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The Healthcare Safety Investigation Branch

The Healthcare Safety Investigation Branch (“HSIB”) is a unique organisation amongst healthcare systems worldwide and came into existence on 1 April 2017. Currently operating under the auspices of NHS Improvement, HSIB both guides and supports NHS organisations undertaking patient safety investigations and also conducts safety investigations of its own. The aim of HSIB is to look at the wider opportunities to learn from incidents where harm has (or could have) occurred and then share that knowledge across the entire healthcare sector. HSIB specifically does not apportion blame or liability and is modelled on the no-blame ethos of aircraft incident investigations. Indeed, HSIB’s Chief investigator, Keith Conradi, was formerly Chief Investigator of the UK’s Air Accident Investigation Branch.

HSIB recently issued its first ever annual report and it’s a very interesting read for anyone involved in healthcare. Twelve national investigations were commenced in Year 1, of which three are now complete. The three completed investigations relate to a wrong site nerve block, implantation of an incorrect prostheses during joint replacement surgery and an unsuccessful transition from child and adolescent mental health services to adult mental health services.

Each completed investigation has resulted in HSIB issuing recommendations and safety observations. For example, in the completed investigation regarding mental health services, HSIB issued five recommendations to NHS England and one recommendation to the Care Quality Commission.

At present, HSIB does not have any statutory power to compel organisations to comply with its recommendations. This is arguably a pity, because the reports of the three completed investigations are thorough, thoughtful and make important recommendations, such as recommending that NHS England require CCGs to prove that budget allocated for children and young people’s services gets spent only on this group.

Having said that, there is also force in the idea that HSIB’s expertise should be in investigation and patient safety only rather than trespassing into enforcement and regulation. If HSIB held the status of a regulatory body, this might possibly dissuade healthcare professionals from speaking freely during HSIB investigations, particularly having regard to the current issues of mistrust between doctors and their regulatory body, the General Medical Council.

A draft Health Service Safety Investigations Bill is currently at pre-legislative scrutiny stage and, if ultimately laid before Parliament and enacted, will transform HSIB into the Health Service Safety Investigations Body (“HSSIB”) – a wholly independent, statutory organisation separate to NHS Improvement. The draft HSSIB Bill provides that recipients of HSSIB recommendations will be obliged to publish their response to those recommendations. In addition, the Joint Committee on the HSSIB Bill has recommended that the Care Quality Commission should incorporate the implementation of HSSIB recommendations into its quality standards in order to ensure compliance (as CQC has a range of enforcement powers it can use against those in breach of its standards).

The government has previously indicated that HSSIB will go live from 2019. I will update this blog post once there’s any news. In the meantime, please don’t hesitate to get in touch should you need help with any investigation.

Update – Coincidentally, the day after I wrote the blog above, Matt Hancock (Secretary of State for Health & Social Care) spoke at the Patient Safety Learning Conference in London and named HSIB and the implementation of HSSIB as one of his early priorities. His speech can be viewed here





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