Abstract
Against the distracting background of setting up the new system for clinical commissioning and the continuing financial crisis, what are the risks that the eye is off the safety ball in the NHS?
The National Patient Safety Agency is dissolved at the end of May with its incident reporting system (the National Reporting and Learning System) moving to Imperial College Healthcare Trust, and other functions being subsumed into the NHS Commissioning Board. Although the impetus for patient safety must come from strong local leadership and frontline commitment, the practical support, innovation and inspiration provided by the NPSA since 2001 may well be sadly missed.
Confidence in the effectiveness of regulation has been steadily falling. Recent press attention has been on trolley waits, discharge timing and medication errors, amongst other concerns, and it is tempting to second guess the findings of the long-awaited public inquiry into the role of the commissioning, supervisory and regulatory bodies in the monitoring of Mid Staffordshire Foundation NHS Trust. While many hospitals recently show impressive performance against mortality and patient safety indicators, there is still continued and depressing evidence of poor patient experience across the service.
It would seem obvious that we cannot wait for the optimum (or even improved) regulatory system. Given the demographic, financial and technological challenges that healthcare faces, perhaps it is now more than ever that the time to press forward in terms of innovation and developing world class clinical leadership.
The technology to bring healthcare delivery into the 21st century is here and there are numerous examples of innovation reported in the industry press. Patients’ experience of such technological advances (and hopefully therefore, improvement) in their day to day care are however likely to be limited and depend on whether there is a pilot scheme in their area. Adam Darkins writes about the practical implications of implementing teleheath services in this issue. A new government report 1 on information has just been published, but it is too early to say whether the rhetoric will be matched by a strategy to address the kinds of safety, financial, technical and contractual issues which Darkins raises. The absence of a clear commitment to central funding must threaten the achievability of a national revolution in healthcare delivery.
The value of clinical leadership is also explored by Gordon Caldwell, who sets out the opportunities and challenges for clinical leaders wishing to improve services and practice. Local clinical leadership is clearly a critical feature in advances in safety and quality across the service: is the national voice of clinicians loud enough to influence the strategic development of new forms of healthcare delivery? The King's Fund has issued a plea for a new style of leadership in another report recently published. 2
Clinical Risk is keen to publish papers on the impact of both clinical and managerial innovation on patient safety and to consider the medico-legal implications of new forms of care delivery. We aim to continue to provide a forum for these issues to be considered and debated by both practitioners and managers.
It is also timely to salute the National Patient Safety Agency and its staff for pioneering a field of endeavour that, fifteen years ago, was very much the “add-on” rather than a high priority for healthcare providers and commissioners. That we are now able to articulate our concerns about safety in the new NHS and, to a considerable extent, measure them, is no small tribute to the achievements of the Agency.