The being fair tool: Supporting staff following a patient safety incident

Patient safety incidents are usually signs of underlying systemic issues that require wider system-level action. Action singling out an individual is rarely appropriate.

By treating staff fairly, the NHS can foster a culture of openness, equity and learning where staff feel confident to speak up when things go wrong.

Supporting staff to be open about mistakes allows valuable lessons to be learnt and prevents errors from being repeated.

However, in rare circumstances a learning response may raise concerns about an individual’s conduct or fitness to practise. It is in these specific circumstances that the being fair tool can help you decide what next steps to take.

Development of the tool

The being fair tool has been developed by the NHS England national patient safety team in collaboration with stakeholders including NHS provider organisations, healthcare regulators, NHS Resolution and patient safety representatives.

This tool replaces the ‘just culture guide’ previously used by NHS England.

NHS England’s just culture guide was published in 2018, based on James Reason’s incident decision tree. It was intended as a tool to ensure that staff were not treated unfairly after a patient safety incident.

A discovery phase ran from November 2023 to March 2024 to assess the effectiveness of the guide in practice, particularly in the light of the rollout of the Patient Safety Incident Response Framework (PSIRF).

Following a series of semi-structured interviews with key stakeholder organisations, and focus groups with 20 provider organisations, NHS England’s ‘a just culture guide’ was identified as no longer fit for purpose.

An updated tool was therefore needed to better meet the needs of the NHS in the context of PSIRF.

2 stakeholder workshops followed the discovery phase to co-produce a revised tool, and the new decision-making tool was then tested in a number of pilot organisations representing regulators and providers including acute, ambulance, mental health and primary care.

Stakeholders included:

• regulators (GMC, NMC, HSCP and PSA)
• AvMA
• NHS Resolution
• the NHS England Civility and Respect Programme
• NHS England Safety Culture Implementation Group
• Northumbria University and Mersey Care NHS Trust (leading on the Restorative Just and Learning Culture Programme)
• patient safety partners

The focus groups comprised of representatives from workforce and Patient Safety Specialists across healthcare sectors, in order to better understand how the guide was used in practice.