In the Observer yesterday:
Patient safety is frequently at risk in NHS hospital trusts in England, with 70% of them failing to meet national safety standards, according to an Observer analysis of inspection reports, with staff shortages the biggest problem. Reports by the regulator the Care Quality Commission (CQC) reveal that managers at one trust failed to act on staff reports of abuse and violence, while a shortage of critical beds at another trust led to three serious incidents resulting in patient harm. Of 148 acute and general hospital trusts, safety standards at 96 are rated as “requires improvement” by the CQC; six are rated inadequate, the lowest category. The others are rated good, with none outstanding.
Scotland’s Nomedia are not reporting any equivalent crisis here. While the absence of evidence is not always the evidence of absence, I feel sure Reporting Scotland would be all over it if they had anything even approaching evidence in, even, a single hospital, so I think we can relax.
We do have evidence from a reliable source that NHS Scotland’s safety mechanisms are secure. From the highly respected and impartial, Nuffield Trust, in 2017:
- Scotland has a unique system of improving the quality of health care. It focuses on engaging the altruistic professional motivations of frontline staff to do better and building their skills to improve. Success is defined based on specific measurements of safety and effectiveness that make sense to clinicians. (3)
- A watershed came in 2008 [first SNP Government?] with the introduction of the Scottish Patient Safety Programme (SPSP), which many of our interviewees saw as the exemplar and the keystone of quality improvement in Scotland. (6)
- A fourth difference is that Scotland’s institutions for scrutiny of health care sit within the same organisation as its institutions for quality improvement. Healthcare Improvement Scotland (HIS) has a scrutiny and assurance directorate, which includes the Healthcare Environment Inspectorate (HEI) that monitors cleanliness and safety through announced and unannounced inspections. (9)
- One interviewee with a pivotal role in developing Scotland’s system answered the challenge by reflecting the question back on us: did we think the people we had spoken to were complacent? The answer is, generally, no. The “chronic unease” about whether more could be done, which has been identified21 as an important orientation in improving safety and quality, was widespread. Interviews carried out by McDermott et al with a wider set of central and frontline employees came to the same conclusion.22 But particularly when considering whether Scottish institutions could be transferred elsewhere, it is. Learning from Scotland’s NHS it is important to recognise that cultural and even individual factors, as much as hard institutions, are the part of the system that guards against complacency. (13)