Our response to report on investigations into serious incidents in the NHS
Guaranteeing the quality, integrity and consistency of the way in which the worst cases are investigated must go hand-in-hand with measures to ensure lessons are learnt across the whole of the health service.
The Parliamentary and Health Services Ombudsman’s has released their report on investigations into serious incidents in the NHS. This report explains the findings of their research, and highlights the issues identified, and sets out the action they believe needs to be taken to improve the quality of NHS investigations.
Key findings from the report include:
- The process of investigating is not consistent, reliable or good enough.
- Staff do not feel adequately supported to investigate complaints
- There are missed opportunities for learning from mistakes.
In response to the report, our Chair, Anna Bradley said:
"Hundreds of thousands of incidents of poor care go unreported every year across the NHS precisely because people fear they either won't be taken seriously or that nothing will change as a result.
"In order to change this we need a complete rebuilding of trust in the complaints system, starting with the way in which hospitals and health professionals review incidents of avoidable harm and death.
"Guaranteeing the quality, integrity and consistency of the way in which the worst cases are investigated must go hand-in-hand with measures to ensure lessons are learnt across the whole of the health service.
"The newly created Independent Patient Safety Investigation Service, which launches in April next year, will have a key role to play here, leading by example through conducting transparent and thorough investigations that focus on the needs of the patients and families involved."
