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20.12.17

What is the HSIB?

NHE’s Seamus McDonnell looks into the purpose of the health service’s newest investigator.

The Healthcare Safety Investigation Branch (HSIB) is the newest addition to hospital safety investigations, the equivalent to the rail and air accident investigation branches.

The new body is specifically charged with investigations into incidents that have happened within the NHS. However, HSIB is not an inspector like the CQC or a regulator like NHS Improvement (NHSI); in fact, it is a relatively small organisation – with only around 30 members conducting investigations.

In accordance with this, it is only resourced to investigate up to 30 incidents every year, albeit over long periods and in great detail.

Keith Conradi, its chief investigator (pictured), spent some time at the NHS Providers annual conference in November explaining the purpose of HSIB and his vision for the direction he expected it to take. As the former chief investigator at the Air Accidents Investigation Branch, Conradi was keen to illustrate the different approach his independent organisation would take to safety.

The body’s key objective is to improve patient safety by determining the causes of incidents rather than pointing out organisations or individuals who are specifically at fault. “Absolutely crucial to us is the fact that we are not here to apportion blame or liability,” he explained. “We go to great lengths in our process to ensure we do not do that because sometimes, even when you are trying not to do it, what you write can push blame or liability in a particular direction.

“That does not mean that there will not be other investigations in future that may be looking at a more judicial view of what has happened, but we are all about safety investigation.”

How it works

There are no mandated incidents or types of event which HSIB will be expected to inspect. Instead, it has been left in the hands of the investigators themselves to choose what should be scrutinised.

During the investigations themselves, the organisation will make recommendations to other bodies involving particular actions aimed at improving safety for patients and, at the end of a case, will publish findings publicly in order to help promote better practice. However, Conradi said these recommendations would be aimed at top-level national bodies, not local organisations – the likes of NHSI rather than individual trusts.

He also explained that the small number of investigations done each year will be subject to very clear guidelines, in order to ensure the wider system benefits from every case.

“We ask ourselves, how bad was the outcome? We are looking for a very serious adverse outcome or the potential for that,” said the chief investigator. “Then we filter it down and ask, is this symptomatic of a more widespread problem? We really want to concentrate on systemic problems.

“Finally, what is the learning potential for the HSIB going in to investigate this? Are there other people who we may have confidence in going in to investigate this? Are there national studies being done on this? Do we really want to waste our resources if there are others already involved in this?”

It is possible for anyone to request an investigation through the branch’s website; however, the criteria are extremely strict due to the limited resources available.

The investigator is not just aimed at acute services: it has the remit of following cases “wherever NHS money goes,” meaning it will research primary care as well as the social care sector. It even has the ability to search through other body’s investigations, such as the CQC’s work, and has the freedom to interview anyone relevant to a case.

To date, HSIB has instituted nine investigations, although none have been completed yet.

FOR MORE INFORMATION

W: www.hsib.org.uk

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