Working with healthcare safety investigators to improve maternity care

The MDU answers members' queries about taking part in HSIB maternity investigations

The Healthcare Safety Investigation Branch (HSIB) is a relatively new organisation that carries out independent investigations to improve patient safety in England, making recommendations to improve systems and processes.

HSIB is funded by the Department of Health and Social Care, but operates independently from it and the CQC. It is not a regulator, nor is it responsible for assessing professional practice.

The purpose of HSIB's investigations is to identify any common themes when something has gone wrong and to influence systemic change within the NHS, rather than to apportion individual blame. HSIB has carried out a number of investigations already and givesdetails of completed and ongoing investigations on its website.

Recently, HSIB was asked to carry out maternity investigations as part of a national action plan to make maternity care safer. The plan sets out extra measures to improve the rigour and quality of investigations into term stillbirths, serious brain injuries to babies and deaths of mothers and babies. HSIB will undertake and collate the findings from around 1,000 investigations into maternity care. There are currently over 100 active maternity investigations ongoing and 14 have been completed, with incidents being referred to the HSIB team by NHS trusts providing maternity services in England.

Here we answer members' questions about taking part in a maternity investigation.

Do I have to participate in an HSIB maternity investigation?

You'll be asked for your consent in order to allow the investigators to obtain relevant information about you and to record your version of events. However, it's important to bear in mind that the GMC expects doctors to cooperate with formal inquiries and states that you must offer all relevant information.

What happens during an HSIB interview?

The purpose of the interview is to ask you about your recollections of the incident and to give you an opportunity to clarify certain points, allowing the investigators to have a full understanding of what happened.

Interviews are conducted by neutral investigators and the reports produced do not name individuals.The meeting allows you to describe your recollection of events and highlight any mitigating circumstances that should be taken into account.

With your consent, the interview is recorded to make sure there is an accurate record of the discussion. Audio recordings prevent inaccuracies and misunderstandings arising later on and ensure that the whole interview is captured without the risk of important information being lost, which could have a detrimental effect on the overall investigation outcome.

The interview is intended to be a safe place where staff are able to speak freely so that the ability to learn lessons and improve future care can be maximised.

Can I bring someone along with me to the interview?

Attending external interviews like this can be stressful, even in a supportive environment, and HSIB says you can bring someone with you for support. It is essential, however, that the supporter doesn't interfere in the process. They should be someone with whom you can comfortably express your feelings and be open.

A successful outcome for an investigation is dependent on collaboration between the investigators and with medical staff and their colleagues across the healthcare system.

The MDU is on hand to support doctors called upon to provide information to the HSIB. We suggest members contact us before attending the interview so that we can provide specifically tailored advice and support.

For a more in-depth introduction to HSIB, you can read an interview with its chief investigator in a recent issue of the MDU journal.

This guidance was correct at publication 30/07/2019. It is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.

Kathryn Leask MDU medico-legal adviser

by Dr Kathryn Leask Medico-legal adviser

BSc (Hons) MBChB (Hons) LLB MA MRCPCH FFFLM DMedEth

Kathryn has been a medico-legal adviser with the MDU since 2007 and is a team leader, trainer and mentor in the medical advisory department. Before joining the MDU, she worked in paediatrics gaining her MRCPCH in 2002 and did her specialty training in clinical genetics. She has an MA in Health Care Ethics and Law, a Bachelor of Law and a Professional Doctorate in Medical Ethics. She is also a fellow of the Faculty of Forensic and Legal Medicine and has previously been an examiner and Deputy Chief Examiner for the faculty exam. Kathryn is currently a member of the faculty's Training and Education Subcommittee.

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