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Wednesday 27 October 2021
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Sign up to Safety: Listen, Learn, Act

Sign up to Safety Campaign

Listening to patients, carers and staff, learning from what they say when things go wrong and take action to improve patients’ safety

Salford Royal is one of the first Trusts to launch Sign up to Safety is designed to help realise the ambition of making the NHS the safest healthcare system in the world by creating a system devoted to continuous learning and improvement. This ambition is bigger than any individual or organisation and achieving it requires us all to unite behind this common purpose. We need to give patients confidence that we are doing all we can to ensure that the care they receive will be safe and effective at all times.


We all recognise that healthcare carries some risk and while everyone working in the NHS works hard every day to reduce this risk, harm still happens.  Some is avoidable but most isn’t.  Whenever possible, we must do all we can to deliver harm free care for every patient, every time, everywhere.  We must be open with our patients and colleagues about the potential for things to go wrong and for people to get hurt, and most of all, we must continuously learn from what happens in order to improve. 


We all accept and embrace the learning that is needed when patients are harmed and we all know it is important to raise concerns. This campaign will support people to feel safe to speak up when things do go wrong. Everyone involved in caring for patients needs to know that they can have these conversations and that they will be heard – they can save lives. 


Everyone involved in caring for patients can make a difference. By harnessing the talent and enthusiasm across the health and care system, together we can make enduring changes to improve safety, halve avoidable harm and most importantly make a positive difference to the people we care for. Together we can save 6,000 lives over the next three years.


Organisations are being asked to develop a plan that describes what they will do to reduce harm and save lives, by working to reduce the causes of harm and take a preventative approach. They will be asked to identify two or more national patient safety priorities (see table at end), such as medication errors or deterioration of patients, and two or more local priorities to focus on in their plans. As part of this work, they will be engaging local communities, patients and staff to ensure that the focus of their plan reflects what is important to the community they serve. They will make public their plan and update regularly on their progress against it. Twelve organisations have already signed up to doing this.


All participating organisations will be asked to adopt or adapt a ‘safety briefing’ for all patients so that they understand the actions that they can take and how they can work with those caring for them to help ensure their care is as safe as possible.


Some organisations may choose to design their plan around the services which generate the highest clinical negligence claims. While very few patient safety incidents result in a claim, all represent potentially devastating consequences for patients and can be very expensive for the NHS. The NHS Litigation Authority, which indemnifies NHS organisations against the cost of claims, will support those organisations which have patient safety improvement plans that demonstrate a reduction in their higher volume, higher value claims. The NHS LA will review the plans and be providing funding for those plans that show how they will reduce harm linked to their negligence claims.  Any savings made in this way will be redirected into frontline care.This is just one way that we can tackle some of the financial costs of poor care. 


Every organisation will face different challenges to improve the safety of the care they provide and some will have more to do than others but all can get involved. Sign up to Safety is for everyone, everywhere. Whether you work in primary, secondary or tertiary care; whether you work in acute, mental health, learning disabilities, ambulance or community care settings; whether you work in a national body or a general practice, Sign up to Safety applies to you.


The ambition is that 60 providers will sign up to the campaign in the first six months.  


Details of those organisations that have signed up already can be found at www.signuptosafety.nhs.uk and you can follow progress on twitter via @signuptosafety and using #signuptosafety


Those organisations that sign up to the campaign can draw on a variety of expert support to help ensure that they realise the ambitions described in their plans. We already have patient safety interventions that have been proved to improve patient safety in the NHS and worldwide, we will help people access these and implement them effectively. These include the use of staff briefings and de-briefings, the use of communication tools, increased skills in investigations and communicating with patients, and the approaches to designing safe care using tools and techniques from other industries, including checklists. 


National partners will work together with improvement experts to establish what a good plan looks like and to support organisations to learn from each other in drawing up and delivering theirs. 


Plans will be built around five core pledges:


  1. Put safety first.  Commit to reduce avoidable harm in the NHS by half and make public the goals and plans developed locally.

  2. Continually learn.  Make their organisations more resilient to risks, by acting on the feedback from patients and by constantly measuring and monitoring how safe their services are.

  3. Honesty. Be transparent with people about our progress to tackle patient safety issues and support staff to be candid with patients and their families if something goes wrong.

  4. Collaborate.  Take a leading role in supporting local collaborative learning, so that improvements are made across all of the local services that patients use.

  5. Support. Help people understand why things go wrong and how to put them right.  Give staff the time and support to improve and celebrate the progress. 


A National Co-ordinating and Support Group has been established to guide the work of the campaign.  The group will be chaired by Sir David Dalton and is supported by Dr Suzette Woodward as Campaign Director.  The group will ensure that linked initiatives to improve patient safety will be aligned with the campaign so that the whole system supports involvement. 


Patient Safety collaboratives – These are regionally based safety improvement networks led by Academic Health Science Networks that will work across whole local systems and all health care sectors, to deliver locally designed safety improvement programmes drawing on recognised evidence based methods.  They will begin their work later in the year.  Organisations that sign up to safety can commit to join their local collaborative as part of their plan (although they are open to all organisations). 


Patient Safety Fellows – Work is underway to create a group of 5,000 respected, enthusiastic and effective safety improvers who will become the backbone of patient safety improvement over the coming decade, making an active contribution to improving safety.  The group will launch later this year and organisations who participate in Sign up to Safety are involved in the collaboratives will benefit from the expertise of the fellows and can also support their own staff to become fellows.


New National Reporting and Learning System (NRLS) – Work is underway to review and re-commission the NRLS.  We already have the world’s most comprehensive  incident reporting system and this will be developed further to make incident reporting as easy, effective and rewarding as possible, so that learning and improvement continue to grow across the system.


SAFE team – A new Safety Action for England team will be developed to provide short-term support to individual trusts in the area of patient safety.  SAFE will provide trusts with a clinical and managerial resource to help to develop organisational and staff capabilities to help improve the delivery of safe treatment and care. SAFE will be piloted later this year and could help support signed up organisations, and others, who require additional help.


Safety website –   A new set of hospital patient safety data is now available on NHS Choices enabling trusts to be compared against each indicator.  Putting key safety information into the public domain supporting transparency and helping patients to make informed choices about their care and exercise their right to challenge their local healthcare providers on safety issues.  Organisations that have signed up to safety can use this public data to inform their plans and conversations with their local communities.


All staff working across the health and care system can also participate in Sign up to Safety by going to the Sign up to Safety website (www.signuptosafety.nhs.uk) and making their own commitment to improve safety.  


National organisations including regulators, inspectors and the Department of Health will all make a public commitment as part of Sign up to Safety representing the system wide commitment to this work.  They will also support local organisations as required to develop their plans.  


NHS England will provide expert clinical patient safety input to the development of improvement plans and framework for plan assessment. They will also play a key leadership role in the campaign and will ensure all their programmes of work described above are actively working to support the campaign.


Monitor and the NHS Trust Development Authority will offer leadership and advice to trusts and foundation trusts who participate in Sign up to Safety and who will develop and own locally their improvement plans.  They will also sign post to partner organisations for specific expertise where required. 


Care Quality Commission will review trusts improvement plans for safety as part of their inspection programme, considering them as evidence of how organisations are meeting expectations for quality and safety. 


NHS Litigation Authority will support those organisations who have patient safety improvement plans which demonstrate a reduction in their higher volume, higher value claims. The NHS LA is committed to support these organisations financially. The NHS LA will review the plans and be providing funding for those plans that show how they will reduce harm linked to their negligence claims.   


NHS Improving Quality will lead the Patient Safety Collaboratives in partnership with the Academic Health Science Networks to test innovations and improvement work that will support improvements in patient care. 


The Department of Health will ensure Government-level support for the campaign. It will work with national partners across the health and care system to ensure that policy is developed in a way that does all it can to support development of a culture of safer care.


All organisations will support staff to give the safest care possible and create an open and blame free culture. It is only by taking a more transparent approach to reporting, learning from when things go wrong and by having open conversations about them that we realise our ambition to be the safest healthcare system in the world.