Will scrapping NHS England help improve patient safety?

Protecting the reputation of the NHS brand often seemed to matter more than doing the right thing. Rarely has a major patient safety failure been uncovered and proactively admitted by NHSE.

Many of the patient safety scandals that I have covered – the deaths of people with learning disabilities and mental health problems at Southern Health, maternity failures in Shrewsbury and Telford, East Kent and Nottingham – were only revealed after the skilled and active campaigning of grieving and committed families, who felt compelled to turn to the media when other efforts had failed.

Consider, for instance, the poor care that mothers and babies received at the East Kent Hospitals University NHS trust. An independent review of its maternity services, published in 2022, found that between 2009 and 2020, at least 45 babies might have survived with better care. The scandal was only uncovered by the tenacity of the Richford family, who lost baby Harry in 2017 following a series of avoidable errors.

But the inquiry revealed NHS England had been aware since 2013 that there were concerns about maternity services. Despite this, "the safety structures within NHSE did not see the trust as being a problem," said the review.

Various efforts were made by NHSE to help the trust but they "failed to secure the necessary improvements in the services provided," and so babies continued to die unnecessarily.

NHS England's answer to the persistence of the problem, found the inquiry, was "a pattern of hiring and firing, initiated by NHSE. It is clear that this approach was not just ineffective in East Kent, but wholly counterproductive. These decisions appear to us to have been made separately from any question of accountability."

Helen Gittos, who lost her daughter Harriet in 2014 at East Kent, is glad that NHSE is being scrapped.

"When families met with Wes Streeting to talk about maternity safety in the autumn, one of our messages was that NHSE was part of the problem, not part of the solution.

"It has been incredibly frustrating to see NHSE's response to successive reviews of maternity services. It's almost as if they haven't read the reports", she said.

The Maternity Safety Improvement Programme, led by NHSE, has not brought the kind of improvements "women and families so desperately need", she added.

An NHS England spokesperson said: "Our staff work exceptionally hard to keep patients safe and we have made significant progress in this area through the implementation of the first ever NHS Patient Safety Strategy, which introduced an NHS-wide programme of training and education in patient safety.

"This strategy, which evolves over time to ensure it meets current challenges, has transformed the governance of safety across the NHS."

NHS England has published hundreds of independent investigations, at a cost of millions of pounds, into the care and treatment that patients have received.

Many of these have been welcomed by the families, providing necessary answers. Individual staff have been commended for their engagement with families, too.

But on too many occasions, it has proved an almighty struggle for them to act.

At the heart of many of the patient safety scandals uncovered in recent years has been a poor culture, an unwillingness to openly engage with patients. At the root of those problems has been poor behaviour in particular trusts, but repeatedly, families have complained that NHSE's own secrecy has added to the problem.

While individual NHS trusts regularly publish their board papers well ahead of meetings, for years NHSE itself didn't publish any board papers until the meeting was over – proof, said critics, of its lack of openness to scrutiny. Its papers are now published – about two hours before a meeting.

"Their organisational culture is very much 'we are the NHS, this is how we do things,' said Peter Walsh, a long-term patient safety campaigner.

"There are certainly some well-meaning people within the organisation, people of integrity, but too often, they have never really seen it as their role to stand up for patients."

Mr Walsh points to a recommendation from the review into maternity failures at the Shrewsbury and Telford NHS trust. The report called for the creation of independent advocates to ensure women and their families were listened to.

NHS England tried to reinvent the role, said Mr Walsh, to make the advocates its employees.

"The very fact they were dead set on employing these independent advocates themselves says something about the culture - its control, and just not even beginning to understand the nature of independence."

Whether the abolition of NHS England does lead to a greater focus on patient safety is uncertain.

The NHS used to have a world-leading organisation, the National Patient Safety Agency, which wasn't perfect but was admired globally for its sole focus on improving patient outcomes. It was abolished in 2012 and subsumed into NHS England.

"In the short term, the reorganisation could set back patient safety," said Paul Whiting, chief executive of the charity Action against Medical Accidents.

"But in the long term, patient safety must be put at the heart of the government's 10-year plan for the NHS, to win back trust," he added.

"I wouldn't put NHS England as an organisation to be any worse than what we've had before or may actually get in the future," said Professor James Walker, who was the first clinical director for maternity care at the Healthcare Safety Investigation Branch, which examined cases of poor neonatal and maternal care.

The upcoming change, however, is "a big opportunity to improve patient safety, but we need a mental shift.

"Throughout the whole of the health service, we've totally lost empathy for the patient. We've become very regimented – we need to focus on how we can help, rather than whether someone fits into a framework of how the NHS delivers care."