The Royal College of Nursing has warned that government reforms to improve patient safety will “fall short” unless the nursing workforce crisis on wards is urgently address.
It comes as Dr Penny Dash, newly appointed chair of NHS England, this week published an independent review of patient safety across health and social care in England.
“The best safety measure would be ensuring there are the right number of nursing staff to meet patient need”
Nicola Ranger
Commissioned by the Department of Health and Social Care (DHSC), the report called for the streamlining of organisations responsible for monitoring and overseeing safety of care.
It follows an announcement last week by the government that over 200 organisations responsible for overseeing and running part of the NHS – including some patient safety organisations – would be scrapped.
While the review identified duplication and confusion across the system, the RCN stressed that the “biggest threat to patient safety” was the lack of nursing staff.
Dr Dash looked at six patient safety organisations overseen by DHSC to find out whether there were overlaps or gaps in functions across them.
The organisations were: the Care Quality Commission (CQC), the National Guardian’s Office, Healthwatch England, the Patient Safety Commissioner, the Health Services Safety Investigations Body (HSSIB) and the patient-safety-learning aspects of NHS Resolution.
One of the main findings of the report was that there had been a shift towards safety compared to other areas of care over the last decade, with many resources invested but little improvement seen.
It said many organisations had been established to consider different aspects of patient safety, resulting in multiple reviews and inquiries being carried out.
An “overwhelming” number of recommendations have been put forward by these organisations, which had caused “considerable confusion” for patients and staff alike.
The Thirlwall Inquiry – investigating convicted serial killer Lucy Letby’s crimes – identified over 1,400 recommendations from 30 inquiries that have taken place in England and Wales in the last 30 years.
Meanwhile, various inquiries and reviews into maternity care over the last 5 years have resulted in over 450 recommendations.
DHSC-sponsored reviews and inquiries into safety were also estimated to have cost at least £100m.
The report found that some organisations analysed had expanded their scope, which it said created further complexity, recommendations and confusion.
For example, the HSSIB was originally set up to look at specific cases or incidents of severe harm but recently broadened its work into making more systemic recommendations.
Similarly, the National Guardian’s Office – which leads a network of Freedom to Speak Up (FTSU) guardians in the NHS – was duplicating work carried out by providers, the report said.
The guardian role – of which there over 1,200 in the health service in England – was designed to be independent, but being hosted within the CQC results in the role “being distant to the people it needs to support an influence”.
Dr Dash found that the current system for complaints and concerns was confusing and lacked responsiveness.
The report said over 20 organisations had offered a place for patients to share feedback, either formally or informally, which had created a “confusing landscape” where they do not understand who to complain to and how.
Overall, the review set out that action was needed to streamline, simplify and consolidate functions where duplication and overlap exist.
Among nine recommendations set out included a reshuffle and merger of the quangos.
The report said the CQC should remain as an organisation but must have clear responsibility and remit and overhaul its registration and inspection processes.
Similarly, the HSSIB should continue as a centre of excellence for investigations but as a “discrete branch” within the CQC, it added.
Meanwhile, the responsibility for the National Guardian’s Office should be brought into providers, meaning the role of the national guardian is no longer required.
The report further recommended a refreshed strategy for improving quality of care, delivered by revamping the National Quality Board, as well as a national strategy for quality in adult social care, underpinned by clear evidence
Responding to the review, RCN general secretary and chief executive, Professor Nicola Ranger, said: “Taking a match to independent organisations designed to protect the public is a high-risk move when things are still so unsafe for patients and tens of thousands of nursing posts lie vacant.
“Reducing duplication is always sensible and it is right that the new national quality board will focus on quality and outcomes, but patients must be prioritised over drives for efficiency and financial savings.”
Professor Ranger warned the biggest threat to patient safety was “having too few nurses”.
Nicola Ranger
She added: “There is a clear link between better nurse to patient ratios and improved patient outcomes, mortality and length of stay.
“The best safety measure would be ensuring there are the right number of nursing staff to meet patient need, including in the community where numbers have collapsed.
“Without urgent investment in the workforce, and the publication of staffing levels to aid public scrutiny, efforts to improve patient safety will fall short.”
Health and social care secretary Wes Streeting said: “Over the past decade and a half, a labyrinth of healthcare regulation has been left to spiral out of control –overcomplicating a system that is needed to save lives.
“The recommendations set out in Dr Penny Dash’s review will help us streamline the patient safety landscape – meaning fewer checkers and more doers – and put patient experience at the heart of the NHS.
“Through our 10 Year Health Plan we will bring safety into the 21st century, using tech and AI to make checks more rigorous and efficient and ensure we never turn a blind eye to failure.”
This is the second review undertaken by Dr Dash in recent months.
Her previous report into the CQC highlighted why it was failing as a regulator, which resulted in it being under new management and on a path to recovery.
Dr Dash had been further commissioned to undertake a third review on quality and governance, but DHSC said this work had instead been fully incorporated as part of the 10 Year Health Plan, published last week.
