The Health and Care Bill that was introduced to Parliament in July 2021 includes proposals for a new, independent patient safety watchdog, the Health Services Safety Investigations Body (HSSIB). Compared with the existing Healthcare Safety Investigation Branch (HSIB), in operation since April 2017, the HSSIB will have expanded powers to conduct major safety investigations into the most serious incidents in the NHS in England.
Subject to Parliamentary clearance, the HSSIB is expected to be fully operational by April 2023. In this article, we take a look at how HSSIB will function and what it means for GPs.
Why is a new patient safety body needed?
When patient safety incidents happen, it is crucial that lessons are learnt to avoid them happening again. It is also important that patients and their families are provided with the full facts of the incident via a rigorous and transparent investigation.
Yet, patient safety concerns are often not adequately addressed and the number of safety incidents is growing, as is expenditure on clinical claims. Across the NHS, the quality of local safety investigations is inconsistent; fear of blame and litigation limit openness, and learning is not always shared so that improvements can be made.
According to the HSSIB impact assessment, “a new, single, independent and accountable investigative body” is required “to undertake investigations into the most serious and avoidable incidents, provide national leadership, to serve as a resource of skills and expertise for the improved conduct of patient safety incident investigations locally, and to act as a catalyst to promote a just and open culture across the whole health system”.
The HSSIB will have expanded powers
If the bill is passed, the HSSIB will investigate up to 30 serious safety incidents each year in the NHS in England. Fully effective investigations will be enabled by:
- Establishing HSSIB as a statutory independent body, without interference or influence by any other body. It will be accountable to the Secretary of State for Health and Social Care.
- Establishing ‘safe space’ protections that prohibit disclosure of information shared during an investigation, except in very limited circumstances. This is to encourage patients, families, NHS staff and others to participate openly and honestly, with the aim of learning what, how and why things have gone wrong.
- Granting statutory powers of investigation, with enforcement via criminal sanctions. These will include powers to enter and inspect premises without a warrant, and to compel individuals, NHS bodies, independent healthcare providers and private companies to cooperate in providing information and answering questions.
HSSIB aims: Learning, not blaming
The HSSIB will aim to ensure that the NHS learns from safety incidents by determining the systemic causes of serious safety issues. It will neither apportion blame nor hold individuals to account. Instead, it will seek to identify the full facts of an incident so as to support improvements in patient safety.
Learning from investigations will be shared across the NHS along with recommendations to provide safer services. The HSSIB will offer guidance on best practice in safety investigations, and set standards to improve patient safety.
An independent HSSIB with provision of ‘safe space’ is intended to improve public and staff confidence in investigations and to encourage an open culture of learning and safety improvement, thereby reducing the risk of future patient harm. This may also diminish the likelihood of litigation and the need for public enquiries.
What are the implications for GPs?
The Department of Health and Social Care has confirmed that patient safety incidents in GP practices will come under the remit of the HSSIB. However, it said the ‘focus is likely to be predominantly on investigating patient safety incidents in NHS trusts’.
HSSIB investigations are expected to be similar in format to HSIB investigations. However, the HSSIB will be backed by legal powers. Primary care staff should be made aware of the HSSIB’s functions and powers when it comes into existence. Failing to comply, obstructing an investigator, or providing false or misleading information will be a criminal offence.
The ‘safe space’ provision should provide GPs with the confidence to be open and honest if they are involved in an HSSIB investigation. The General Medical Council commented in 2019: “We support the creation of a ‘safe space’ approach to investigation. This is consistent with our guidance to doctors about their responsibilities to learn from mistakes and reflect on their practice, and their duty to take part in systems of quality assurance and quality improvement to promote patient safety.”
If you need advice about dealing with a patient safety incident or participating in an investigation, please contact Medical Defense Society to speak with our team of medico-legal experts.
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