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  • Beds, backlog and bureaucracy (a blog by Helen Hughes, Chief Executive of Patient Safety Learning)

    Summary

    In this blog, Patient Safety Learning’s Chief Executive, Helen Hughes, reflects on participating in a recent Health Service Journal (HSJ) Patient Safety Congress webinar, held in association with BD, which considered some of the key emerging patient safety issues for 2022. 

    Content

    Last Wednesday I participated in an invigorating and informative HSJ Patient Safety Congress webinar discussing the legacy left by the Covid-19 pandemic for patient and staff safety. We looked at what needs to be done to ensure that patient safety is designed into elective care recovery plans and the need for greater co-production in the NHS.

    I was delighted to Chair the session and discuss these issues with Annie Hunningher, Consultant in Anaesthesia at Barts Health NHS Trust, and Jono Broad, who works in the Integrated Personalised Care Team for NHS England in the South West Region. At Patient Safety Learning, one of our key aims is to ‘listen to and amplify the voice of the patient safety frontline’ - both staff and patients. This session was a fabulous reminder of how much there is to learn from the wisdom and insight of those who are directly seeing the challenges and opportunities for delivering safer care.

    Covid-19 and patient safety

    Kicking off the webinar, I reflected on the huge impact that the Covid-19 pandemic has had on the safe provision of healthcare. I am a member of a World Health Organization (WHO) expert group considering the implications of the pandemic for patient safety (with a WHO report on this issue due to be published later this month). Through this role and my work at Patient Safety Learning, I identified several key patient safety challenges:

    • There has been a significant fall in patients presenting at primary care during the pandemic, with numbers in the UK estimated to be around ten million. There are many unanswered questions about what care they might need, whether their conditions have deteriorated and if they need more support and treatment because of the delays.
    • The impact of the suspension of screening, diagnostics, and other vaccination programmes during the pandemic.
    • The challenge of tackling significantly increased waiting lists for elective care when we are facing a global workforce crisis and lack a clear workforce plan for the NHS.
    • Ensuring patients are supported and have access to care based on need and equity. Many services were reprioritised with a focus on Covid treatments and vaccination, reducing services for those with long-term care needs. How will recovery plans make up for lost time?
    • The ongoing challenge of Covid-19 infections and providing appropriate care and support for those living with Long Covid.

    Beyond these challenges, the impact the pandemic had on patient safety is still a significant unknown. While there have been some specific pieces of work on this, such as the analysis by the Patient Safety Authority in Pennsylvania, we lack a broader understanding, particularly in the UK. Has avoidable harm increased and, if so, why?

    The pandemic has shown us that staff safety is a huge issue and is intrinsically linked with patient safety. So many staff have experienced fatigue, burnout and moral injury over the last two years, compounding the issue of workforce shortages.

    I emphasised how important it is to ensure we understand the causal factors of these key patient safety challenges and that we need to ensure safety is designed into the core of recovery plans.

    At Patient Safety Learning, we believe that patient safety should be treated as core to the purpose of health and social care, not as one of several competing priorities to be traded off against each other. In our report, A Blueprint for Action, we set out an evidence-based analysis of why harm is so persistent and what is needed to deliver a patient-safe future, identifying six foundations of safe care.

    ‘Work as done’ - the operational reality

    To start her presentation, Annie Hunningher discussed the impact on patient safety of the ongoing challenge of bed shortages. She shared anonymised WhatsApp messages from colleagues highlighting their experiences of this, and talked about the direct impact bed shortages have on the movement of patients through hospitals from admission to discharge. Summing up these issues, Annie said that:

    “… we can openly say, across the NHS, that there’s a crisis of safety, efficiency and flow.”

    Discussing the impact of the elective care backlog, Annie emphasised that it was important that the implementation of newly published elective recovery plans takes into account the operational reality. She noted that a set of targets that push a system harder when it does not have the spare capacity to respond poses a risk to patient safety and quality of care.    

    To successfully tackle the backlog and address the safety risks associated with this, Annie noted it was important to have in place:

    • Clear and streamlined processes.
    • Robust induction and standard operating procedures.
    • Strong governance.
    • Civility and kindness.
    • Learning from excellence.
    • Working as “teams not tribes” - recognising that a team of experts is different from an expert team, and the importance of training together as multidisciplinary teams.   
    • Better IT support for staff.
    • Support for staff wellbeing.

    Annie also referenced the work of Steven Shorrock and the need to differentiate between ‘work as imagined’ and ‘work as done’. She talked about the importance of senior leaders seeing what really happens on the frontline, not just hearing about it via Teams calls. She reflected positively on her Trust’s Deputy Director of Improvement coming to see their team’s work for the day, and their work to understand how policy translates into practice.

    Finally, she highlighted the importance of safety culture and the need to place patient safety at the heart of everything we do if we are to successfully meet the challenges ahead.

    Co-production and patient perspectives

    Introducing his presentation, Jono Broad outlined the five key ‘Rights’ for every patient journey: Right care, Right place, Right time, Right person, and once these four are in place, it should be possible to achieve the Right outcome.

    He echoed Annie’s comments on the challenges caused by an ongoing shortage of beds, noting this problem long predated the pandemic. He reflected on the significant reduction in community nursing services and the raised the concern that focusing on early discharge from hospital make create patient safety concerns if the new models of care are not properly resourced.

    Turning to the backlog of care and increasing waiting lists, he highlighted concerns about lack of communication with patients. He spoke about cases where individuals were not informed of a cancelled procedure until the day before it was scheduled. Speaking about support for patients on waiting lists, he said that currently:

    “We’re not placing safety at the heart of waiting well”

    Jono emphasised that we need to do more to provide the right support for patients so they can ‘wait well’, ensuring there is:

    • Monitoring of potential deterioration of patients on long waiting lists.
    • Awareness of the secondary consequences on a patient’s mental health.
    • Support and plans for prehabilitation in advance of elective care.
    • Social prescribing available.
    • Personalised care packages in place.

    He spoke about the NHS approach to patient safety more broadly, and his personal involvement in the development of the National Patient Safety Strategy. However, reflecting on the implementation of this, he noted that:

    “It is visionary, it is excellent, it could be brilliant – but only if it's resourced. Only if it’s given the credence and the dedication that it needs to be delivered, and only if patients are properly and truly involved in the design and delivery of all patient safety aspects.”

    Jono emphasised the importance of co-production, making sure that people using services, the public and staff can all work together to shape how services are designed, delivered, and evaluated. He stressed that key to this was ensuring that we enable patients to be active partners in care.

    Working with patients and staff to tackle post-pandemic challenges

    We ended with a question and answer session discussion with participants, which included:

    • Annie and Jono’s experiences of co-production between staff and patients and the value in improved safety and clinical outcomes this brings.
    • The question of where the co-production agenda is in the development of Integrated Care Systems.
    • The impact of culture on patient safety and concerns about bullying.

    I found the webinar a powerful exploration of some of the key patient safety issues that the HSJ Patient Safety Congress in Manchester later this year will focus on.

    For me, patients and clinicians are our conscience, they speak truth to power, and it is vital that we listen to and act on their insights and wisdom. It is important to capture compelling stories from patients and staff to hear what needs to be changed, and crucially to share how changes then happen. Given the huge challenges we face in a (hopefully soon to be) post-pandemic world, we need to ‘work with’ staff and patients to ensure that patient safety is at the heart of healthcare.

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    I really enjoyed this webinar and found it real, energetic and illuminating. Well done for capturing the spirit of it and sharing the learning and potential more widely here. 

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