Recommendation 9: Suspicion of Deliberate Harm Protocol and guidance

Protocol
i. By 31 March 2027, NHS England must produce and distribute a one-page protocol
setting out the steps to be taken by managers when concerns or suspicions are raised
that a healthcare professional may have deliberately harmed a patient. The Suspicion
of Deliberate Harm Protocol must make explicit that:
a. It is irrelevant whether the person to whom the concerns have been expressed does
or does not believe they are true, as is the fact that the person raising the concern is
not sure.
b. Where concerns or suspicions of deliberate harm are being raised in good faith, they
must be acted upon immediately.
c. Only in cases where the concerns are obviously irrational or malicious (which
assessment must be recorded) will no further action be justified.
d. Pending investigation of a member of staff, action to protect patients by moving
the person suspected of causing harm is likely to be the first step.
e. The moving of a person suspected of causing harm and the investigation into
suspicions and concerns about a member of staff is a neutral act.
f. Safeguarding steps must be followed, as a result of which the police will become
involved.
Guidance
ii. Guidance of no more than two pages should accompany the protocol. It must set out
the factors to be considered when assessing the nature of the concerns and suspicions.
The reader should be directed to guard against their own biases, loyalties and prejudices.
The guidance should explain what should be said and when to those who are or who
may be involved with any investigation (such as patients, parents and staff). This must
include that patient safety comes first, and investigation is required. The guidance
should also explain that failure to follow the protocol will be a breach of contract by
an employee, as well as a breach of the relevant code of conduct.
Implementation
iii. Trusts must embed the Suspicion of Deliberate Harm Protocol and guidance within their
hospital.