The Health and Care Act 2022 delivered several innovations, and as with any package of reforms to the health and care system, there was a mixed reaction.
For the MDU, it is the culmination of a concerted lobbying effort we have been engaged in on behalf of our members. One of the most significant and potentially positive reforms the Act has brought in is the creation of the Health Service Safety Investigations Body (HSSIB).
Our members may well come into contact with this new body over the course of their career, so while the legislation was going through parliament, we worked hard to ensure their voice was heard.
We have sought to make sure the HSSIB can begin its work in the best shape possible. After all, there is no shortage of investigations and procedures that can follow an adverse incident - so the HSSIB has got to be different.
How is the HSSIB different?
When something goes wrong in medicine, there has long been a compelling case for an investigative process that is not focused on apportioning blame or liability, but rather on identifying learning opportunities to improve patient safety. That is exactly what the HSSIB will be tasked with doing.
To support this objective, the Health and Care Act has created a legal 'safe space' in the HSSIB's statutory remit. The safe space rests on the fact that the HSSIB will have the power to compel healthcare professionals to cooperate with it, but will in turn be prohibited from disclosing the information or evidence they submit. This is essential if doctors are to have the confidence to engage fully with the HSSIB's investigations without fear or blame.
Making the 'safe space' as safe as possible
From the moment the legislation was first introduced in the House of Commons in 2021, it was clear the MDU would need to campaign to improve the safe space as then proposed.
The government initially intended that coroners should be exempt from the above prohibition on disclosure, and allowed access to information submitted to the safe space. But because multiple consequences can flow from being named in a coronial investigation - such as a referral to the GMC - allowing coroners routine access to material held by the HSSIB could have risked the protections it offered failing in the eyes of doctors from the outset.
Despite cross party-support, amendments supported by the MDU to remove coroners from the scope of the HSSIB section of the Bill were initially unsuccessful in the House of Commons. However, after receiving a ringing endorsement by the House of Lords, the government dropped its opposition to the amendment and agreed to the removal of coroners' access to the safe space.
A victory for patient safety
Creating an open, learning, no-blame culture in the NHS is not something that any one piece of legislation or policy innovation can solve. It is an ongoing journey. The HSSIB will begin its work with a safe space that is much stronger than it was at the start of the legislative process, and we hope it now does what we all want to see: win the trust of both healthcare professionals and patients, and improve safety in the NHS.
The power of members' voices
Over the past 12 months, we have been keeping members updated on our lobbying work in this area through this publication and our website - and asking for their support. As a result, a number of members reached out to their MPs about the HSSIB and the safe space, urging them to get behind the MDU's amendment.
The collective voice of the MDU's members is something powerful, and we were able to put it to good use. We're proud to be an unapologetic and unrelenting champion of healthcare professionals, and by working together we can ensure they are heard by governments, elected representatives, regulators and other oversight bodies.
Head of government & external relations
Head of government & external relations
Thomas (Tom) has worked in the medico-legal sector since 2014, prior to which he was employed in the House of Commons as a parliamentary researcher and adviser to a number of MPs. He is a graduate of the University of Exeter, where he studied Politics, Law and International Relations. Tom has a long academic interest in medical ethics, beginning with his undergraduate dissertation which examined the law on abortion in England and Wales. In addition to his role at the MDU, he is also a magistrate for the Central London district.
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