Building a culture of safety

The NHS is making some progress in improving its safety culture but there is some room for improvement. Levels of incident reporting to the National Reporting and Learning System (NRLS) continue to increase. However we are concerned that awareness among staff of incidents affecting patient or staff safety, and how to report them, may be diminishing. There are still some barriers for staff in reporting incidents, and confidence in their employers' handling of incident reports is not as high as it could be.

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 PCTs 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

Our inspections of NHS hospital trusts against the new statutory hygiene code have found good levels of compliance.  However, we have identified some areas where more attention is needed, including;

• better governance
• improved compliance with policies and procedures
• improved uptake of staff training
• provision of adequate isolation facilities

The number of MRSA infections and the rate of infections have fallen between 2005/2006 and 2006/2007. In 2006/2007 just 44% of NHS hospital trusts were on track to meet their reduction targets for 2008. In Wales the rate of infection was around half that in England, and was decreasing faster.

On Clostridium difficile, rates of 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 some ground for cautious optimism that the rate of infections may have peaked.

Violence and aggression against staff and patients

Levels of violence and aggression remain too high, and too many staff and patients are exposed to this on a routine basis. 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 more on learning from information already available to them, in particular data on 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)
Download the State of Healthcare 2007 report (PDF 1540kb) (Opens new window)