Patient safety
Blame culture persists, warns new report
Action is needed to tackle the persistence of blame cultures and fear of speaking up in the NHS. This is according to the latest report by Patient Safety Learning. So, how can we strive to achieve ‘a culture of safety’, where staff feel able to speak up and organisations learn from mistakes without apportioning blame?
Following the inquiry into devastating failures at the Mid Staffordshire NHS Foundation Trust, Robert Francis QC published his review into ‘speaking up’ in 2015. In this seminal report, he set out the key recommendation that: “Every organisation involved in providing NHS healthcare, should actively foster a culture of safety and learning, in which all staff feel safe to raise concerns.”1 Among the recommendations in the report,
Robert Francis called for the following: l Every organisation involved in providing NHS healthcare should actively foster a culture of safety and learning in which all staff feel safe to raise concerns.
l Raising concerns should be part of the normal routine business of any well-led NHS organisation.
l Freedom to speak up about concerns depends on staff being able to work in a culture which is free from bullying and other oppressive behaviours.
l All employers of NHS staff should demonstrate, through visible leadership at all levels in the organisation, that they welcome and encourage the raising of concerns by staff.
l When a formal concern has been raised, there should be prompt, swift, proportionate, fair and blame-free investigations to establish the facts.
NHS Improvement and NHS England later published an NHS Patient Safety Strategy in July 2019,2
which reinforced the need to act on the
recommendation to implement ‘a culture of safety and learning’. NHS Improvement and NHS England stated that the NHS will need to build on two foundations: a patient safety culture and a patient safety system. Three strategic aims were outlined to support their development: l Improving understanding of safety by drawing intelligence from multiple sources of patient safety information (Insight).
l Equipping patients, staff and partners with
the skills and opportunities to improve patient safety throughout the whole system (Involvement)
l Designing and supporting programmes that deliver effective and sustainable change in the most important areas (Improvement).
However, five years into the NHS Patient Safety Strategy, a new report published by Patient Safety Learning has revealed that we have a long way to go. The report, We are not getting safer: Patient safety and the NHS staff survey results, argues that NHS leadership needs to introduce clearer plans to help organisations create and maintain safety cultures.3
them fairly if they are involved in an error, near miss or incident.
l More than 260,000 staff are unable to say that they feel safe to speak up about anything that concerns them in their organisation.
l 43.19% of staff cannot say that they are confident that their organisation would address any clinical practice concerns raised.
The report
looks in detail at responses to the NHS Staff Survey 2023 relating to the reporting, speaking up and acting on staff patient safety concerns. It argues that the latest results indicate that blame cultures and a fear of speaking up continue to persist in a significant part of the NHS, highlighting several alarming statistics, including: l 40% of staff are unable to say with confidence that their organisation treats
The report also concluded that, for many organisations, accountability and transparency around patient safety performance and improvement is inadequate. If staff are unable to clearly see their organisation’s approach to learning and acting on safety concerns, there is little hope that patients and the public will get a clear understanding of this. Patient Safety Learning added that open assessment and reporting on patient safety is vital if we are to have confidence that NHS leaders are taking this issue seriously.
Scandals and whistleblowers The report goes on to highlight further concerns
August 2024 I
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