Establish framework for future investigations
This Investigation was hampered at the outset by the lack of an established framework covering such matters as access to documents, the duty of staff and former staff to cooperate, and the legal basis for handling evidence. These obstacles were overcome, but the need to do this from scratch each time an investigation of this format is set up is unnecessarily time-consuming. We believe that this is an effective investigation format that is capable of getting to the bottom of significant service and organisational problems without the need for a much more expensive, time-consuming and disruptive public inquiry. This being so, we believe that there is considerable merit in establishing a proper framework, if necessary statutory, on which future investigations could be promptly established. This would include setting out the arrangements necessary to maintain independence and work effectively and efficiently, as well as clarifying responsibilities of current and former health service staff to cooperate. Action: the Department of Health.
How was this assessed?
Response
Accepted
Response
Accepted69. We accept this recommendation in principle.
A new Independent Patient
Safety Investigation Service will conduct independent, expert-led investigations into
patient safety incidents. The Service will also respond to the concerns that had been
previously subject to public inquiries or national investigations, such as Mid-
Staffordshire NHS Foundation and University Hospitals Morecambe Bay NHS
Foundation Trust. We intend to establish an expert advisory group who, over the
coming months, will advise on the purpose and function of the new Independent
Patient Safety Investigation Service. As part of this work, we will build on the useful
insights that participants in this Investigation have shared.
70. We agree that independent non-statutory investigations provide a useful, more
rapid and potentially more efficient alternative to statutory public inquiries as a last
resort for investigating failings in care. This route has now been well tested and has
the benefit of being able to engage with affected families, ensuring their key
concerns are built into the Terms of Reference and can therefore be addressed by
the investigation/ panel; and of not being a legal process which can inhibit people’s
willingness to engage openly and candidly.
71. We are considering whether we can use, or build on, the central Cabinet Office
support provided to inquiries, including guidance for each stage of the inquiry, useful
documents and access to a Whitehall officials' and former inquiry secretaries'
network, and which is currently being updated and considered by a cross-
Government group.
Complaints: 31