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National Patient Safety Agency

NPSA casts consultation net on serious incident reporting system

Friday 14 August 2009


Healthcare practitioners and managers across England and Wales are being asked for their views on improving a system that will strengthen the reporting of and learning from serious incidents across the NHS.


The 'National Framework for Reporting and Learning from Serious Incidents Requiring Investigation' provides a consistent definition of a serious incident, clarify roles and responsibilities, draw together legal and regulatory requirements, information on timescales and signpost tools and resources that support good practice.


It will also increase levels of openness, trust, continuous learning and service improvement. 


Serious incidents (previously referred to within the NHS as Serious Untoward Incidents) include the unexpected or avoidable death, permanent harm to one or more patients, staff, visitors or members of the public.


The framework has been developed by the National Patient Safety Agency (NPSA) in collaboration with practitioners and staff across the NHS.


NPSA's Chief Executive Martin Fletcher said: "Commissioners, providers and managers of NHS care want to ensure that when a serious event or incident occurs, there are systemic measures in place for safeguarding people, property and NHS resources.


"One of the building blocks for doing this is a clear, nationally agreed approach to notifying, managing and learning from serious incidents.


"That is why this consultation is so important and I would encourage as many people as possible to give their feedback to us."


Mr Fletcher added that the framework is an important foundation for Patient Safety Direct - an NPSA initiative which will be a single point for frontline healthcare staff to report and learn about improving safety for patients.


The deadline for responses is 13 November when all comments received will be considered for inclusion in the final publication, due out at the end of the year.




Notes to Editors:


For all media enquiries, contact the NPSA Press Office:

Simon Morgan, Senior Media Manager

020 7927 9580 / simon.morgan@npsa.nhs.uk

Paul Cooney, Press Officer

020 7927 9351 / paul.cooney@npsa.nhs.uk

Out of hours

0788 411 5956

The National Patient Safety Agency is an Arm’s Length Body of the Department of Health. It encompasses three divisions; the National Research Ethics Service, the National Reporting and Learning Service and the National Clinical Assessment Service. The NPSA’s vision is to lead and contribute to improved, safe patient care by informing, supporting and influencing healthcare individuals and organisations. For more information visit: www.npsa.nhs.uk.