Reflections on four years of the NHS patient safety strategy

It is now almost four years since we first published the NHS Patient Safety Strategy in July 2019. We recognised it wouldn’t stand the test of time if it was static and not able to evolve with the changing challenges and priorities for the NHS and committed to update the strategy periodically to ensure it remained relevant and can impact on the areas where need is greatest.

In 2021, through our first strategy update, we introduced new priorities on health inequalities in patient safety and supporting the NHS to keep patients safe in light of new risks brought about by the pandemic. As we now enter the next phase, we will be continuing our journey from a reactive safety response, towards a proactive and ultimately generative safety culture in the NHS and responding to safety issues in real-time.  Systems-based patient safety approaches and principles can help us identify strategies for improvement as patients flow through the system and we will focus on learning from where things go well, as well as the challenges, in line with Safety II thinking. These new elements will build upon the strategy’s original key pillars of culture, continuous improvement and effective patient safety systems.

The aim of the strategy was to avoid 1,000 deaths a year and save the system £100m each year from 2023-24. We did not predict a pandemic, so some work has inevitably been delayed and is being done in an increasingly stressed system, however I genuinely believe that we are moving forward in our strategic objectives.

This is largely through the strategy’s major delivery programmes, including the introduction of the new Patient Safety Incident Response Framework, the Learn from Patient Safety Events service, Patient Safety Specialists, and the NHS Patient Safety Syllabus. It is hard to quantify yet, but there is much hope for significant impact as these initiatives are embedded across the NHS and come to fruition.

In the improvement arena however, our programmes have more demonstrable data on impact. Our national patient safety improvement programmes have seen a reduction of lives lost in the world of neonatal health running into hundreds, and the same for cerebral palsy cases in prems. Significant impact has also been seen in our work to reduce long term opioid use, with a suggestion more than 300 deaths have been prevented. And our work to support staff in 11,621 care homes in England to identify signs of deterioration, has led to reductions in 999 calls, emergency admissions and bed days.

You can read more about this, on our new NHS Patient Safety Strategy – progress so far webpage, along with a number of case studies.

The strategy’s aim remains to reform the whole system of safety with prevention ahead of better identification, investigation, action and improvement. This next phase will contribute to and compliment the ongoing delivery of the strategy’s existing programmes.

The NHS Patient Safety Syllabus is building knowledge, capability, and capacity in ‘systems-thinking’, alongside the creation of the Patient Safety Specialists network, which brings together over 800 patient safety leaders from across NHS providers, integrated care boards (ICBs) and other organisations.

The new Patient Safety Incident Response Framework (PSIRF) has also landed well. Since its publication, NHS trusts and ICBs have been preparing to introduce the framework in their organisations, ahead of it replacing the current Serious Incident Framework from the Autumn. We have anecdotal indications of early adopters saying it has helped improve safety cultures, identify more effective risk reduction strategies, and enhance harm reduction.

A key tenet of patient safety since ‘An organisation with a memory (2000)’ has been the importance of acting nationally to identify and mitigate risks that exist across the NHS. The continuing development of the Learn from Patient Safety Events service (LFPSE), which is replacing the National Reporting and Learning System (NRLS) as a new national system for recording and analysing patient safety events, is ensuring our efforts in this space benefit from the latest technologies to learn more from the 2 million+ patient safety events recorded each year, with a far more accessible and user-focussed service, and the ability to react as close to real time as possible. All providers will be recording patient safety events onto the new system by early autumn.

We are also supporting NHS organisations to ensure the vital contributions, perspective and insight patients bring is embedded into local patient safety work, through the Framework for involving patients in patient safety. The framework also helps providers to support patients to be more involved in their own safety.

Our work on patient safety improvement through the COVID-19 pandemic has taught us a lot about implementation. This includes the ability to flex the patient safety improvement resource and deliver improvements to care pathways that span organisational boundaries, working with system leaders in the new ICS landscape, to effect change.

It is critical, given the current context of system pressures, staffing, demographic change, that providing more care in different and innovative ways is a clear priority. This means the ability to apply evidence-based, just and effective patient safety principles is more important than ever.

Aidan Fowler, National Director of Patient Safety in England

Aidan Fowler is the National Director of Patient Safety in England and a Deputy Chief Medical Officer at the Department of Health and Social Care (DHSC). He was previously the Director of NHS Quality Improvement and Patient Safety and Director of the 1000 Lives Improvement Service for NHS Wales. He had responsibility for QI/PS across the Welsh NHS and was a board member of Public Health Wales.

Aidan was a Consultant Colorectal Surgeon in Gloucestershire for ten years and Chief of Service for Surgery for four before entering the NHS Leadership Academy Fast Track Executive Training Programme during which he worked as an executive at University Hospitals Bristol and subsequently worked briefly as a Medical Director in Mental Health and Community care in Worcestershire. Aidan trained as an Improvement Adviser(IA) with the IHI in Boston and was IA to the South West Safer Patient Programme and has worked on Patient Safety with WEAHSN. He has also worked as faculty with the IHI in the peri-operative safety domain in Qatar, infection reduction in Portugal and teaching improvement and safety in the UK and internationally. Aidan’s surgical training was in the South West, but he graduated in medicine from University College London.