Abstract
The NHS has set out plans to alter how it investigates serious incidents, as part of a new national patient safety strategy in England. Published by NHS Improvement and NHS England,1 the strategy says that the NHS should move away from current thresholds for investigating serious incidents and should prioritise incidents that give the best opportunity for learning. The strategy is designed to encourage staff to speak up and contribute to continuous improvement, by learning and acting when things go wrong. It includes a raft of recommendations (see box) which, if implemented successfully, could save around 1000 lives and £100m (€111m; $126m) in care costs a year by 2023-24, said NHS Improvement. A significant part of the strategy is the new Patient Safety Incident Response Framework, due to be implemented throughout England by …
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