Area of Research: Quality, Safety and Outcomes of Health and Social Care
Section 1: Summary of main strands/themes for research
Patient safety, effectiveness and patient experience/voice are key priorities for this government and NHS England (NHSE). For some of the themes listed below the department has a more developed understanding of specific research questions and for others the department has a policy / strategic goal to better understand the theme but requires close collaboration with the unit to outline specific research questions.
Some themes link to NHSE’s Patient Safety Strategy research needs. Topics within the four themes set out include, but are not limited to:
1. Safety and response to harm:
- Understanding failure to disclose amongst clinicians and contributors.
- Patient motivations for different actions following harm or concerns, including bringing a legal claim.
- Developing measures of safety and/or response to harm including from a patient perspective to allow comparisons across units/areas and over time.
2. Effectiveness and quality of care:
- Evaluating/adapting quality measures following recent, and likely future, changes in the health and social care landscape.
- How the growing volume of metrics and indicators of quality relate to each other and to the overall concept of effectiveness in care quality.
- Exploring interventions to improve quality (e.g. regulation, organisational culture, or competition and choice).
- Using digital innovations to improve the quality and safety of patient care.
3. Patient voice and experience:
- Understanding when/why the system doesn’t meet the needs or priorities of the patient.
- Developing and promoting outcome measures which assess quality of life in social care and how these link to health quality of life.
- Cost-effective methods for capturing patients and carers’ views of their experience of care and preference and needs for future care.
- Exploring the use of digital to improve feedback.
- Considering the healthcare data collected on complaints and experience and ways of increasing its use to improve patient care.
Assessing the quality of metrics for patient voice in services/commissioning.
4. Clinical negligence costs:
- Understanding how claimants experience the claim journey; what outcomes claimants sought and whether they achieved them; and long-term sufficiency of compensation levels awarded.
- Further understanding of the drivers behind rising clinical negligence costs (including patient, clinical and societal factors) and approaches to addressing the rising costs.
- Comparing international systems for clinical negligence claims.
Section 2: Details of policy context and background
Research will build on the White Paper People at the Heart of Care, along with the Integration White Paper and the Elective Recovery Delivery Plan. It will also link in with the newly formed Integrated Care System which aims to achieve an increasing patient-centred and systems-based approach. We also want to ensure that we empower patients, embrace technology, and deliver high quality safe care.
In its White Paper of February 2021, the Government emphasised the need to, “ensure a [health and social care] system that is more accountable and responsive to the people that work in it and the people that use it”. The recent final independent review of maternity services at the Shrewsbury and Telford Hospital highlights the importance of patient safety and quality care and emphasises the need for staff to feel able to raise concerns around safe care.
In addition, we know that improving patient safety and the response to harm requires good leadership, learning cultures and specialist training, better data and research, advances in technology, and authentic patient partnership. We are keen to ensure that research can support this key priority for the Government.
An effective response when healthcare does not go to plan is an important theme for the NHS and government. While only a small proportion of incidents lead to a legal claim, the costs of clinical negligence claims against the NHS, which are met from NHS budgets, have risen four-fold and claim numbers have doubled over the last 15 years. Therefore, the government wishes to further deepen its understanding of factors and motivators in this space and how these might be influenced.
Section 3: Justification for research topics
Recent events such as the Ockenden Report and historic inquiries have identified recurring problems with how the NHS responds to the voice of patients, and of staff. Patients are often confused by the health system and feel their concerns and complaints are not heard or acted upon. In addition, despite some incremental progress, NHS staff often feel unable to speak up. The government has taken action on these areas, but more research needs to happen to understand these barriers, including how different groups are impacted.
In addition, in recent years more funds have been diverted for the purpose of addressing clinical negligence claims. We think this is because the cost components of claims have been growing at rates far higher than inflation rather than NHS care being any less safe. We want to better understand the drivers of clinical negligence costs, the interactions with the legal market and patient experience to foster a claims environment in which NHS resources are allocated fairly for both patients and taxpayers.
Section 4: Other related research activity of which the Unit will need to be aware
The unit will be expected to develop links with other PRUs where priorities may align. We expect any associated research to be closely aligned to NHSE priorities for the next three years.
Section 5: Other issues relevant to this programme of research
How quality improvements affect inequalities in health and social care outcomes should be assessed across the programme. The unit should also consider how the views and outcomes of under-represented groups can be captured. Also, in relation to patient experience, issues should be viewed from both a healthcare and social care quality perspective, with a strong preference for exploring the interactions between the two.
Key documents of which applicants might like to be aware include:
- NHS (2017). Digital Clinical Safety Strategy [Accessed August 2022]
- NHS England (2016). Shared commitment to quality [Accessed August 2022]
- National Audit Office (2017). Managing the costs of clinical negligence in trusts [Accessed August 2022]
- UK Parliament (2022). MPs urge radical reforms to negligence compensation system that costs NHS billions each year [Accessed August 2022]
- UK Parliament (2021). NHS litigation reform [Accessed August 2022]