In a drive to improve safety standards within the NHS and prevent “avoidable harm” coming to patients within secondary care, a review of incident reporting across all NHS trusts in England has been undertaken by the Department of Health and NHS England.
All trusts within England are required to report safety incidents into the National Report and Learning System. A review of these systems, together with the results of the staff survey on safety reporting, have revealed that a shocking 29 out of 141 trusts were not registering the expected number of safety incidents. That one in five trusts is failing to record this information is a sign of a "poor" safety culture within the NHS. The review has found that some of the under-reporting relates to incidents that have caused severe harm or even death to patients. The trusts with lower-than-expected incident reporting will be followed up by NHS England health officials as this is widely acknowledged to be a sign of problems.
The Department of Health has stressed that there could be “justifiable reasons” for the findings of low reporting, such as the trust being safe or innocently not using the recording system properly. However, the Department of Health has highlighted the need to understand the cultures adopted within the various trusts and to understand what is preventing these trusts from being open about incidents.
The Health Secretary, Jeremy Hunt, has urged all trusts in England to join the “Sign up to Safety campaign” and to draw up plans to significantly reduce the number of incidents such as medication errors, blood clots and bedsores that result in avoidable harm to patients. The Government has set a target to halve the incidence of avoidable harm by 2016-17.
Naomi Holland, an associate in the Penningtons Manches' clinical negligence team, comments: “It is important to have a culture within the NHS which encourages openness to adverse incidents to ensure that any errors and failings in the care afforded to patients can be appropriately highlighted to prevent recurrence. Unfortunately, the results of this review do not come as any surprise, as a number of the negligence claims that we deal with arise out of this poor safety culture. We also we see repeated similar mistakes being made because patient safety incidents are not properly reported, recorded and considered.It is hoped that the follow up to this review will ensure proper reporting and that, in turn, this will lead to higher patient safety standards.”