What does safety mean?

On 2nd September, our CCG launched a consultation about proposed changes to children’s and maternity services at the Friarage Hospital in Northallerton. I have written about this before. We have been doing this work for the past 2 years and it has been a bumpy ride. It’s a complicated issues and it’s difficult for the public to understand. This week I have been going back to basics in many media interviews to explain why we need to make changes to services there. I’ve explained that it really isn’t about money. As a CCG we pay for each patient that goes into hospital. No matter where they are treated, it costs us the same. It is all about safety and quality.
It is interesting isn’t it that despite all the publicity about safety in the NHS, when we did our engagement exercise people rated services being close to home above safety. I can only assume that is because we as a community still assume that if a service is there, it must be safe. And yet when I explain that is isn’t, people want to fight to keep it open anyway. The obvious conclusion is we mustn’t be very good at explaining what safety really means. So this time when I was interviewed I talked about reducing death rates and disability after illness. That evidence tells us babies born in obstetric units where consultants are present on the ward all the time have a lower chance of sustaining birth injuries than those where the consultants are on call from home. Children in other European countries who travel further to more distant large children’s units have lower child death rates than we do. Some people have said that is too blunt. Too scary! So my question is how do we get it right? Clinicians know what we mean by safety but it is clear others don’t. If parents had to sign of a form saying that they agreed to their child being admitted to a less safe service than there is at the hospital in the next town, would they sign it? I wouldn’t. And yet by our CCG sanctioning the continuation of a service we know to be less safe, we are effectively doing this on behalf of all our patients aren’t we?
Of course no service is completely safe. There is no such thing as 100% safety. But surely if we can see a way of improving safety from 94% to 97%, then that is worthwhile? Imagine if that increase of 3% saved your child or your baby. The Friarage is a lovely hospital; small friendly, quiet. Lots of one to one care. When things go well there is no better place to be. But when things go wrong I would rather my children, my grandchildren were safe is a bigger perhaps more impersonal environment where the expert teams who see and deal with emergencies every day are there on hand when we need them. So that means that if there is a small chance of that happening - if my daughter had a high risk pregnancy or my grandchild was hot, lethargic and not responding to the usual things that make little people better, I would drive further for them to be where it is safer. If I would do that for my own family, why would I not want it for everyone whose health care standards are now my responsibility?
How have we come to our conclusions? We have listened to those people who are experts in the field and know far more than we do. Consultants who have delivered care at the hospital for years and national experts whose job it is to understand what makes a service safe. They have all said we are doing the right thing. Hilary Cass President of the Royal College of Paediatrics and Child Health, The NCAT inspection team led by Professor Chris Clough and the whole consultant body at South Tees Hospital NHS Foundation Trust all agree.
And then we are left with a dilemma. We are accused of not listening to the public if we do not agree with them and instead do what we believe is the right thing to ensure the safety of our patients. Surely that is a fundamental principle we shouldn’t compromise on.
We can address issues of transport, of accessibility to other local trusts (some of which are as near for many of our residents as the Friarage is), we can improve community children’s nursing so many of the services some children have in hospital now can be delivered at home. But if we can’t compromise on safety will we always be accused of not listening to the concerns of those who campaign against us? And finally who speaks for the silent majority who do not respond to our invitation to talk to us? Are they with us or against us? I wonder what their views are about it all.