HSSIB investigation report: Temporary staff – involvement in patient safety investigations (14 March 2024)

Summary

The NHS regularly uses temporary staff to fill gaps in its workforce. This investigation explored the challenges of involving temporary clinical staff (bank only staff, agency staff and locum doctors working within trusts) in local trusts’ patient safety investigations. Trust-level investigations are important because they are a way to identify learning to improve healthcare systems, with the aim of reducing the potential for harm to patients. Identifying learning requires staff to be engaged in an investigation; if temporary staff are not involved, learning may be lost, posing a risk to patient safety.

HSSIB identified this risk following analysis of serious incident reports provided by acute and mental health NHS trusts. To explore the issue further, the investigation carried out site visits and engaged with NHS trusts, providers of bank staff, agencies that supply staff to NHS trusts, substantive (permanent) NHS staff, bank and agency staff, and a range of national stakeholders.

Content

Findings

• Limited engagement of temporary staff in patient safety investigations may limit the potential for learning and undermine an investigation’s ability to influence future safety improvements.
• Patient safety investigations are being concluded without vital information because of observed and perceived barriers to engaging with temporary staff.
• Temporary staff are not always able to report patient safety incidents, and this impacts on the development of an open reporting culture and the ability to learn from patient safety incidents.
• The extent to which patient safety investigation findings are fed back to temporary staff varies, limiting the ability for all of those involved to learn.
• Support is not always provided for temporary staff following a patient safety incident; this can have an impact on staff members’ welfare and on patient safety.
• NHS England’s approved framework agreements for agency staff do not specifically refer to patient safety, or to support for staff following patient safety incidents.

Local-level learning

Healthcare providers can use the findings from this investigation as prompts to help them consider how they involve temporary staff in patient safety investigations:

• How do you ensure that temporary staff are aware of how to record patient safety incidents?
• If an incident takes place, how do you ensure that temporary staff are able to record it?
• How do you engage temporary staff in a learning response?
• Do you have processes in place so you can conduct interviews with temporary staff?
• Can you work with employment agencies to create agreed methods of including temporary staff in learning responses through your contractual arrangements?
• How do you ensure that learning is fed back to those staff involved, including temporary staff?

HSSIB makes the following safety recommendations

• HSSIB recommends that NHS England includes guidance on engaging temporary staff in learning responses within their 'engaging and involving patients, families and staff following a patient safety incident'. This should be developed in collaboration with providers of temporary staff to the NHS to help assist healthcare providers being able to fully investigate incidents from a systems perspective, enabling learning that can improve patient care.
• HSSIB recommends that NHS England updates the agency worker framework agreement criteria to explicitly require framework agreements to adhere to the staff support principles of the NHS England Patient Safety Incident Response Framework. This will improve patient safety as there is a recognised link between staff having wellbeing concerns and the delivery of patient care.

HSSIB makes the following safety observation

• Agencies providing temporary staff to the NHS can improve patient safety by facilitating the involvement of temporary staff in investigation processes, including interviews. This is to enable the investigation of patient safety incidents in line with the Patient Safety Incident Response Framework.