Too often, NHS boards pay more attention to governance, finances and targets than they do to patient safety, yet each year tens of thousands of patients suffer unnecessary harm - and at a huge cost the NHS, say MPs.

Nearly a decade ago, the UK government became one of the world’s first to prioritise patient safety across a whole healthcare system and, since then, important steps have been taken, such as the creation of the National Patient Safety Agency. Yet the NHS has failed to collect evidence about whether patients are any safer as a result of these initiatives, according to the House of Commons Health Select Committee, in a critical new report.

Significant failings in current patient safety policy and the persistent failure to eliminate the “blame culture” must also be urgently addressed, the MPs add.

They praise the government for pioneering patient safety, but add: “government policy has too often given the impression that there are priorities, notably hitting targets (particularly for waiting lists, and Accident and Emergency waiting), achieving financial balance and attaining Foundation Trust status, which are more important than patient safety. This has undoubtedly, in a number of well-documented cases, been a contributory factor in making services unsafe.”

Regulation of safety issues has become burdensome and costly, involving too many organisations whose roles are ill-defined; it is unclear what Strategic Health Authorities and Monitor (the independent regulator of NHS Foundation Trusts) are supposed to be doing, says the report. It condemns the Annual Health Check’s failure to detect notorious cases of bad care, such as at Mid-Staffordshire Foundation Trust, Maidstone and Tunbridge Wells Trust and Stoke Mandeville hospital - and describes Monitor’s taking at “face value the Mid-Staffordshire Trust's excuse that its poor mortality figures were a statistical anomaly” as “wholly unacceptable.”

Some NHS Trusts have never considered issues of patient safety, and while Primary Care Trusts (PCTs) are required to ensure the quality and safety of the services they pay for, this happens too rarely, say the MPs.

Moreover, the Committee is “appalled” that the Department of Health (DH) still has no timetable for introducing the NHS Redress Scheme, under which some harmed patients, who currently face “lengthy and distressing litigation to obtain justice,” would not have to sue to get compensation.

The delay in introducing technologies proven to improve patient safety is “extremely alarming,” while serious deficiencies remaining in the medical training curriculum are also detrimental to patient safety, the Committee adds.

Committee chairman Kevin Barren said the panel had been “saddened” by the avoidable harm that so many patients suffer. “Our report highlights many areas where urgent action is required, in some cases where it is a life-or-death situation,” added Mr Barron, Labour MP for the Rother Valley.

Among the report’s recommendations are for: - boards and senior management to make patient safety their top priority; - commissioning, performance management and regulation arrangements to be clarified and rationalised to become more effective; - measurement of patient harm rates by regular reviews of samples of patients’ case notes; - introduction, without delay, of the NHS Redress Scheme; and – speedy launch of proven technologies which can improve safety.

Open culture
Key tasks for the government include ensuring that the NHS develops a culture of openness and “fair blame” and that it strengthens, clarifies and promulgates its whistleblowing policy. Fear of litigation or prosecution underlines the need for the government to address the medico-legal aspects of patient safety; “we particularly recommend the decriminalization of dispensing errors on the part of pharmacists,” say the MPs.

“We strongly endorse the DH’s view that no Board in the NHS should always be meeting behind closed doors and we urge the government to legislate as necessary to ensure that Foundation Trust Boards meet regulatory in public,” they add.

Dr Hamish Meldrum, chairman of council at the British Medical Association (BMA), described the report as “a stark reminder of the need for transparency and openness in the NHS.”

“Doctors are committed to raising standards and cutting out avoidable errors. But for that to happen, they have to be able to report their concerns in a safe, no-blame environment. At the moment, NHS staff who highlight threats to patient safety are often ignored, bullied, or – worse still – threatened with career termination,” he said.