The Healthcare Safety Investigation Branch: Glass half full or half empty?
by Peter Walsh
Chief Executive of AvMA
The much trumpeted Healthcare Safety Investigation Branch (HSIB) came a step closer to becoming a reality with the announcement today (3rd June) that Keith Conradi is to be appointed the Chief Investigator. Mr Conradi is currently the Chief Executive of the Air Accidents Investigation Branch, on which proposals for the HSIB are largely based.
Most people concerned with patient safety, including AvMA, will welcome the creation of HSIB and indeed anything that will help address the urgent need to improve the quality of NHS investigations. However, celebrations are unlikely as so much uncertainty remains about the principles and ethical framework with which HSIB will work; its independence, and its capacity to make significant improvements. The HSIB will be a branch of NHS Improvement and have capacity to undertake around 30 investigations a year.
Most controversially, the Government has already set statutory directions on how HSIB should work which are starkly different to the recommendations on openness with patients and families made by the Expert Advisory Group. After careful consideration this broad church of experts in patient safety recommended that all relevant information about a patient’s treatment ‘must’ be shared with the patient/family and that they would be ‘free to use it as they wish’. However, the directions say only that the Chief Investigator ‘may, when requested’ disclose such information to the patient ‘but such disclosure may only be made… to such extent that the Chief Investigator judges… to be consistent with the safe space principle’.
The ‘safe space’ principle is very ill-defined. Few would argue that there should be some protection for health professionals who provide evidence in good faith to investigations, but I and members of the Expert Advisory Group itself are shocked that experts’ advice on this issue has been ignored and the possibility of information about a patient’s own treatment being withheld from them has deliberately been built into the directions. This seems completely at odds with the principles of the Duty of Candour and the NHS Constitution.
Suddenly, the ill-defined notion of ‘safe space’ seems to trump responsibilities to patients/families. Even more worryingly, ministerial announcements about the HSIB suggest that consideration is being given to extending the approach to all NHS safety investigations.
I wish Mr Conradi and the HSIB well. I am sure it will make a positive contribution to patient safety, even though it is clear it will have very limited capacity, questions remain about its independence, and much more needs to be done to improve local NHS investigations. However, we would have had much more to be happy about had the Expert Advisory Group’s advice been followed, and the principle of guaranteeing openness and honesty with patients been upheld.