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18 May 2011: Patient Safety Congress
'Delivering a safer NHS: Openness, Transparency & Outcomes'

  • Last modified date:
    24 May 2011

Thank you.  Now the eagle-eyed among you will have noticed that, despite what it may say on the website, I am not in fact Andrew Lansley.  Andrew sends his sincere apologies for not being able to be here, but Cabinet business keeps him away.

I know that Andrew was particularly keen to be here to speak with you today, for the same reason that I was more than happy to take his place.  The annual Patient Safety Congress has quickly become the place to be if you are interested in improving patient safety and that is exactly what Andrew and I want most of all.

Judging by the number of exhibitors and looking at the long list of speakers and workshops, it’s easy to see why this is the case.  There are so many people here, not only from England, but from around the world.  All with fresh ideas and new ways of thinking about patient safety.  All hungry to learn from each other the lessons of their experience. 

Bottom-up, not top-down

And it is this enthusiasm for patient safety that I hope our plans to modernise the Health Service will promote.  Because no matter how hard we try, I just don’t think it is possible to mandate patient safety from Whitehall. 

While we will use legislation wherever we need to to create the best framework for patient safety, it needs an awful lot more than new laws to have any sort of lasting impact.  It needs a culture of safety to seep into every last corner of the NHS, and you can’t make that happen simply by declaring that it should.

So what can we do from Whitehall?  Well I believe there is a great deal we can do.  Things that can start to make a real difference, that can start to encourage and support that culture of patient safety that we so badly need throughout the NHS.

Just over 100 years ago, the US supreme court judge Louis Brandeis argued that ‘sunlight is the best disinfectant’ for any organisation acting in the public interest.  A century on, his words continue to resonate across all public services – especially within the National Health Service.  Openness and transparency acts like U.V light – irradiating poor practice and giving incompetence no place to hide. 

We need to be utterly transparent about exactly how well the NHS – how well each individual part of the NHS – is performing.

Outcomes

We need to change how we measure success in the NHS.  For what does it matter that you treat more people in a shorter period of time, if the quality of the care suffers and the outcomes aren’t up to scratch?  If a patient’s safety is put at risk?

Too often we measure the success of the Health Service by the number of units it processes – as though it were some sort of assembly line producing widgets – not by how well it improves lives of individual people.

From now on, I want all parts of the NHS to be judged on the clinical outcomes they achieve. 

In December, we published the Outcomes Framework to help clinicians all across the country to pull in the same direction.  From now on, we will judge the success of NHS providers based on whether they are:

• Improving survival rates;
• improving the quality of life for people with chronic conditions;
• enhancing recovery after treatment;
• continually improving patients’ experience of their own healthcare;
• cutting the number of infections and maximising safety.

On all of these points, NICE are developing quality standards that we can use to see how well providers are performing and we will publish the results for all the world to see. 

Not only at the provider level.  But for each department and even each consultant-led team.  If you provide NHS services, then you will be open to scrutiny by your clinical colleagues and by the public.

NRLS

This is not entirely new, of course.  The NPSA should be congratulated for the success of the National Reporting and Learning Service, which covers all adverse incidents.  The most comprehensive of its type anywhere in the world. 

And I can confirm that we will build upon its success with an investment of £3.7 million in this financial year for the system to be developed further.  Improving patient safety by making it easier to learn lessons and to improve care.

Never Events

We have also increased the number of ‘Never Events’ from eight to 25.  The things that under no circumstances should ever happen, things like wrong site surgery or the maladministration of Insulin.

And should such an event occur, which I hope will be increasingly infrequent, commissioners will be able to withdraw payment for it and for any subsequent treatment needed as a result.  A powerful additional incentive for providers to avoid making such potentially fatal errors in the first place.

Transparency

I believe this will herald a new era of openness.  And I expect the results of transparency to be startling.  Just as they have been already for cardiac surgery.

About a decade ago, cardiac surgeons, entirely independent of government, decided to measure the outcomes of their work and then, some 5 years ago, they took the important further step of publishing those results.  This was not an easy decision to take.  Standing underneath a spotlight can be a very difficult thing to do professionally.  But they took the risk and they have reaped the rewards.

During those five years, they examined their performance and worked hard to improve it.  And improve it they certainly have.

At the start, mortality rates were around the European average.  Since then, they have halved, taking them significantly below that average. 

That is a remarkable achievement in a relatively short space of time.  An incredible example of what clinical leadership can do.  And it is one that I want to see replicated across the whole of the NHS.

Last month the National Cancer Intelligence Network published, for the first time, mortality rates 30 days following surgery for bowel cancer.  Across the country, the figure was 5.8%.  Not bad, perhaps.  But that national figure masked huge variation.  From just 1.7% at Central Manchester University Hospital to 15.6% at Burton Hospital in Staffordshire.

Now this doesn’t automatically mean that care at one place is necessarily better or worse than elsewhere.  As you know, there will be all sorts of factors at play.  But it does give clinical teams pause for thought. 

To ask the questions:
• is there more that we can do? 
• can we make our care safer? 
• are there things the best performers are doing that we are not?

And we can learn by knowing more about them

This new era of openness and transparency will, I believe, have an huge impact on the safety culture within the NHS.  I want people to take great pride in their safety record.  This can only happen if everyone’s record is available for everyone to see.

Whistleblowing

One important step along the way will be to eradicate the culture of blame from within the NHS.  I want people to feel not only that they will not be unfairly blamed for speaking up, but that they will be encouraged and supported in doing so.

Now this change may take some time to become universal.  Longer in some organisations than in others.  But I think we are designing the incentives in a way that means it will happen.

For a start, we are strengthening the protection of whistleblowers.  Already, all NHS organisations must comply with the terms of the Public Interest Disclosure Act, but implementation is not always consistent. 

So we’ve issued guidance to all NHS organisations that their terms and conditions of employment must cover whistleblowing rights. 

We’ve worked with NHS trade unions to amend the terms and conditions of the service handbook to include a contractual right to raise concerns.

And we’re looking at reinforcing the NHS Constitution to make clear staff and employer rights and responsibilities when it comes to whistleblowing.

But giving protection to those who feel they cannot speak out publicly, or who feel their organisation just won’t listen, still implies that there is some way to go.  I look forward to a time when there is no need for people to ‘blow the whistle’ because the culture of openness and transparency is such that it is never necessary.

NHS Commissioning Board

If this is going to happen, then the responsibility for patient safety cannot remain at arms length to the Health Service.  It must be ingrained within it.

That is why many of the responsibilities of the National Patient Safety Agency will move to the new NHS Commissioning Board.

It will be for the Commissioning Board itself to decide on the best approach to embedding patient safety.  And it will do so based on the best clinical evidence available.

In doing so, the Board will learn the lessons of tragedies such as what happened at Mid Staffs, where a culture of secrecy led to the death and poor treatment of far too many people. 

It will take heed of the current listening exercise and of an ongoing dialogue with the professions to make sure that it is always changing, always adapting as necessary to improve patient safety.  Never getting stuck in the past, doing what might have been best once, but is no longer the case. 

Flexibility will be vital to ensuring patient safety both now and long into the future.

Commissioning

With the Commissioning Board in the lead, the central importance of patient safety can be embedded throughout the NHS through clinical commissioning and the contracts agreed with all providers of NHS services.

Soon, every contract within the NHS will demand specific attention to patient safety.  And every organisation will be held directly accountable for it, with their patient safety outcomes published for all to see. 

It will be in the direct interests of every provider, every commissioner, every individual operating within the NHS to place patient safety at the top of their list of priorities.

Clinical leadership

But it will also be their responsibility – your responsibility – to work out just how best to improve your own organisation’s safety record.  For while government will do all it can to put patient safety at the top of everyone’s list, as I said before, it’s not possible to mandate patient safety from Whitehall. 

That is where the other side of our plans for the modernisation of the Health Service come to the fore.  We want to remove the politics with a capital ‘P’ from the NHS.  To end the constant micro-management and interference from politicians like me, spurred on the that morning’s headlines and driven to endless centrally-imposed initiatives that do little more than drive you to distraction.

No.  If patient safety is to really take off as we want it to, if clinical outcomes really are the most important thing, then the NHS must be genuinely clinically led.

Listening

That is why it is so important that we get the Health and Social Care Bill right.  Because this isn’t about another top-down reorganisation, whatever people might think. 

On the contrary, this is about putting a stop to the constant meddling from above by placing real power in your hands. 

You know your organisations and your patients far better than we ever could in Whitehall.  So it’s right that you are the ones in charge of doing whatever it takes to ensure patient safety.

With all of this, we need to make sure that what we want to happen is the same as what actually happens.  We need to get the Bill right, we need to get modernisation right – and just as you are the ones who should lead the NHS in the future, it’s also you who are best placed to help us get this right today.

So I urge all of you to go to one of the many listening events happening around the country or to make your views known directly through the Department of Health website. 

For the foundations we lay in the coming months will affect your daily lives for years to come. 

Conclusion

But with clinical leadership, a genuine focus on outcomes and whole new level of transparency, I know we can change the NHS for the better.  I know we can create a new culture within the NHS.  A culture of openness, where errors are not hidden away, but discussed, learned from and shared. 

If we can only harness the determination and enthusiasm on show here at this Congress, then I am not only confident we can make a huge impact on patient safety.  I am certain of it.

Thank you.

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