Safety of Services Provided by Health and Social Care Trusts
A Report published today by the Comptroller and Auditor General, Kieran Donnelly, examines the extent to which the Health and Social Care (HSC) Trusts are successful in delivering safe services to patients and clients.
Mr Donnelly said: “Overall, we enjoy high standards of care from Northern Ireland HSC Trusts. However, reducing adverse incidents that cause, or could have caused, unexpected harm to patients and clients is a core task for the Department of Health, Social Services and Public Safety (the Department) and HSC Trusts. Two factors are crucial to this: the establishment of a culture in which incidents can be reported easily, honestly and without fear of blame; and the ability to ensure that lessons learned from these incidents are successfully taken on board by HSC staff.”
“Today’s report shows that, while the Department and HSC Trusts have made significant progress in both of these areas, there is more to be done. Whilst reporting of adverse incidents has improved at the local level, the Department accepts that under-reporting of incidents continues. At the regional level a reporting and learning system exists for serious adverse incidents but a regional system to ensure the effective evaluation of numbers, types and causes of all adverse incidents has still to be introduced.”
Main Findings
The incidence and cost of care-related harm
Approximately 83,000 adverse incidents are reported each year by HSC organisations. Apart from the distress caused to patients, relatives and front-line staff, these lapses in safety are a very expensive diversion of healthcare funds. In the past five years, the Department has paid out £116 million to settle claims for clinical and social care negligence – £77 million in compensation and £39 million in legal and administrative costs. In addition, the Department estimates that it could cost a further £136 million to meet the compensation costs of all the active negligence claims currently in the system.
The cost of negligence settlements provides some idea of how patient and client harm can add to the financial pressure on HSC services. However, the true cost of adverse incidents remains unknown because the treatment costs of remedying the harm caused to patients or clients are not routinely measured.
Assuring the competence of HSC staff
Ensuring that all HSC staff continue to perform their duties competently is central to a comprehensive patient safety programme. The report found considerable variation in the extent to which the skills and knowledge of HSC staff groups are appraised regularly.
HSC culture and the reporting of adverse incidents
The publication of Quality 2020 is an important initial step by the Department to reduce the level of patients and clients who experience harm while in a clinical or social care setting. The report also acknowledges the significant moves made by the Department to raise awareness among HSC Trusts of the need to ensure more openness and honesty when things go wrong. However, while levels of reporting are increasing, there continues to be under-reporting, particularly within hospitals.
More needs to be done to ensure an open culture and to encourage the reporting of adverse incidents or near-misses as a mechanism for learning lessons and driving improvements. It is also important for the Department to periodically assess how the safety culture is improving.
Learning from adverse incidents
Regional sharing of lessons learned from serious adverse incidents is currently in place. However, the Department has been developing plans for a centralised database of all adverse incidents for some time. Currently there is no cohesive management information reporting system capable of delivering, at a regional level, high-quality, routinely available information on patterns, trends and underlying causes of harm to patients and clients. This limits the ability of HSC services to monitor performance and improve patient safety. HSC Trusts, therefore, have been unable to benchmark against other HSC Trusts and regional sharing of “lessons learned”, except for serious adverse incidents, has not been as structured and comprehensive as it could be.
Settling smaller clinical and social care negligence cases
Under the current legislative process substantial legal and other costs can be incurred in settling individual negligence cases. In smaller cases, the legal and administrative costs of settling claims can, on occasion, exceed the money actually paid to the victim. The report considers that the Department needs to consider the development of a means through which these resources are better targeted to meeting the needs of the harmed patient/client in smaller cases.
Background briefing can be obtained from the Audit Office by contacting Sean McKay (028 9025 1075) or Clare Dornan (028 9025 1035).