In line with NHS services, Haven House is changing the way we learn from those occasions when things don't go to plan, and where service users may be harmed as a result.

These are known as patient safety incidents.

A new approach, called the Patient Safety Incident Review Framework (PSIRF) is being introduced and will focus on:

  • compassionate engagement and involvement of patients, their loved ones and staff
  • new approaches to learning that look for all the complicated issues that are combining to cause risks
  • considered and proportionate responses when things go wrong
  • continuing to learn and evolve over future years.

Policy and Plan

We are required to publish two key documents to explain how we will meet the requirements of PSIRF - a PSIRF Policy and Plan.

Incident Management Policy

PSIRF Incident Response Plan

These documents describe how Haven House will oversee the process of learning from incidents and making improvements, and which areas of patient safety we will focus on in the first 12-18 months.

We will initially focus on proactively improving safety in the following three areas.

  1. Bruising/unexplained injury/risk of fractures of CYP during stays at HH
  2. Medicine Administration or Reconciliation Errors
  3. Injury or adverse outcome as a result of challenging behaviour


Should you have reached this section of our website because you have suffered harm whilst at Haven House, we are sorry.

We undertake to be honest and open with you in our words and actions as we respond to this. We will also support you as necessary. Making sure service users, families, carers and staff are supported and involved when incidents occur, is a priority for Haven House.

If you need support, or wish to discuss the care you or your family received from us, please contact our family support team.

Learning from Incidents

There are a number of different ways of learning from patient safety incidents - ranging from an immediate debrief, a multidisciplinary meeting and a detailed investigation which may be submitted to external organisations.

If you are, or someone you care for is, involved in a patient safety incident, you will be able to speak to someone who will:

  • listen to you
  • understand what questions you have
  • explain the different types of learning methods that may be used; and
  • explore what your needs are in any learning response that is undertaken.

If you would like to speak to someone, and have not already been introduced to one, please contact us who can direct you to the most appropriate person.