A national incident reporting and learning system in England and Wales, but at what cost?

Recent high-profile failures in healthcare highlight the ongoing need for improvements in patient safety. Moreover, the fiscal challenge facing many health systems has brought the costs and economic efficiencies associated with improving quality (and safety) to bear. Currently, there is a lack of economic evidence underpinning resource allocation decisions in patient safety. Incident reporting systems are considered an important means of addressing these challenges by monitoring incident rates over time, identifying new threats to patient care and ultimately preventing repetition of costly adverse events. Uniquely, for more than a decade, the UK has been developing a National Reporting and Learning System to provide these functions for the English and Welsh health system(s), in addition to pre-existing local systems. The need to evaluate the impact of national incident reporting, and learning systems in terms of effectiveness and efficiency is argued and the methodological challenges that must be considered in an economic analysis are outlined.