Trust investigations

Articles in this category

1. Stories of our times podcast: The scandal that shook the NHS (6 February 2023)

   • Investigation
   • Recommendations
   • (and 4 more)

     Tagged with:

     • Investigation
     • Recommendations
     • Patient harmed
     • Legal issue
     • Organisation / service factors
     • Organisational culture

   By Patient Safety Learning, 19 hours ago

   • 0 comments
   • 17 views
   • 
   • Added by Patient Safety Learning
   • 19 hours ago

2. RQIA: Report on the Expert Review of Records of Deceased Patients (Neurology) (November 2022)

   • Investigation
   • Recommendations
   • (and 8 more)

     Tagged with:

     • Investigation
     • Recommendations
     • Decision making
     • Communication problems
     • Diagnosis
     • Patient / family involvement
     • Patient harmed
     • Northern Ireland
     • Medicine - Neurology
     • Reports / results

   By Patient Safety Learning, 1 December, 2022

   • 0 comments
   • 106 views
   • 
   • Added by Patient Safety Learning
   • 1 December, 2022

3. Bill Kirkup speaks to HSIB staff about 'Reading the signals' (17 November 2022)

   • Investigation
   • Maternity
   • (and 5 more)

     Tagged with:

     • Investigation
     • Maternity
     • Recommendations
     • Organisational culture
     • Patient harmed
     • Patient death
     • Organisation / service factors

   By Patient Safety Learning, 18 November, 2022

   • 0 comments
   • 230 views
   • 
   • Added by Patient Safety Learning
   • 18 November, 2022

4. Will lessons be learned? An analysis of the systemic failures in the East Kent Maternity report

   • Investigation
   • Recommendations
   • (and 11 more)

     Tagged with:

     • Investigation
     • Recommendations
     • Maternity
     • Organisational culture
     • Baby
     • Patient harmed
     • Patient death
     • Patient / family involvement
     • Just Culture
     • Standards
     • Regulatory issue
     • System safety
     • Organisational learning

   By Patient Safety Learning, 17 November, 2022

   • 2 comments
   • 1,208 views
   • 
   • Comment by richard vA
   • 12 December, 2022

5. House of Commons debate – Abuse and deaths in secure mental health units (3 November 2022)

   • Mental health
   • Self harm/ suicide
   • (and 4 more)

     Tagged with:

     • Mental health
     • Self harm/ suicide
     • Patient death
     • Investigation
     • Children and Young People
     • Mental health unit

   By Mark Hughes, 4 November, 2022

   • 0 comments
   • 174 views
   • 
   • Added by Mark Hughes
   • 4 November, 2022

6. Independent investigation reports into the care and treatment of Christie, Nadia and Emily at Tees, Esk and Wear Valley NHS Foundation Trust (November 2022)

   • Mental health
   • Self harm/ suicide
   • (and 4 more)

     Tagged with:

     • Mental health
     • Self harm/ suicide
     • Patient death
     • Investigation
     • England
     • Children and Young People

   By Patient-Safety-Learning, 3 November, 2022

   • 0 comments
   • 359 views
   • 
   • Added by Patient-Safety-Learning
   • 3 November, 2022

7. House of Commons Debate - East Kent Maternity Services: Independent Investigation (20 October 2022)

   • Maternity
   • Investigation
   • (and 3 more)

     Tagged with:

     • Maternity
     • Investigation
     • Patient harmed
     • Patient death
     • Baby

   By Mark Hughes, 24 October, 2022

   • 0 comments
   • 157 views
   • 
   • Added by Mark Hughes
   • 24 October, 2022

8. Ministerial Statement: Independent Investigation into East Kent Maternity Services (19 October 2022)

   • Maternity
   • Investigation
   • (and 3 more)

     Tagged with:

     • Maternity
     • Investigation
     • Patient harmed
     • Patient death
     • Baby

   By Mark Hughes, 20 October, 2022

   • 0 comments
   • 209 views
   • 
   • Added by Mark Hughes
   • 20 October, 2022

9. Patient Safety Learning: Initial response to the East Kent Maternity Inquiry Report (19 October 2022)

   • Recommendations
   • Maternity
   • (and 7 more)

     Tagged with:

     • Recommendations
     • Maternity
     • Investigation
     • Patient harmed
     • Patient death
     • Baby
     • Leadership
     • Organisation / service factors
     • Teamwork

   By Patient Safety Learning, 19 October, 2022

   • 1 comment
   • 999 views
   • 
   • Comment by melanie newton
   • 7 November, 2022

10. 'Reading the signals': Maternity and neonatal services in East Kent – the Report of the Independent Investigation (19 October 2022)

    • Investigation
    • Recommendations
    • (and 6 more)

      Tagged with:

      • Investigation
      • Recommendations
      • Patient death
      • Patient harmed
      • Maternity
      • Organisational learning
      • Patient / family involvement
      • Leadership

    By Patient Safety Learning, 19 October, 2022

    • 0 comments
    • 759 views
    • 
    • Added by Patient Safety Learning
    • 19 October, 2022

11. Fit and Proper Person Investigation Report into the conduct of former Shrewsbury and Telford Hospital Trust chair Ben Reid (13 October 2022)

    • Leadership
    • Investigation
    • (and 5 more)

      Tagged with:

      • Leadership
      • Investigation
      • Patient death
      • Baby
      • Maternity
      • Organisational culture
      • Patient / family involvement

    By Patient Safety Learning, 13 October, 2022

    • 0 comments
    • 207 views
    • 
    • Added by Patient Safety Learning
    • 13 October, 2022

12. Letter to families about the Independent Thematic Review of maternity services at Nottingham University Hospitals NHS Trust (26 May 2022)

    • Maternity
    • Investigation
    • (and 3 more)

      Tagged with:

      • Maternity
      • Investigation
      • Baby
      • Patient death
      • Organisation / service factors

    By Patient Safety Learning, 26 May, 2022

    • 0 comments
    • 525 views
    • 
    • Added by Patient Safety Learning
    • 26 May, 2022

13. Ockenden report: the refusal of our healthcare service to take patient experience seriously (BMJ, 1 April 2022)

    • Investigation
    • Maternity
    • (and 3 more)

      Tagged with:

      • Investigation
      • Maternity
      • Patient death
      • Patient / family support
      • Patient / family involvement

    By Patient Safety Learning, 4 April, 2022

    • 0 comments
    • 730 views
    • 
    • Added by Patient Safety Learning
    • 4 April, 2022

14. Patient Safety Learning: Initial response to the publication of the Ockenden Review (30 March 2022)

    • Maternity
    • Patient death
    • (and 10 more)

      Tagged with:

      • Maternity
      • Patient death
      • Patient harmed
      • Baby
      • Investigation
      • Recommendations
      • Organisational learning
      • Organisation / service factors
      • Patient / family involvement
      • Staff safety
      • Organisational culture
      • Leadership

    By Patient Safety Learning, 30 March, 2022

    • 2 comments
    • 1,422 views
    • 
    • Comment by Sam
    • 5 April, 2022

15. Ockenden Report: Findings, conclusions and essential actions from the independent review of maternity services at The Shrewsbury and Telford Hospital NHS Trust (30 March 2022)

    • Maternity
    • Investigation
    • (and 13 more)

      Tagged with:

      • Maternity
      • Investigation
      • Recommendations
      • Patient death
      • Patient harmed
      • Baby
      • Organisational learning
      • Organisation / service factors
      • Workforce management
      • Safe staffing
      • Accountability
      • Training
      • Clinical governance
      • Patient / family involvement
      • Patient / family support

    By Patient Safety Learning, 30 March, 2022

    • 0 comments
    • 2,377 views
    • 
    • Added by Patient Safety Learning
    • 30 March, 2022

16. Queen Elizabeth University Hospital Review (June 2020)

    • Infrastructure / building / equipment
    • Infection control
    • (and 5 more)

      Tagged with:

      • Infrastructure / building / equipment
      • Infection control
      • Investigation
      • Recommendations
      • Healthcare associated infection
      • Scotland
      • Patient death

    By Patient Safety Learning, 9 May, 2021

    • 0 comments
    • 387 views
    • 
    • Added by Patient Safety Learning
    • 9 May, 2021

17. Patient Safety Learning: Reflections on the initial findings of the Ockenden Review

    By Patient Safety Learning, 10 December, 2020

    • 0 comments
    • 329 views
    • 
    • Added by Patient Safety Learning
    • 10 December, 2020

18. Ockenden Report: Emerging findings and recommendations from the independent review of maternity services at the Shrewsbury and Telford Hospital NHS Trust (10 December 2020)

    • Investigation
    • Recommendations
    • (and 5 more)

      Tagged with:

      • Investigation
      • Recommendations
      • Patient death
      • Patient harmed
      • Maternity
      • Organisational learning
      • Organisation / service factors

    By Patient Safety Learning, 10 December, 2020

    • 0 comments
    • 18,232 views
    • 
    • Added by Patient Safety Learning
    • 10 December, 2020

19. Stage 1 Report into Southern Health NHS Foundation Trust (February 2020)

    • Investigation
    • Patient death

    By PatientSafetyLearning Team, 28 October, 2020

    • 0 comments
    • 652 views
    • 
    • Added by PatientSafetyLearning Team
    • 28 October, 2020

20. Independent investigation into the management of the Trust’s disciplinary process resulting in the dismissal of Mr Amin Abdullah (August 2018)

    • Nurse
    • Investigation
    • (and 5 more)

      Tagged with:

      • Nurse
      • Investigation
      • Safety culture
      • Organisational culture
      • Self harm/ suicide
      • Staff support
      • Recommendations

    By Patient Safety Learning, 3 January, 2020

    • 0 comments
    • 702 views
    • 
    • Added by Patient Safety Learning
    • 3 January, 2020

21. Report of the Liverpool Community Health Independent Review (February 2018)

    • Community care
    • Community care facility
    • (and 2 more)

      Tagged with:

      • Community care
      • Community care facility
      • Patient death
      • Investigation

    By PatientSafetyLearning Team, 6 November, 2019

    • 0 comments
    • 1,265 views
    • 
    • Added by PatientSafetyLearning Team
    • 6 November, 2019

22. Great Ormond Street Hospital: Inquest of Amy Allan (1 October 2019)

    • Hospital ward
    • Outpatients
    • (and 9 more)

      Tagged with:

      • Hospital ward
      • Outpatients
      • Care assessment
      • Care coordination
      • Medicine - Cardiology
      • Surgery - Cardiothoracic
      • Documentation
      • Clinical process
      • Patient death
      • Investigation
      • Children and Young People

    By Claire Cox, 7 October, 2019

    • 0 comments
    • 865 views
    • 
    • Added by Claire Cox
    • 7 October, 2019

23. Dorset Healthcare University NHS Foundation Trust: Policy for reporting and investigating deaths (August 2017)

    • Patient death
    • Workforce management
    • (and 4 more)

      Tagged with:

      • Patient death
      • Workforce management
      • Training
      • Clinical governance
      • Retrospective
      • Policies / Protocols / Procedures

    By Claire Cox, 6 October, 2019

    • 0 comments
    • 750 views
    • 
    • Added by Claire Cox
    • 6 October, 2019

24. Report into the deaths of people with a learning disability or mental health problem at Southern Health NHS Foundation Trust (December 2015)

    • Investigation
    • Patient death
    • (and 4 more)

      Tagged with:

      • Investigation
      • Patient death
      • Mental health
      • Mental health - CAMHS
      • Young Adult
      • Learning disabilities

    By PatientSafetyLearning Team, 6 October, 2019

    • 0 comments
    • 750 views
    • 
    • Added by PatientSafetyLearning Team
    • 6 October, 2019

25. Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry (February 2013)

    • Patient death
    • Investigation
    • (and 2 more)

      Tagged with:

      • Patient death
      • Investigation
      • Safety management
      • Safe staffing

    By PatientSafetyLearning Team, 6 October, 2019

    • 0 comments
    • 1,134 views
    • 
    • Added by PatientSafetyLearning Team
    • 6 October, 2019