Dash Patient Safety Review

Revamp, revitalise and significantly enhance the role of the National Quality Board. A revamped, revitalised and reinforced NQB should be responsible for developing a comprehensive strategy to improve quality of care that is in line with the aims of DHSC and the NHS in England. It should set out a vision of quality of care that describes what good looks like for the various dimensions of quality, build expertise in assessing healthcare value, and develop an overarching strategy for how improvement and innovation can best be supported across health and care. NQB should develop an operating model that includes a repository of recommendations from multiple sources, a clearing-house function to co-ordinate and prioritise recommendations, and ongoing monitoring and evaluation of their impact. NQB could be co-chaired by the chairs of CQC and chair of NHS England, transitioning over time to the lead non-executive director for quality on the board of DHSC, and be directly accountable to the Secretary of State for Health and Social Care.

Continue to rebuild the Care Quality Commission with a clear remit and responsibility. CQC should remain the principal independent regulator responsible for oversight of the health and care system. It should develop sector-specific approaches to registration and assessment, set standards for the quality of health and care in co-ordination with NQB, and assess how well providers are identifying and controlling risks and have mechanisms in place for improvement. CQC should renew its focus on the role of governance, boards and accountability systems, specifically reviewing commissioner and provider boards on their ability to improve all aspects of quality of care. Where independence from and oversight of commissioners and providers of health and care is required, CQC should host those functions.

Continue Health Services Safety Investigation Body's role as a centre of excellence for investigations and clarify the remit of any future investigations. HSSIB should continue to operate as a dedicated, expertise-led incident investigation facility, collaborate with DHSC through NQB to agree the scope of investigations, and have a role advising and supporting best practice in local investigations. Recommendations from HSSIB investigations should be considered as part of the clearing-house function of NQB. It is recommended that the functions of HSSIB should be transferred to CQC, continuing to operate as a discrete branch within CQC and retaining its independence for providers.

Transfer the hosting arrangement of the Patient Safety Commissioner to MHRA, and broader patient safety work to a new directorate for patient experience within NHS England, transferring to the new proposed structure within DHSC. The original function of the Patient Safety Commissioner — to promote the safety of and enable the user voice on adverse impacts of medicines and medical products — should be hosted by MHRA. The wider remit adopted by the Patient Safety Commissioner should be integrated into a new directorate for patient experience within NHS England (later transferring to DHSC), to include patient and user engagement, managing and learning from complaints, and formal support for those who have suffered unsafe care.

Bring together the work of Local Healthwatch, and the engagement functions of integrated care boards (ICBs) and providers, to ensure patient and wider community input into the planning and design of services. The statutory functions of Local Healthwatch relating to healthcare should be combined with the involvement and engagement functions of ICBs. The statutory functions relating to social care should be transferred to local authorities. The strategic functions of Healthwatch England should be transferred to the new directorate for patient experience at DHSC. CQC should explicitly test whether every ICB and provider is listening to patients and users effectively, using existing local networks.

Streamline functions relating to staff voice. Staff should be supported and encouraged to share concerns about quality and safety as part of a data, evidence and learning-led culture. The functions of the National Guardian's Office could be more aligned with other staff voice functions in NHS England. Since guardians have been established across providers, the responsibilities of the National Guardian for Freedom to Speak Up in the NHS and National Guardian's Office should be incorporated into providers, meaning the distinct role of National Guardian is no longer required. CQC should assess whether every commissioner and provider has effective Freedom to Speak Up functions.

Reinforce the responsibility and accountability of commissioners and providers in the delivery and assurance of high-quality care. Far greater emphasis should be given to how individual providers deliver high-quality care and how their commissioners commission on the basis of all dimensions of quality and hold providers to account. DHSC, NHS England, commissioners in local authorities and ICBs and providers should demonstrate clear and aligned governance and accountability structures. Commissioners and providers should operate effective quality and safety management systems covering all aspects of quality, including efficiency and people management, and be incentivised to engage in large-scale improvement activities that include systematic sharing of best practice.

Technology, data and analytics should be playing a far more significant role in supporting the quality of health and social care. Technology — in particular the use of AI — has the potential to significantly improve the safety, effectiveness and responsiveness of care delivery, and the use of resources. NHS longitudinal data at patient, provider and ICB level could be used to evaluate safety and quality in providers. Advanced analytics and AI would enable far greater insights into where and why poor-quality care is happening. Regulators will also need to consider how to regulate new technologies and should compare outcomes with current levels of quality or safety, not hypothetical 100% safety.

There should be a national strategy for quality in adult social care, underpinned by clear evidence. A national strategy should develop and agree a set of metrics to assess quality of care (outputs and outcomes rather than inputs), agree how to disseminate best practice, and ensure appropriate governance structures, systems and processes are in place across all providers. Consideration should be given to consistent data sets which all social care providers should collate. Further opportunities to ensure effective commissioning of adult social care should also be considered. A national strategy for quality of social care will need to align with or be embedded into the Casey Commission.