Healthcare safety investigations
In October last year, the Department of Health launched a consultation titled “Providing a ‘safe space’ in healthcare safety investigations”. The consultation ran until mid-December with its purpose to collate views on the creation of a fair and balanced ‘safe space’ in healthcare safety investigations in order to support NHS staff in speaking up about incidents without fear of recrimination.
The consultation document published in October 2016 was authored by the CQC and provides a case for the creation of a safe space as well as an analysis of deeply rooted issues in patient safety investigations, particularly whether and the extent to which NHS staff feel comfortable about submitting evidence to investigations. The consultation focuses on the necessity for people to feel safe when submitting such evidence in order for high-quality investigations to be produced.
At the time of writing this blog, the feedback collected from the consultation is still under analysis. It will be soon published on the Department of Health’s website.
So what exactly is meant by the term ‘safe space’ and where did it come from? In the context of this consultation a ‘safe space’ is a proposed statutory requirement that would legally ensure information that staff provide as part of a safety investigation would be kept confidential, except where there is an immediate risk to patient safety, or where the High Court makes an order permitting disclosure. The concept of ‘safe space’ has been increasingly alluded to, not least in relation to the recently established Healthcare Safety Investigation Branch (HSIB).
The notion of a ‘safe space’ in healthcare was proposed by the Public Administration Select Committee (PASC) in 2015. Their ‘Investigating Clinical incidents in the NHS’ report highlighted that in order for investigation to optimally generate and drive meaningful learning and improvement, investigations must offer ‘safe space’ that provides protection to patients, families, clinicians, staff by enabling them to talk freely about incidents without fearing the repercussions. Primarily the need for a ‘safe space’ arises from people’s fear of judgement or blame for errors and mistakes and of damage to their relationships with colleagues.
The ‘safe space’ concept mooted by PASC has its roots in aviation. The Air Accidents Investigation Branch’s (AAIB) investigatory framework allows its investigators to offer a safe space to people they speak to as part of their investigations. In practical terms this is facilitated by a robust statutory framework, whereby investigators are legally bound to not share information obtained during investigations with other bodies, unless a request is made by the High Court or in other exceptional circumstances (such as when criminal activity may have taken place).
There will be a number of challenges with implementing a safe space successfully in the NHS. One such challenge will be achieving a balance between reassuring staff and reassuring patients and their families. HSIB experts have already voiced concerns about extending the safe space beyond HSIB investigations into local investigations. These concerns are generally borne out of the potential for misusing safe spaces and contradicting duty of candour principles.
It will be interesting to read the outcome of this consultation and whether it will result in any changes to legislation for safety investigations in healthcare.