We have received some concerns from patients, families, carers and next-of-kin about the quality and content of the Serious Adverse Patient Safety Event (SAPSE) review reports provided following a SAPSE. These concerns centre around transparency and openness, particularly during the Statutory Duty of Candour (SDC) process.
It has been identified that some health services are providing a summarised or abridged report (claiming to be the SAPSE review report) which is less detailed than the version available in the Sentinel Event Portal when the event is classified as a sentinel event.
We have now released a position statement on SAPSE review reports. To ensure compliance and transparency, we recommend that the report provided within the Sentinel Event Portal is the SAPSE review report. This report should be provided to the patient, family, carer, or next-of-kin as part of the SDC and SAPSE review process.
This approach aims to uphold statutory protections, foster trust, and support the intent of the SDC process by ensuring patients and families receive complete and accurate information about SAPSEs affecting them and their loved ones.