'Almost half' of NHS providers not reporting mistakes properly


Almost half of NHS providers are not reporting their mistakes properly, new figures suggest.

New league tables that rate services across the country on their reporting culture show that a large number need to improve their openness and transparency.

The tables have been introduced as part of a package of measures to help improve safety across the NHS in England.

The Department of Health said the aim of the tables is to encourage NHS trusts to look at how well others are doing and improve the ways they can encourage staff to speak up.

NHS Improvement will publish the annual Learning From Mistakes League which rates NHS providers in terms of their openness and transparency based on information gathered from various data sources including the NHS Staff Survey.

The first table will show that 120 organisations were rated as "outstanding" or "good" but there were "significant concerns" about 78 providers and 32 were rated as having a "poor" reporting culture, the Department of Health said.

Speaking at the first ministerial-level Global Patient Safety Summit, Health Secretary Jeremy Hunt will say that the NHS needs to make "secrecy a thing of the past".

He will also set out a series of other new safety measures for the health service including:

:: Plans to introduce medical examiners - who will review every death certificate to independently review and confirm the cause of all deaths.

:: The introduction of an independent Healthcare Safety Investigation Branch - where health workers can report concerns about their place of work without bringing them into conflict with their employer or attaching their names to reports of wrongdoing.

:: Changes to guidance so doctors and nurses who admit to mistakes and apologise will be given "credit" if their cases are heard by tribunal panels.

:: England will also become the first country in the world to publish estimates by every hospital trust of their own avoidable mortality rates.

Mr Hunt said: "A huge amount of progress has been made in improving our safety culture following the tragic events at Mid Staffs but to deliver a safer NHS for patients, seven days a week we need to unshackle ourselves from a quick-fix blame culture and acknowledge that sometimes bad mistakes can be made by good people.

"It is a scandal that every week there are potentially 150 avoidable deaths in our hospitals and it is up to us all to make the need for whistleblowing and secrecy a thing of the past as we reform the NHS and its values and move from blaming to learning.

"Today we take a step forward to building a new era of openness and the safest healthcare system in the world."

James Titcombe, whose son Joshua died after failings at Morecambe Bay, said the measures were "major steps" which will help the NHS learn from mistakes.

Mr Titcombe who now acts as a national adviser on patient safety, culture and quality, said: "Time and time again, we hear the promise that 'lessons will be learned' following reports about systemic failures and individual stories of avoidable harm and loss in the NHS. Yet, far too often, the same mistakes are repeated and meaningful learning and lasting change simply doesn't happen.

"If we are going to transform this, it's clear that we need to do something different. Events at Mid Staffs and Morecambe Bay serve to highlight the devastating consequences of a culture that failures to learn.

"These announcements are about saying 'never again' - the measures announced are major steps that will help move the NHS towards the kind of true learning culture that other high risk industries take for granted."

Commenting on the measures, Labour's shadow health secretary Heidi Alexander said: "Labour is supportive of any measures that will improve safety and make the NHS more open to learning from mistakes.

"However alongside measures to investigate harm there needs to be action to prevent harm from happening in the first place. On Jeremy Hunt's watch hospitals are overcrowded, understaffed and facing financial crisis. Patients are suffering longer waits and satisfaction with the NHS is getting worse, not better."