Is the Healthcare Safety Investigation Bureau an accident waiting to happen?
In March this year we blogged about the introduction of the Healthcare Safety Investigation Bureau (“HSIB”); a body set up to investigate the worst failings in patient safety each year. The idea behind the Bureau is to set up an organisation akin to the Air Accident Investigation Bureau (“AAIB”), which has been tremendously successful in reducing air accidents by way of a “no fault” style of investigation.
Like the AAIB, the idea is that HSIB investigators will be solely interested in the cause of errors that have led to serious harm to patients, and how measures can be put in place to avoid this in the future. The investigations will not apportion blame to individual clinicians, in the hope that offering this “safe space” will encourage doctors and other NHS staff to come forward with information that might assist HSIB.
But MP’s have criticised the way in which HSIB has been implemented, and raise concerns about its independence from those it will be investigating. The Public Administration and Constitutional Affairs Committee (“PACAC”), a group of cross-party MP’s has raised concern that without the implementation of laws to ensure HSIB’s independence and this “safe space” that is considered crucial for thorough investigations to be undertaken, HSIB will fail in its efforts.
HSIB will be set up later in 2016 within the NHS Improvements organisation; a body that overseas the practices of NHS Trusts throughout the country. The fact that HSIB will be a part of the organisational structure that it will be investigating has led to questions over whether or not HSIB can be truly independent.
The committee’s chairman, Bernard Jenkin MP, has said:
“The secretary of state’s decision to set HSIB up as an NHS quango as a permanent response to our recommendations was both disappointing and would be unacceptable … but the prospect of a secure legislative base will enable HSIB to emulate the successful air, marine and rail investigation branches”.
The government has not yet committed to rolling out legislation to ensure HSIB’s objectives can be met, but the Department of Health has said “we agree that the independence of the branch will be essential to its success, which is why we made explicit legal provisions for its independence when we set it up”.
Independence is not the only issue being raised, however, in respect of HSIB’s likely effectiveness in protecting patient safety. Action Against Medical Accidents (“AvMA”) a leading charity campaigning for patient safety and of which Clarke Willmott is a member, has said that the focus on creating a “safe space” for the clinicians involved in the investigation is not putting a patient’s interest first. Peter Walsh, Chief Executive of AvMA said “this would undermine public confidence in HSIB and run against the principle of the newly created duty of candour”. The principle behind the duty of candour is to ensure that hospitals and their staff acknowledge errors that have been made by them, and this protection of wrongdoers identified in HSIB’s reports might be at odds with that principle.
As with any new body or initiative, we must give HSIB time to settle into its role and assess the quality of its investigations in the coming years, but there is no doubt that campaigners will be calling for change if HSIB’s effectiveness is hindered by its connection to the NHS and a lack of statutory framework behind it.
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