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The biggest patient safety initiative in the history of the NHS – Mike Durkin

NHS England has kicked off a year of action for patient safety. 

A ‘design day’ event has seen work begin in earnest to create a countrywide network to improve patient safety across England.

The event saw 120 leaders and experts in patient safety join forces to combine their knowledge and experience to begin shaping the future of the patient safety collaboratives, which promise to be the biggest patient safety initiative in the history of the NHS.

Dr Mike Durkin, NHS England National Director of Patient Safety, reflects on the day and the next steps to bring the collaboratives to life:

Some of the best minds in patient safety have come together in one room to work together to refine a vision for a network of patient safety learning and improvement collaboratives.

A long and productive design day saw academics, clinicians, nurses, GPs and patient representatives enthusiastically feed into discussions and debates to formulate what will now become the foundations of a whole-system approach to continuous learning around patient safety.

One thing is particularly clear to me from what people had to say; the patient safety collaboratives will be key to re-energising NHS staff to focus on the potential to make care safer.

Before going into the details of the design day itself, I should first refresh your minds on the basics of what the patient safety collaboratives are about. As part of the government’s response to the recommendations of the Francis report, and following Don Berwick’s recommendations for patient safety, early plans have been agreed around the idea of setting up a national patient safety collaborative, focussed on improving safety for patients right across England using evidence based improvement science.

With 15 localised teams (or local collaboratives) spread across the country, local people from both inside and outside the NHS will be able to work together to build local learning systems capable of continually improving care at the front line and reducing the likelihood of harm to patients. These teams will come together to share their learning so that the lessons learned can be spread, benefitting patients right across the NHS.

At NHS England we are absolutely committed to helping local teams improve patient safety and ensuring they are locally owned, and we will be working in partnership with NHS Improving Quality who will support local teams to develop their skills in practical improvement and change expertise.

From hospital care to care in custody, and from local GP practices to mental health trusts, the collaboratives will address safety issues in every healthcare setting in a way we have never attempted before. They will be inclusive, bringing people from all settings together, working with patients and carers, along with front line staff and management, and patient safety academics.

These learning systems will identify safety issues at a local level and then design, implement and evaluate the solutions, as they are adopted by organisations locally. A large part of the collaboration programme will see the sharing of these solutions across the country, so that successful new initiatives can be shared to bring best practice to similar health providers nationwide.

Be it simple or complex solutions, from building skills through training, ensuring the right levels of staffing resources, building networks for sharing, or formulating safer approaches to treatment and care, the focus for each system will always be on addressing the most pressing local needs.

I’ve had the privilege of being involved in this work in the South West, where a whole system came together to develop an open and transparent approach to sharing best practice, measuring improvement in many different clinical situations, and then supporting each other to spread that learning into every setting. This work has now demonstrated year on year improvement in both the reduction of in hospital mortality and significantly in demonstrable reduction in harm. A key to its success in every sector was the commitment of not only the safety enthusiast but most importantly the board and executive teams of the trusts in acute, mental health and community settings.

While all this sounds fantastic on paper, the challenge is bringing these aspirations to life and making them a reality. Which is why we invited people from a variety of backgrounds, who we know have a real passion for making a difference to patient safety, to help us get started on developing a plan that reflects their individual expertise and experience from a range of settings.

Of course our listening doesn’t end with just one event. Next we have four regional events at venues across England (these are still yet to be determined but will be published on this website when they have been finalised) so we can listen to the views of people locally, which may well be very different to what we see as the national picture. One thing that was very apparent at this first event in London was that each of the future collaboratives must be able to set their own local priorities.

The views and opinions of all 120 of those who generously contributed their time at the design day will prove to be invaluable. We have taken away a wealth of insightful materials that we will now go over, reflect on and refine to ensure they become concrete fundamental features of the overall design and vision for the collaboratives programme.

There is a lot of work to be done to analyse everything people told us during the event, but at this early stage some the key points raised include:

  • The patient and their carers and families must be at the core of the planning of this initiative and not an add-on;
  • Enabling priorities to be set locally in each collaborative, and that any national directive should only be used to add extra value;
  • Learning from what is already being done, not just in this country but across the world, and ensure best practice can be shared across all healthcare settings;
  • Learning not only from healthcare but also to look at safety in other industries;
  • Being inclusive and listening to all voices at all levels of staff within healthcare organisations;
  • Putting a simple vision at the heart of the collaboratives rather than a complex system of structures and directions;
  • Having a central focus on learning, sharing and innovating, with patients involved in the setting of training priorities for healthcare staff at all levels;
  • Using patient safety data  transparently and only where appropriate to recognise where problems exist, not for blame;
  • Setting up collaboratives that are small enough to get local buy in, so that all local people feel they can access and contribute towards their work;
  • Emphasising a strong focus on measuring what we are trying to improve, and measuring it correctly.

As you can see, there is a lot of aspiration for national improvement through the collaboratives programme. In many ways this is our big chance to get things right and leave a lasting legacy that will make a massive difference to the safety of patients in every corner of the country.

It is also important that we don’t lose sight that for most people when they enter this profession they do it because they care, and through this vital programme of work we will support frontline staff across the NHS to do just that, in a way they can be confident about and be proud of the organisation they work for.

Finally, I must instil the need for urgency in tackling and focussing on improving patient safety across England through this nationally connected patient safety collaborative programme, which will be owned and run by local people. This isn’t about reinventing the wheel, it’s about sharing and learning, which in the interests of the safety of all our patients is something that can’t happen soon enough.

The NHS has gone through a lot.  We have come through an extended period of internalising the lessons from the tragedies at Mid Staffs and Winterbourne, and we have had more than a year of planning about how to make things better.  The time for action is now and I for one can’t wait to get started.

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5 comments

  1. anonymous says:

    I am still to see any details of the four regional events. Can you please publish when and where these will be held and who will be invited?

  2. lydie edimo says:

    Good action, ad a nurse in emergency care want to know what are the recommended safe staffing level in place?
    thank you

  3. I am thrilled to hear about these plans and hope that safety initiatives are planned which impact across the board – primary and secondary care, mental health, children and young people

  4. Mariella Dexter says:

    Please can you advise when and where the four regional events are scheduled and who will be invited.

    Thank you

  5. Christine Johnson says:

    really looking forward to seeing the plans for the patient safety collaborative and to ensuring general practice is included and gains from the experience.