Question to the Department of Health and Social Care:

To ask the Secretary of State for Health, what steps the Government has taken to ensure that NHS trust investigations into patient deaths are of a high standard.

Improving patient safety across the National Health Service is a key priority for the Government. We want to continue improving how the NHS investigates and learns from mistakes when things go wrong as we work towards making the NHS one of the safest healthcare systems in the world.

We are taking forward a national programme with system partners to support trusts to improve the way they learn from deaths of people in their care. This responds to all the recommendations in the recent report by the Care Quality Commission (CQC) ‘Learning, candour and accountability: A review of the way NHS trusts review and investigate the deaths of patients in England’.

In March, the National Quality Board published ‘National Guidance on Learning from Deaths’. This responded to a key recommendation of the CQC to deliver a national framework for trusts on identifying, reviewing, investigating and learning from deaths of people in their care. We are also requiring individual trusts to publish on a quarterly basis from 2017-18 how many deaths could have been avoided had care been better, and evidence of learning and improvements arising from that information in Quality Accounts from June 2018.

The national programme, including support for trust boards to implement the new learning from deaths framework, is about initiating a standardised and robust approach to learning from deaths across the NHS, including investigations into patient deaths. The CQC will also examine trusts’ approach to learning from deaths as part of its new inspection processes.

The Government has also established the Healthcare Safety Investigation Branch (HSIB) to conduct major safety investigations into the most serious risks for patients. We have announced our intention to publish a Bill in draft later this year to establish the HSIB as a fully independent body to take its work forward and embed a culture of learning within the NHS.