The nine recommendations of the Dash Review aims to make clear where responsibility and accountability sits within the NHS and should improve patient safety.
The Dash Review on patient safety across the health and care landscape in England, commissioned by Wes Streeting, secretary of state for health and social care, has completed.
This follows Penny Dash’s report on the operational effectiveness of the Care Quality Commission and published in September last year.
The new chair of NHS England, looked at six bodies – the Care Quality Commission, the National Guardian’s Office, Healthwatch England and the Local Healthwatch network, the Health Services Safety Investigations Body, the Patient Safety Commissioner and NHS Resolution – and how they work within the wider healthcare landscape, with a particular focus on patient safety.
“She specifically addressed whether patients would be better served by a different approach or delivery model, working closely with senior leaders and directly hearing from more than 100 people or partner organisations with an interest in patient safety,” said Streeting in parliament in early July.
These changes, he continued, will improve quality, including safety, by making it clear where responsibility and accountability sits at all levels of the system.
Nine recommendations
Dash made nine recommendations.
First, there should be a refreshed strategy for improving quality of care, which will be delivered by revamping and revitalising the role of the National Quality Board.
That the Care Quality Commission should continue to rebuild with a clear remit and responsibility and overhaul its registration and inspection processes to ensure they are sector specific.
Third, that the Health Services Safety Investigations Body should continue as a centre of excellence for investigations, but as a discrete branch within the Care Quality Commission.
Fourth, that the hosting of Patient Safety Commissioner should transfer to the Medicines and Healthcare products Regulatory Agency (MHRA) to strengthen links between the patient voice in medicines safety and the MHRA’s work to capture adverse events more effectively. The Patient Safety Commissioner’s work on wider patient safety should transfer into a new directorate of patient experience in Department of Health and Social Care (DHSC).
Fifth, Local Healthwatch and the engagement functions of integrated care boards (for healthcare) and local authorities (for social care) should be brought together to ensure patient and community input into the planning and design of services, and the strategic functions of Healthwatch England should also be transferred into the new patient experience directorate in DHSC.
Sixth, staff voice functions should be strengthened, with the responsibilities of the National Guardian for Freedom to Speak Up incorporated into the new DHSC structure and providers.
Seventh, the responsibility for and accountability of commissioners and providers to deliver and assure high quality care should be reinforced.
Eighth, technology, data and analytics should play a much more significant role in supporting the quality of health and social care.
Finally, there should be an evidence-based national strategy for quality in social care.
Broadly welcomed
The report has been broadly welcomed by a cross-section of the healthcare sector.
“NHS leaders will welcome Dr Penny Dash’s review, which supports the direction of the Ten Year Health Plan in streamlining the role of the centre and devolving accountability to local leaders, while giving the public the tools to make informed choices about their care,” said Matthew Taylor, chief executive of the NHS Confederation, though he also encouraged the government not to forget the failings in care that led to these bodies being set up in the first place and tread carefully so as to ensure their vital missions continue in future.
“Disentangling the complex and overlapping world of patient safety organisations will improve the way the NHS functions and how it responds when things go wrong,” said Rebecca Hilsenrath, chief executive of the Parliamentary and Health Service Ombusman.
David Hare, chief executive of the Independent Healthcare Providers Network, said that he had welcomed the opportunity to provide input into the Dash Review as part of its expert advisory group.
“As anyone who works in the health service will attest to, there is a real need for a much more simplified and strategic approach to looking at the quality, safety and effectiveness of healthcare providers and the wider health care landscape,” he said.
The report’s recommendation signalling a fundamental change to the role of the National Quality Board is therefore “a real opportunity to look across the whole system – including in the independent sector – to drive meaningful improvement and innovation in healthcare,” he continued.
