Why Independence Matters — and Why Accountability Still Has a Place

Estimated reading time:  5 minutes

I have been reflecting on the recent discussions about the Health Services Safety Investigations Body’s (HSSIB) proposed move to sit under the Care Quality Commission (CQC) and whether this decision will compromise its independence, whether perceived or real. And Luca Tiratelli’s recent Blog for The King’s Fund also stimulated my interest in the role Healthwatch has played over time as an independent voice in healthcare.

This got me thinking about AvMA’s own position as an independent charity in the health sector. For us, independence is not an abstract principle. It is fundamental to our ability to stand alongside people avoidably harmed in the course of their healthcare treatment and to speak honestly about what needs to change.

Those who come to us are often doing so at one of the most vulnerable points in their lives. They are seeking understanding, answers, and reassurance that what happened to them matters. To serve them properly, we must be trusted – and that trust depends on our independence from the systems whose failures we may need to challenge.

Independence is not opposition.

Being independent does not mean being anti-NHS, anti-clinician, or anti-system. On the contrary, we are deeply committed to the values that underpin public healthcare and patient safety. Independence simply means that our primary duty is to those who have been harmed, not to institutional reputation, professional defensiveness, or political convenience.

Without independence, uncomfortable questions are less likely to be asked. Patterns of harm are easier to minimise. Lived experiences can be reframed as isolated incidents rather than signals of systemic risk. Independence allows us to say, respectfully but clearly, this is not good enough. And linked to this are issues of accountability, as the people we support often explicitly cite that as something they need to move on with their lives, as best they are able to.

The sensitivity around ‘accountability’

Few words generate more unease in healthcare than ‘accountability’. For many professionals, it is associated with blame, punishment, or fear. That sensitivity is understandable but misplaced in my view. A blame culture does not improve patient safety, and AvMA has long argued against simplistic or punitive approaches.

But avoiding the word altogether carries its own risks.

For people impacted by avoidable medical harm, accountability often means something much more basic: acknowledgement that something went wrong, clarity about why it happened, and confidence that lessons will be learned. When accountability is absent, harm can feel compounded – not just by the original event, but by silence, defensiveness, or denial that follows. The publication of a Harmed Patient Pathway late last year was in direct response to this ‘compounded harm’ that we too often see and hear from those we support.

Accountability as learning, not retribution

Used properly, accountability is not about scapegoating individuals. It is about responsibility at every level of the system – organisational, professional, and structural. It is about transparency, curiosity, and a willingness to change.

Independence is what allows organisations like AvMA to help reframe accountability in this way. We can advocate for approaches that are fair, proportionate and focused on learning, while still being clear that avoidable harm must never be normalised or excused.

Why this matters now

Healthcare systems are under extraordinary pressure and, in my view, the independence of bodies like Health Services Safety Investigation Body (HSSIB) are being challenged. In difficult times, there is a natural tendency to close ranks, to prioritise resilience over reflection, and to see challenge as a threat.

History shows that patient safety improves when independent voices are heard rather than sidelined, and accountability is understood as part of care, not an attack on it.

That makes our independence more important, not less.

At AvMA, our role is not to provide easy reassurance, but honest support. Independence gives us credibility. Accountability, handled with care and purpose, gives meaning to the experiences of those who have been harmed and hope that future harm will be avoided.

Both are essential if we are serious about achieving the right outcomes – not just for individuals today, but for all the patients of tomorrow.

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AvMA is the only UK charity dedicated specifically to supporting people affected by avoidable medical harm.
We use what we learn from patients and families to influence policy and improve safety across healthcare systems and practice.