Surgical Fires in the NHS

Maria Caulfield Excerpts

Thursday 16th December 2021 Westminster Hall

[The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)]

It is a pleasure to serve under your chairmanship, Ms Rees. I thank the hon. Member for Strangford (Jim Shannon) for securing this hugely important debate. While he is right that we may be small in number this afternoon, it is the quality not the quantity of the Members that counts.

Health is a devolved matter, so I can really only respond on behalf of the NHS in England to the issues the hon. Gentleman raised, but, as the SNP spokesman, the hon. Member for Coatbridge, Chryston and Bellshill (Steven Bonnar), said, surgical fires are a priority area of concern in all the devolved nations. Patient safety is our absolute focus. We want to provide the public with the safest care possible. As the hon. Member for Strangford said, a fire affects not only patients but the NHS staff working in those units. We traditionally think of surgical fires as taking place in hospital-based settings such as theatres, but more and more minor surgery is taking place in community facilities such as primary care facilities. This issue is expanding to other areas of the NHS, so it is important that lessons learned in hospital trusts are learned in the community as well.

Supporting a culture of safety in the NHS is critical, and we have put in place a number of measures aimed at supporting the NHS. The key is learning from incidents. Where there have been surgical fires in the past, it is important to identify their causes and how they could be prevented in the future. It is also important to hear from staff, who will sometimes not be surprised when an incident occurs or who may have flagged issues a number of times before attention is taken.

We are taking a number of initiatives to improve patient safety across the board. The first is establishing the health safety investigation branch, which conducts independent reviews and investigations into any patient safety concerns, including surgical fires. We are also introducing a statutory duty of candour to ensure that NHS organisations are open and honest towards patients. If a surgical fire happens, as in the hon. Gentleman’s tragic example, a patient who may have been asleep at the time should be made aware of that and receive an apology and support afterwards. Sometimes the fires are quite minor and the patient is not affected, but it is important that they know that an incident happened. We are also setting out in legislation the first ever patient safety commissioner, which will be for England only. They will be a champion for patients in relation to medicines and medical devices and will certainly look at the issue of surgical fires.

Regrettably, despite some of the progress and some of the measures we are putting in place, and despite the high quality of care provided by NHS staff, incidents happen that cause harm to patients and put staff at risk. If a surgical fire is extensive enough to take a theatre out of service for a time, that has a knock-on effect for other patients on surgical waiting lists, who may be delayed as a result. Minimising the risk of surgical fires is an area we take very seriously, and although rare, when they do occur in or around the operating table, they can cause extensive damage and put patients and staff at risk.

The issue is how to best minimise the risk of fires in the first place. As has been pointed out, work is going on into this area. NHS England’s national patient safety team has been involved with the expert working group on the prevention of surgical fires, which the hon. Gentleman referred to and which is chaired by the chief executive of the Association for Perioperative Practice. We will continue to support the development of its guidance. I am happy to meet the hon. Gentleman to follow this up, because as highlighted by the shadow Minister the working group published a report in September last year on the prevention and management of fires and made a number of recommendations. It is the view of the national patient safety team that further work on surgical fire prevention following the report is best developed alongside the wider national safety standards for invasive procedures. Those standards were created to support all aspects of patient safety in the surgical environment and are currently being led by the Centre for Perioperative Care, which is responsible for ensuring that national safety standards for invasive procedures continue to be fit for purpose.

[Jim Shannon]

I am very encouraged by the Minister’s response. I referred to four key recommendations, which she referred to. She also referred to the fact that there are ongoing negotiations and discussions with the expert group. Has there been an opportunity to push for those four key recommendations as part of the change that is needed?

[Maria Caulfield]

That is certainly an area that we can discuss further when we meet. I am very happy to do that. The hon. Gentleman is right that experts in this field are best placed to consider whether we have the right standards in place. Work is ongoing to ensure that the standards in place are the correct approach to minimise the risk of surgical fires happening in the first place and to advise the NHS on the issue.

The hon. Member for Strangford talked about the fire triangle of ignition, heat and oxygen. There are potential risk factors in all three of those areas that can make a fire more likely. As I said at the beginning of my remarks, we are working on learning lessons about where fires have happened, to make sure that we learn from those experiences.

In terms of the data, I am obviously concerned that there is no central record of how many surgical fires are taking place, but a new learn from patient safety events service is coming in next year and will better record patient safety events, improve data collection and help NHS trusts to collect the data, use it and learn from it. Although that is not specific to surgical fires, I am keen that fires in general, including surgical fires, are reduced as much as possible and that we learn from these events when they happen.

I am also keen that staff training is a priority. There is a legal duty on NHS trusts to ensure that their staff are trained in fire safety when first employed but also on an ongoing basis. Very often, particularly in theatre, new equipment comes in. The hon. Member for Coatbridge, Chryston and Bellshill (Steven Bonnar) talked about lasers and diathermy equipment. As those machines and that equipment are introduced and upgraded, it is important that staff are trained properly and are able to flag faults with the equipment and ensure that action is taken quickly, for a whole host of reasons. A theatre is a very risky place not just in terms of fire but for a number of reasons.

All colleagues touched on never events. By its very nature, a never event is something that should never happen, but there are not many classified never events if we look on the list. In theatre, there is a never event on swabs used in theatre procedures. We have very clear guidance and procedures in place when swabs are used—they are counted in and counted out to absolutely make sure that nothing is left behind after an operation. That is key.

Surgical fires are not a never event at the moment because there are no clear guidelines that staff can follow that can absolutely rule out any particular fire from happening. That is the crux of the matter. Fires should absolutely be preventable and we should learn the lessons when a surgical fire takes place, but we do not have the guidelines to be able to say to staff what has to be followed to absolutely prevent a fire from happening in the first place. When I meet the hon. Member for Strangford, we need to look at the guidelines and make sure they are coming forward. I have been informed by NHS England that it cannot classify surgical fires as a never event at the moment, until the national guidance or safety recommendations are in place. It has also confirmed that it always reviews any new guidance when it is published. That is the nub of the issue.

The shadow Minister touched on the Whipps Cross hospital renovation. Sadly, that is not in my portfolio, but it does come in the portfolio of the Minister for Health, the hon. Member for Charnwood (Edward Argar), so I will speak to him to try to get an update on progress.

In conclusion, I want to reassure the House that patient safety remains a top priority for the Government. The risk of surgical fire is a real issue, and surgical fires do put patients and staff at risk. The issue is taken very seriously by the Department, and work continues in this field to ensure that the correct guidance is there to minimise the risk of surgical fires occurring in the first place. I look forward to, hopefully, sharing some progress with Members in the new year.

I thank all Members and staff for their hard work this year. It has been a very tough year for everyone, so hopefully everyone will get to enjoy their Christmas. Like the shadow Minister, I also thank all the staff at the Department of Health and Social Care and across the NHS, who may be having a very tough Christmas this year, and I place on record our thanks and gratitude to them—their hard work has not gone unnoticed. With that, I thank everyone, and especially the hon. Member for Strangford for securing the debate.

[Christina Rees (in the Chair)]

Thank you for your remarks, Minister—they are much appreciated.