Author name: Dr Sean Weaver
Author institute: Royal Bournemouth Hospital, University Hospitals Dorset, Deputy Medical Director, Healthcare Safety Investigation Branch (HSIB)
- Serious Incident
- Duty of Candour
- Patient Safety Incident Response Framework
HSIB – Healthcare Safety Investigation Branch. An independent NHS body which investigates incidents nationally. It aims to improve patient safety through effective and independent investigations that do not apportion blame or liability.
PSIRF – Patient Safety Incident Response Framework. The planned replacement to the Serious Incident Response Framework planned to be in place in spring 2022.
SI – Serious Incident.
PALS – Patient Advice and Liaison Service.
Complaints and Serious Incidents – tips on how to handle your first few
When a consultant takes responsibility for a patient’s care, it can be surprising when a complaint is received regarding the care. Receiving a complaint on care that has been given, or been responsible for, is often distressing. Finding out that the care given has resulted in a serious incident and is being investigated will make any individual feel anxious. The complaint is often perceived as wrapped in a cloak of confidentiality so that it may not be talked about openly and one may feel isolated and alone. We can be defensive, demoralised, or depressed in these situations, and yet they will happen to all of us. What follows are some practical tips on how to deal with these incidents, as well as a guide to some of the governance and frameworks supporting them.
Tip 1 – Think of the patient.
No matter what you are feeling, there is a patient involved for whom things have not gone as they have expected. A complaint or an incident may have happened months or years ago or may have happened just now on someone who is still receiving active care. There may be an immediate issue which still needs to be acted on, either by yourself or handed over to someone else. Ensure that the patient is receiving any immediate care that they need and that everything that needs to be done acutely is being done, despite the complaint.
Tip 2 – Ask for help.
There will be a wealth of experience around you. As well as senior colleagues in all the professions we work with, there will be complaints managers, a patient safety team, and a patient advice and liaison service (PALS). Whatever happened, they know that it will not have been intended and they will be able to guide you in an appropriate manner, especially at a time when your emotional distress may be high. You will also be a member of a medical defence body who will have experienced staff who can advise you.
Tip 3 – Duty of candour and saying sorry.
There is a statutory legal responsibility to be open and transparent about what has happened in an incident if it has caused significant harm. There is also a professional duty of candour to be open and honest with our patients. We should explain when something has not gone as planned and explain why and what that means. We should apologise and say sorry. This does not mean that we are admitting liability. Communication with a patient or a relative should be about their needs – not ours. It should be timely, but not done in a panic. It is helpful to have someone else present, either a colleague or a member of the governance or patient safety team. Different people may want different things – a letter, a phone call, or a meeting (virtual or in person). In some incidents, it may be best to meet a patient or relative in a neutral venue away from the hospital where the incident may have happened. Seek advice from those around you and be human and honest. It may be uncomfortable for you, but offering visibility and a meeting is generally better than hiding away.
Tip 4 – Write any witness statement thoroughly and promptly.
There is usually guidance on writing statements for a complaint response, incident investigation, or coroner’s court. Use the guidance to help you and be aware that the audience may not have much medical knowledge so use plain English wherever possible.
Tip 5 – Ensure that any complaint or serious incident is mentioned in your appraisal.
Ensure that any complaint or serious incident is mentioned in your appraisal. It should have identifiable information redacted and should have a reflection which can be shared with your appraiser.
Tip 6 – Ask for help again.
No one comes to work in the NHS to do a bad job or intending to harm people. Sometimes things do not go as intended and there is a debate on how achievable the aspiration of zero harm care is. Until that time, no matter how hard people try to improve safety in healthcare, there will always be patient safety incidents and people who, with or without justification, make a complaint. Patients and families who have come to harm may deserve a settlement even if liability is uncertain. Acknowledging the need for supporting staff involved in patient safety incidents has been increasing and is well summarised in a recent report by the Healthcare Safety Investigation Branch (HSIB – see useful resources below). Support should be timely, relevant, and personalised, and be supported by an open culture of no blame.
In short, you will get a complaint, and there will be incidents involving care you, or others you are responsible for, have delivered. They should matter and we should reflect on them, but this does not make you a bad doctor. There is help all around you and the most important thing is to ask for it and ask again if necessary.
When is an incident a serious incident?
In 2021, the NHS started working to the Serious Incident Framework from 2015. This defines what is classified as a serious incident and therefore when there should be a serious incident investigation. This hinges on the interpretation of “serious harm” and “avoidable injury”. Although that might be clear immediately, it may only be apparent after an investigation. In spring 2022, NHS England and NHS Improvement are planning to bring in the Patient Safety Incident Response Framework (PSIRF). This will guide how to respond to incidents to promote learning and will not have a distinction between incidents and serious incidents. It does state which incidents will require a patient safety incident investigation and allows a healthcare body the ability to pursue investigations based on local criteria or priorities.
Sean splits his time between being a consultant gastroenterologist at the Royal Bournemouth Hospital, and being deputy medical director at the Healthcare Safety Investigation Branch – HSIB. He trained in Oxford, Cambridge, Sydney, and Bath where he obtained a PhD in molecular pharmacology. He was appointed in Bournemouth in 2005 and specialises in Inflammatory Bowel Disease and colonoscopy. He has been clinical director and subsequently associate medical director for safety and quality. During this role, Bournemouth obtained the highest feedback nationally for safety in NHS staff survey, and got outstanding for well led in a CQC inspection. He has completed a Masters in Quality Improvement and Leadership as part of the competitive Generation Q programme, funded by the Health Foundation. He was the national lead for the Royal College of Physicians Inflammatory Bowel Disease Quality Improvement programme. As deputy medical director at HSIB, he has co-authored the national learning report on Never Events.