident.
Their internal resources may be limited, making it challenging to gather all perspectives and conduct a truly objective review. In such cases, an independent investigation can provide them with the expertise and resources needed for a thorough assessment.
Similarly, public confidence may be shaken by a serious incident. An independent investigation, free from potential internal biases, can restore public trust in the healthcare system’s commitment to a transparent and accountable review process. Multi-agency incidents, involving multiple healthcare providers or services, might benefit from an independent investigation to ensure a unified approach and clear leadership throughout the review.
If an incident holds significant learning potential for a broader geographical area, an independent investigation can gather and analyse information in a way that benefits the entire healthcare system, leading to improved practices and national-level safety improvements.
How are independent NHS investigations commissioned?
The responsibility for commissioning independent NHS investigations falls to NHS England. This ensures a standardised and objective approach across the healthcare system. Importantly, these investigations are conducted entirely separate from any police investigations, legal proceedings, or the Coroner’s inquest. This allows for a free and open review focused solely on patient safety and learning.
To undertake the investigation, NHS England appoints an independent, expert organisation. This organisation is granted full access to all relevant information and reports about the patient’s care and treatment, adhering to strict patient confidentiality regulations. They are also empowered to interview any NHS staff directly involved in the incident, ensuring a comprehensive review.
The National Patient Safety Independent Investigations Team (NPSIIT)
The NPSIIT plays a critical role in establishing and maintaining a standardised approach across the entire process. This ensures consistency in governance, the investigation process itself and the valuable insights gleaned from these reviews. Furthermore, they support both national and regional NHS England teams, providing guidance on commissioning investigations and escalating issues when necessary. Additionally, the NPSIIT coordinates the dissemination of insights and learning derived from these investigations, fostering system-wide improvements in patient safety.
NHS England Regional Independent Investigation Teams (RIITs)
Each NHS England region has its own Regional Independent Investigation Team (RIIT). These teams work collaboratively with the NPSIIT and play a crucial role in supporting the commissioning process at the regional level. They provide local expertise and knowledge, ensuring investigations are tailored to the specific circumstances of each incident.
This two-tiered structure, with the NPSIIT providing national oversight and the RIITs offering regional support, allows for a coordinated and effective approach to independent NHS investigations.
Examples of independent NHS investigations
The scope of independent NHS investigations is wide-ranging. They can be triggered by a variety of patient safety incidents (PSIs), each offering unique opportunities for learning and improvement. These can include:
- Serious mental health incidents.
- The high-profile category of Never Events – preventable patient safety incidents.
- Safeguarding incidents, where vulnerable patients are at risk, may also warrant independent investigation to understand systemic failings.
- Persistent complaints from patients or the public can prompt a deeper, independent review.
- A cluster of related incidents or a particularly complex situation may necessitate a broader investigation, akin to the review into the actions of Jimmy Savile, to uncover systemic issues and implement wide-ranging changes.
In summary
Independent NHS investigations are a vital tool for ensuring patient safety and driving improvements across the healthcare system. By providing an unbiased and expert perspective, these investigations uncover critical insights, identify systemic issues, and foster a culture of learning and transparency.
Verita understands the importance of these investigations and offers a wealth of experience in conducting thorough and impartial reviews. So, if your organisation is considering commissioning an independent investigation, Verita is here to provide support with the expertise and commitment necessary to deliver valuable insights and drive positive change.
If you would like to know more about independent NHS investigations and how we can assist your team, please book a free consultation or contact Ed Marsden on 020 7494 5670 or [email protected].
