Overview of patient safety

Patient safety is defined by NHS Improvement as ‘the avoidance of unintended or unexpected harm to people during the provision of healthcare’.

Since the inception of modern day medicine, patient safety has been paramount. The phrase ‘first do no harm’ is often attributed to the Hippocratic Oath but the actual text from 2,500 years ago demands doctors to swear ‘I will utterly reject harm’. More recently, Florence Nightingale stated in her Notes on Nursing: What it is, and what it is not (published 1858) that ‘the very first requirement in a hospital is that it should do the sick no harm’.

When one examines healthcare in the current century in more detail, it would be fair to say that in the United Kingdom and at a global level the focus on patient safety has reached unprecedented levels. One only has to look at the NHS as a barometer to see how patient safety has taken centre stage over the last twenty years. In many ways the publication of An Organisation with a Memory by the Chief Medical Officer in 2000 popularised patient safety. Many relevant initiatives and documents have since followed, among them Lord Darzi’s Report High Quality Care For All (2008) that stated care must be ‘personal, effective and safe’ and Donald Berwick’s review into patient safety (2013) entitled A promise to learn – a commitment to act: improving the safety of patients in England.

Since the turn of the century patient safety has rarely been out of the spotlight. Sadly over the last two decades the NHS has experienced a steady run of high profile failures where patient safety has been willingly or unwillingly compromised: Bristol Royal Infirmary Inquiry, Shipman Inquiry, Morecambe Bay Inquiry, Francis Inquiry, Winterbourne View scandal etc. With the NHS increasingly under media scrutiny and patients increasingly encouraged to seek legal representation, it is not surprising that patient safety is top of the healthcare agenda and it is hard to see that ever changing in the future.

To help try to make healthcare safer, the NHS has spent significant sums of money setting up many bodies and initiatives over the last two decades. In many ways the creation of the National Patient Safety Agency in 2001 was the standard-bearer for what has followed since. The purpose of the NPSA was to reduce risks to patients receiving NHS care and to improve safety. The NPSA used data from the National Reporting and Learning System to identify key trends as well as creating many resources and training opportunities.

It is impossible to list all of the various initiatives set up in the NHS since the creation of the NPSA in 2001 but patient safety alerts, national clinical audits and revalidation have all been designed to identify problems, raise standards and make care safer. Many former and current NHS bodies have also had patient safety firmly in their sights including: NHS Institute for Innovation and Improvement, Central Alerting System, Academic Health Science Networks, NHS Vanguards, NHS Improvement and the Care Quality Commission.

Data indicates that reporting of patient safety incidents continues to rise. Certainly during the last decade healthcare professionals have been encouraged to report incidents and raise concerns. As more and more emphasis is placed on patient safety one would expect reporting of incidents to continue to grow especially in light of recent Duty of Candor regulations and the introduction of Freedom to Speak Up Guardians. While increased reporting of incidents is vital in helping the NHS to understand why mistakes happen and to learn from them, we should not underestimate the scale of the task at hand. In 2016 a total of 1.87 million incidents were reported to the National Reporting and Learning System. From April 2016 to March 2017 the NHS reported 445 never events (click here for more details) and according to the NHS Litigation Authority, NHS Trusts paid out £1.4 billion to settle medical negligence claims in 2015 (compared to £583 million in 2008). As Don Berwick stated in his 2013 report: the NHS must place the quality of patient care, especially patient safety, above all other aims. Click here to find out more about Berwick’s key priorities for improving patient safety in the NHS.

Following on from the work of Berwick and his team, in 2018 the NHS conducted a major consultation of all stakeholders to find out views on how patient safety investigations are conducted. This culminated in the publication of the new Patient Safety Strategy in 2019, available here. The new strategy represents a landmark shift in terms of how patient safety is managed within healthcare teams with more focus on understanding systems / human factors and a move away from blaming individuals. Going forward the emphasis will be on learning and improving, plus getting patients and family members much more involved. New standards have been developed and the emphasis is on trained experts conducting incident reviews. The Patient Safety Incident Response Framework (PSIRF) was published in 2022 and represents perhaps the biggest shift ever in terms of how the NHS deliver patient safety. To find out more about PSIRF, click here. Our graphic also describes the main elements of PSIRF and is available here.


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