Quality and safety
The NHS is making progress in improving its safety culture but there is room for improvement.
Levels of incident reporting to the National Reporting and Learning System (NRLS) are increasing. However we are concerned that staff are not aware of incidents, or how to report them and that this might affect patient safety.
There are still some barriers for staff in reporting incidents, and confidence in their employers' handling of incident reports could be higher.
- NHS compliance with safety standards
- Independent healthcare compliance with safety standards
- Decontamination
- Infection control
- Violence and aggression against staff and patients
- Recommendations
NHS compliance with safety standards
In 2006/2007 most NHS trusts in England were compliant with all applicable core standards relating to safety:
- 64% of acute trusts and 46% of Primary Care Trusts were compliant with all nine safety standards
- 77% of mental health trusts and 58% of ambulance trusts were compliant with each of the eight safety standards applicable to them.
The standards trusts had the most difficulty with were:
- Infection control and hygiene
- Medical devices
- Medicines management.
Independent healthcare compliance with safety standards
Most independent healthcare providers met most of the national minimum safety standards. We have seen an increase in independent providers meeting the core minimum standards on safety and the safety standards that apply to their specific sector of healthcare.
Decontamination
Compliance with standards on decontamination remains an issue for the NHS and independent sector.
Infection control
On the whole NHS Trusts have scored well on infection control. However, we have identified some areas where improvement needed, including;
- governance
- compliance with policies and procedures
- staff training
- isolation facilities
The number of MRSA infections and the rate of infections have fallen between 2005/2006 and 2006/2007.
Rates of Clostridium difficile infection have gone up year-on-year since the start of mandatory surveillance in 2004, but between 2005 and 2006 the rate of increase slowed, and the first published data for 2007/2008 gives suggests that the rate of infections may have peaked.
Violence and aggression against staff and patients
Levels of violence and aggression remain too high. There have been improvements in arrangements for dealing with violence and aggression in adult mental health wards, but there is some way still to go in older people's mental health wards. In general, incidents of violence and assault are under-reported across the NHS.
Recommendation
Healthcare providers and commissioners need to focus on learning from information already available to them, especially clinical outcomes and complaints, errors and near misses.
Trust boards and senior staff must take the lead in establishing a culture of learning from mistakes and putting patients at the centre of the decision making process.
Download the chapter Developing a culture of safety (PDF 278kb) (Opens new window)
