There are concerns that the cuts to ICB running costs are ‘likely to exacerbate’ and put at risk the ‘already patchy oversight and support’ that ICBs provide around patient safety, according to a new report.
The report, by the Health Services Safety Investigations Body (HSSIB), looked at the impact of the patient safety incident response framework (PSIRF) on investigation practices since it was rolled out to all NHS trusts.
The PSIRF was published in August 2022, and has previously been criticised for giving ICBs ‘reduced visibility of incidents’ compared to the Serious Incident Framework 2015 (SIF), which it replaced.
The report said that NHS staff feedback on the framework found that oversight from ICBs was ‘patchy’, particularly interviewees involved with patient safety specialist training.
Under PSIRF, organisations are asked to work with ICBs to design processes of oversight, which could include sharing incidents and investigations reports, but this is not a requirement unlike in the previous framework. ICBs therefore felt ‘more detached’ from organisations and less knowledgeable about incidents and investigations being undertaken, interviewees said.
The report said: ‘Interviewees said that those working in ICBs had pointed out the challenges they faced in providing meaningful oversight – specifically, limited time and resources. For example, ICBs are responsible for many different organisations, and interviewees said that while attending PSIRF meetings seemed reasonable in principle, in reality they did not have the time to do this.’
Concerns were raised about how the 50% cuts to ICBs would impact this going forward.
It said: ‘Interviewees said the Department of Health and Social Care reforms to the structure and role of integrated care boards, and the requirement to cut running costs by 50%, is likely to exacerbate and put at risk the already patchy oversight and support they provide for PSIRF implementation.’
It added: ‘Interviewees pointed out the need for identified support and clarity about the detail of oversight responsibilities if the potential of PSIRF in terms of system-based investigations and engagement of those affected is to be realised.’
NHS England responded to the HSSIB saying it had commissioned the Health Innovation Network South London to look at oversight by ICBs, which will ‘help inform any changes or additional support required’.
The analysis also found that there was variation in investment organisations have made into implementing the framework, and therefore also variation in progress and practice.
‘Greater oversight and support are needed to help ensure consistency in how PSIRF is understood and applied in NHS trusts,’ it concluded.
Mel Ottewill, senior safety investigator at HSSIB, said: ‘The process of putting together this report has been positive and encouraging, highlighting how well the PSIRF has been received across the NHS in England. Staff strongly agree with the shift to a system-based approach to investigation and the need to compassionately engage and involve those affected by incidents, seeing this as not only beneficial but the right thing to do.
‘However, the findings also point to the need for a greater focus on implementation and resourcing to ensure PSIRF can reach its full potential.’
She said boards and senior leaders play a ‘critical role’ in shaping the culture and practice of investigations.
‘Their full organisational support is essential to create the conditions needed for PSIRF’s aims to be realised,’ she added.
It comes as an RCGP survey has revealed that almost three quarters of GPs say patient safety is being compromised by their workload.
It found that 73% of GPs said workload pressures affected their ability to keep patients safe, and that there was ‘significant concern’ over the new neighbourhood health services from the Government in the 10 year plan, with 68% of respondents reporting worries over the lack of GPs to effectively deliver this.
Professor Kamilla Hawthorne, chair of the RCGP, said: ‘I understand that apprehension completely. When your workload is like a river that never stops flowing, no matter how hard you work, no matter how many hours you put in, it is difficult to have the mental capacity even to think about long-term strategy.
‘And many who do grapple with it say they are caught between hope and scepticism. They are hopeful because the aspirations in the 10-Year Health Plan make sense. They are sceptical because they have heard similar hopes expressed before.’
It comes as the demand and capacity pilots are seeing an impact in PCNs, according to the NHS England board.
However, the funding of ICB redundancy costs remains unclear.
