Safe Space

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Following its consultation on providing a 'Safe Space' in healthcare safety investigations, at the end of April, the Government published its summary of responses and next steps.

The majority of respondents expressed support for the proposal that the new Healthcare Safety Investigation Branch (HSIB) should operate in accordance with 'Safe Space' principles. But the proposal to extend those principles to local NHS investigations was not well-received, with the majority of respondents opposing it.

Reasons for this were numerous. Several of the professional regulatory bodies suggested that an extension of the 'Safe Space' principles to local NHS investigations would undermine the professional regulator's ability to carry out their statutory functions and protect the public. The NMC, GPhC and GOC (among others) all pointed out the difficulties they would encounter in trying to investigate allegations and consider whether interim action should be taken if information gathered in local investigations was not made available to them.

Concerns were also raised about whether a 'Safe Space' approach to local NHS investigations would be consistent with the duty of candour. Others suggested that NHS bodies should not adopt a 'Safe Space' approach until the quality of local investigations was consistently high, and they could be trusted to use it appropriately, and not to cover up mistakes.

There was also some significant minority opposition to the 'Safe Space' approach more generally. Many respondents noted the difference between the air industry, where the approach originated, and the health service, and suggested that any lack of transparency in healthcare safety investigations would not be acceptable in our public national health service.

The PSA also took issue with the language of 'Safe Space', suggesting it was "distinctly unappealing" to apply the term to health professionals "as though they were the victims of patient safety errors". Others suggested that to refer to 'Safe Space' for one type of investigation may suggest that more open and transparent types of investigation are not 'safe'.

In response to all of this, the government has decided to take the middle course. The HSIB will apply 'Safe Space' principles to its investigations, but there will be no extension to local NHS investigations without further consultation.

So all eyes will be on the HSIB, and how much of a success they can make of 'Safe Space' investigations. Keith Conradi, the chief investigator of the HSIB, has previously expressed his reservations about the language of 'Safe Space', so this may be one of the first things to change. The establishment of effective working relationships between the HSIB and its stakeholders, including the public, the professional regulators, and the healthcare professionals and bodies, will be key.