Press release

NHS rated on open and honest reporting culture in world leading transparency drive

Sir Robert Francis launches new review into NHS reporting culture to make it easier for NHS staff to speak up.

This was published under the 2010 to 2015 Conservative and Liberal Democrat coalition government

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  • Unprecedented hospital data release aims to ensure NHS remains a world leader on safety

  • New safety drive with ambition to save up to 6,000 lives and halve avoidable harm

New data published today will for the first time allow the public the opportunity to compare key safety measures across hundreds of NHS Trusts in England.

It shows that the vast majority of NHS hospitals are rated as “good” or “ok” for their reporting culture. However, around one in five acute trusts, or 20 per cent have been rated as “poor” for open and honest reporting, underlining the need to support NHS staff to report and raise safety concerns.

The data has been published as the Health Secretary outlined a package of measures to ensure the NHS remains one of the safest healthcare systems in the world:

  • Sir Robert Francis QC, will lead a review Freedom and Responsibility to Speak Up: An Independent Review into Creating an Open & Honest Reporting Culture in the NHS, to consider what further action is necessary to protect NHS workers who speak out in the public interest and help to create the kind of open culture that is needed to ensure safe care for patients.
  • NHS Choices safety website: a new microsite which gives patients, regulators and staff unprecedented safety data. The seven safety indicators will allow people to look at safety and staffing data across the country, driving up competition and standards.
  • Launch of the Sign up to Safety campaign: Sir David Dalton, Chief Executive of Salford Royal NHS Foundation Trust will lead a major patient safety campaign which aims to halve avoidable harm, and in doing so save up to 6,000 lives over the next three years. Following the Mid Staffordshire Inquiry, the Government introduced major reforms to the NHS. Today’s measures will build on these and help create an open culture that will improve patient safety and give staff the confidence to know that they will be supported and listened to.

Last week, the Commonwealth Fund released a study that ranked the UK 1st in the world for quality of care, including safety. However healthcare systems around the world continue to have high levels of avoidable harm. Tackling unsafe care and avoidable harm such as medication errors, blood clots and bed sores will not only improve patient outcomes but will save the NHS money that can be reinvested into patient care. A 2007 study estimated the cost of adverse events due to medication errors at £774 million per year and the NHS currently spends around £1.3 billion per year on litigation claims.

Health Secretary, Jeremy Hunt said:

Globally, the levels of avoidable harm in health care are shocking. The NHS is already leading the way on safety, more than 300 people suffered as a result of some of the most serious types of preventable harm last year. Today’s campaign will go further and aims to save thousands of lives.

We have come a long way since Mid Staffordshire, however there are too many cases where NHS staff who have raised concerns about safety have been ignored. Today we have introduced measures to help tackle this head on.

Sign up to Safety campaign

All Trusts are invited to join the Sign up to Safety campaign which aims to drive up safety standards throughout the NHS, halve avoidable harm and save up to 6,000 lives over the next three years.

Twelve Trusts are already developing plans that will outline how they will reduce avoidable harm and save lives. An essential part of the plans are that Trusts must provide information on how they will plan to tackle two national patient safety priorities and two local priorities.

NHS Trusts who sign up and develop plans will have their plans reviewed by the NHS Litigation Authority and, when approved, they will receive a financial incentive from the NHS Litigation Authority to support implementation of the plan.

Sir David Dalton, Chief Executive of Salford Royal Hospital and leader of the campaign said:

I am delighted that this campaign focuses on saving lives and reducing harm. This is the right thing to do. Healthcare carries inherent risk and while healthcare professionals work hard every day to reduce this risk, harm still happens. Some is unavoidable but most isn’t. Sign up to Safety seeks to reduce this harm and is a unique opportunity for us all to work together to listen, learn and act to make a difference.

NHS Choices safety website

Going further than any other health care system in the world, the NHS Choices safety website has published an unprecedented amount of patient safety information to allow patients, regulators and staff to see safety performance across a range of indicators.

The seven indicators are:

  • CQC standards
  • Patient safety reporting: “open and honest” reporting
  • Safe staffing - % of nursing and midwifery hours filled as planned
  • Infection control and cleanliness
  • Patients assessed for risk of blood clots
  • Responding to patient safety alerts
  • Recommended by staff to their relatives and friends

Chief Nursing Officer for England, Jane Cummings, said:

Today is a watershed moment – for the first time, patients and the public will be able to find out about staffing levels down to ward level in their local hospital.

It isn’t possible to compare safety standards on staffing levels yet but the new site puts services more closely under the microscope, highlighting variations where questions need to be asked and most importantly, identifying where action is needed to deliver improved care for our patients.

Freedom to speak up: An Independent Review into creating an open and honest reporting culture in the NHS

Sir Robert Francis QC, the barrister who led the public inquiry into failings at Mid Staffordshire NHS Foundation Trust, will chair a new independent review into the reporting culture in the NHS and how staff on the frontline can be supported to raise concerns.

The independent review will look at what further action is necessary to protect NHS workers who speak out in the public interest and help to create the kind of open culture that is needed to ensure safe care for patients. It will issue a call for evidence from NHS whistleblowers, NHS frontline staff, NHS employers, trade unions, professional and systems regulators, amongst others and will use this evidence to learn lessons from historic cases so the NHS can learn for the future.

It will provide independent advice and recommendations to the Secretary of State for Health on measures to:

  • Build confidence to speak out: by ensuring that NHS staff in England can raise concerns about any aspect of the quality of care, malpractice or wrongdoing at work and be sure that they will be listened to and that appropriate action will be taken
  • Prevent mistreatment: staff should not suffer detrimental treatment as a result of raising concerns. The review will explore whether there are appropriate remedies so that those mistreating can be held to account;
  • Consider independent dispute resolution: the review will consider whether new and/or independent mechanisms are needed to resolve disputes in the NHS that involve whistleblowers; and consider options so that where tribunals or courts find in favour of individuals who have raised concerns, arrangements are in place to help them go back to work in the NHS;
  • Separate out concerns about care, malpractice or wrongdoing at work from personal grievance disputes: however complex cases become, in future, concerns about care need to be pulled out and dealt with separately; and
  • Seek out and learn from best practice. Sir Robert Francis QC will chair a new review on whistleblowing and culture in the NHS. The review will look at what further action is necessary to protect individuals who speak out and to help to create the kind of open culture that enhances safety.

Sir Robert Francis said:

We need a culture where ‘I need to report this’ is the thought, foremost in the mind of any NHS worker that has concerns – a culture where concerns are listened to and acted upon .

The Mid Staffordshire Public Inquiry showed the appalling consequences for patients when there is a “closed ranks” culture. This review will help us to learn more about what we need to do to support staff to raise concerns, and support the NHS to listen to them.

Background information

  1. The 12 Trusts who have signed up to safety are: Central London Community Healthcare Trust, Frimley Park Hospital NHS Foundation Trust, NHS Nottingham University Hospitals, North Bristol Trust, Oxleas FT, Royal Berkshire FT, Royal United Hospital Bath Trust, Salford Royal FT, Sheffield Teaching Hospitals FT, Staffordshire and Stoke Trent Partnership Trust, Taunton and Somerset FT, 2Gether FT.
  2. A new indicator will judge hospitals on its open and honest reporting culture. A red (poor) blue (ok) or green (good) rating will be awarded, based on five different categories: * Potential under-reporting of patient safety incidents to the NRLS * Potential under-reporting of death and severe harm patient safety incidents to the NRLS * Proportion of incidents reported to the NRLS that are harmful * Organisational commitment to at least monthly reporting to the NRLS * NHS Staff survey KF15 Fairness and effectiveness of incident reporting procedures
  3. About the campaign: * Organisations are being asked to develop a plan that describes what they will do to reduce harm and save lives. They will be asked to identify two or more national patient safety priorities and two or more local priorities to focus on in their plans. * As part of this work, they will be engaging local communities, patients and staff to ensure that the focus of their plan reflects what is important to the community they serve. They will make public their plan and update regularly on their progress against it.
  4. The support available to those who sign up: * Those organisations that sign up to the campaign can draw on a variety of expert support to help ensure that they realise the ambitions described in their plans. These include the use of staff briefings and de-briefings, the use of communication tools, increased skills in investigations and communicating with patients, and the approaches to designing safe care using tools and techniques from other industries, including checklists.
    * Collaboratives – are regionally based safety improvement networks that will work across whole local systems and all health care sectors, to deliver locally designed safety improvement programmes drawing on recognised evidence based methods. They will begin their work later in the year.
    * Fellows – work is underway to create a group of 5,000 respected, enthusiastic and effective safety improvers who will become the backbone of patient safety improvement. The group will launch later this year and organisations who sign up to safety will benefit from the expertise of the fellows and can also support their own staff to become fellows * SAFE team – a new Safety Action for England team will be developed to provide short-term support to individual trusts in the area of patient safety. SAFE will provide trusts with a clinical and managerial resource to help to develop organisational and staff capabilities to help improve the delivery of safe treatment and care.
  5. Look at those organisations that have signed up already and you can follow progress on twitter via @signuptosafety and using #signuptosafety
Published 24 June 2014