The Secretary of State for Health and Social Care (Wes Streeting)
I would like to update the House on Dr Penny Dash’s report on patient safety across the health and care landscape in England.
In September, Dr Dash completed her review of the Care Quality Commission. Her work was thoughtful and thorough, and shed a huge amount of light on how the principal regulator for quality and safety had been letting people down. The CQC is now under new management, and on a clear path to recovery.
Following this important work, I asked Dr Dash to undertake a further review—this time looking at six key organisations overseen by the Department of Health and Social Care and how they work with the wider patient safety landscape. Today, we are publishing this review, and I am grateful to Dr Dash for her work.
Her review focused on the Care Quality Commission, the National Guardian’s Office, Healthwatch England, the Patient Safety Commissioner, the Health Services Safety Investigations Body and the patient safety learning aspects of NHS Resolution. I asked her to assess whether the current range and combination of organisations delivers effective leadership, listening, learning and regulation of health and care systems in relation to patient safety.
She specifically addressed whether patients would be better served by a different approach or delivery model, working closely with senior leaders and directly hearing from more than 100 people or partner organisations with an interest in patient safety.
She found that there has been a shift towards safety—in comparison with other areas of quality of care—over the last five to 10 years, with too much focus on inputs and structures, rather than outcomes for patients. She also found there has been limited strategic thinking on improving quality of care during this period.
The review sets out how many organisations are carrying out reviews and investigations, leading to an overwhelming number of recommendations. This causes confusion for patients and staff alike. At the same time, patient experience is not given the attention it deserves in the NHS, with few boards having an executive director dedicated to this purpose.
As a result of this analysis, Dr Dash has made nine recommendations, which the Government have accepted in full. These commitments form an important component of our 10-year plan for health, published last week.
First, there should be a refreshed strategy for improving quality of care, which will be delivered by revamping and revitalising the role of the National Quality Board.
Secondly, the Care Quality Commission should continue to rebuild with a clear remit and responsibility and overhaul its registration and inspection processes to ensure they are “sector specific”.
Thirdly, the Health Services Safety Investigations Body should continue as a centre of excellence for investigations, but as a discrete branch within the Care Quality Commission.
Fourthly, the hosting of Patient Safety Commissioner should transfer to the Medicines and Healthcare products Regulatory Agency (MHRA) to strengthen links between the patient voice in medicines safety and the MHRA’s work to capture adverse events more effectively. The Patient Safety Commissioner’s work on wider patient safety should transfer into a new directorate of patient experience in DHSC.
Fifthly, local healthwatch and the engagement functions of integrated care boards (for healthcare) and local authorities (for social care) should be brought together to ensure patient and community input into the planning and design of services, and the strategic functions of Healthwatch England should also be transferred into the new patient experience directorate in DHSC.
Sixthly, staff voice functions should be strengthened, with the responsibilities of the National Guardian for Freedom to Speak Up incorporated into the new DHSC structure and providers.
Seventhly, the responsibility for and accountability of commissioners and providers to deliver and assure high quality care should be reinforced.
Eighthly, technology, data and analytics should play a much more significant role in supporting the quality of health and social care.
Finally, there should be an evidence-based national strategy for quality in social care.
Next steps
I previously announced that Dr Dash would undertake a third review on quality and its governance. However, this work has been fully incorporated as part of the 10-year health plan, and we are taking this forward with immediate effect.
Patient and staff voice should not be kept at arm’s length but be at the heart of everything the NHS does. As part of the plan, we are therefore streamlining and consolidating functions across the patient safety landscape, delivering a refreshed strategy for improving the quality of care and transforming how the NHS collects and uses patient feedback.
These changes will improve quality, including safety, by making it clear where responsibility and accountability sit at all levels of the system, and making it easier for staff, patients and users to directly feed into the system to improve quality of care.
[HCWS785]