Introduction to safety incidents

Our findings revealed, in some services incidents were not consistently reported. This meant leaders did not have clear oversight of safety incidents, which could impact their ability to foster an open, learning culture.

We found concerns with the grading of safety incidents in some services. Inaccurate grading of incidents could mean they are not correctly investigated, and services could miss vital learning opportunities.

It is important that staff feel able to report safety incidents. Safety incidents should be investigated in a timely manner, with oversight from leaders to ensure duty of candour and learning.

Failure to learn from incidents could result in more people being exposed to harm.