This is part of our series of Patient Safety Spotlight interviews, where we talk to people working for patient safety about their role and what motivates them. Tracey talks to us about the role of NHS Supply Chain in ensuring the products procured through the NHS Supply are of high quality and are safe for healthcare organisations to use. She also highlights the vital importance of complaints and the need for staff who don’t work in direct care delivery to recognise their role in patient safety.
About the Author
Since starting her nursing career in 1992, Tracey has worked in a variety of nursing and healthcare management roles. She is now the Clinical Intelligence and Patient Safety Lead at NHS Supply Chain. Having lived and breathed the NHS for thirty years, Tracey understands and appreciates its complexities, challenges and the constant changes it faces. What gets her up every day is knowing that she is making a positive difference and being part of a system that enables safe, high quality healthcare for patients.
Questions & Answers
Hello Tracey. Please can you tell us who you are and what you do?
My name is Tracey Cammish and I'm the Patient Safety and Clinical Intelligence Lead at NHS Supply Chain. NHS Supply Chain is part of the NHS family and manages the sourcing, delivery and supply of healthcare products, services and food for NHS trusts and healthcare organisations across England and Wales. We manage more than 7.7 million orders per year and deliver over 35 million lines of picked goods to the NHS. We supply a whole myriad of different products, from central venous catheters to cottage cheese—anything that’s used in the NHS!
How does NHS Supply Chain ensure patient safety in the products it supplies?
At NHS Supply Chain, our robust essential product specification processes are a key part of our proactive patient safety offer. These processes enable us to design in product requirements for products before we buy them and this provides assurance that the products that are purchased through us are safe and fit for purpose. It is important to point out that NHS Supply Chain is not the only supply chain route to the NHS and we can only provide due diligence on our own products.
We also proactively want to hear and receive feedback and complaints about the products that we supply. The patient safety team sees all product complaints and feedback received by the organisation through our product complaints route. The team triages these complaints and risk assesses each one to determine whether harm has occurred or if there is a risk of harm occurring. If a product triggers a risk score, we initiate a ‘containment response’ which triggers the specific buyer to liaise directly with the supplier of that product. The containment action response can take place in different time frames depending on how high the risk score is - from 72 hours for a product complaint that has scored a low to moderate risk score, to 24 hours for a product that has scored high to very high. If need be, we can request that the product line is suspended until we have received reassurance from the supplier that they are taking proactive steps to understand the issue and stop it happening again. We need to know that the issue is being looked into or that there is sufficient evidence to determine that this is an isolated incident related to a particular batch or lot code. Because we know who we have sold specific lots to, we can communicate with affected organisations and ask them to quarantine the product, which we will then replace it with an alternative product.
The patient safety team ensures our internal systems all pull together to contain and mitigate product safety issues. We also make sure that we use the information we have gained to inform future procurement. For example, if we receive a report about a central venous catheter that has snapped upon insertion, we will take steps to understand from the supplier's investigation why it snapped, so that we can outline what we don’t want in future products. We help close the safety loop by using data and learning to design out problems and failures from the supply chain. Our aim is to make sure the organisation is learning from feedback from patients and end users.
How did you first become interested in patient safety?
I started my nursing training in 1992 and right from the get-go, patient safety was driven into us, so it became inherent in me. As a nurse, you are an advocate for patients, so patient safety needs to be at the forefront of every interaction and task.
When I first started working at NHS Supply Chain in 2020, patient safety was seen as an ‘add-on’ rather than a foundation of our work and our offer to the NHS. The organisation was very focused on commercial savings; however, fast forward two years and there is a different narrative throughout the organisation. We can see evidence that our staff are now aware and have understanding of the patient safety agenda, from finance and procurement through to our inventory teams. It has been a challenge to help everyone realise they have a role to play in the patient safety agenda, whether they work in an office or on the front line. Part of my role is to bring the patient safety agenda to life for those areas that might not see how it is relevant to them. I try to help people see that because the products we buy and supply are used in direct care delivery, we all have a responsibility for patient safety.
Which part of your role do you find the most fulfilling?
When I joined the organisation nearly three years ago, it could be perceived from a customer perspective that NHS Supply Chain didn’t do much with the complaints we received. Having come from frontline services, I knew from an end-user perspective that it felt futile to complain about products—it appeared that feedback wasn’t taken on and nothing was done with the information or issues reported. Now, we can absolutely say that not only do we listen to those complaints, we do something about them. That’s probably the most fulfilling thing—ensuring that feedback from customers does inform and does make a real change to the safety of products and the NHS Supply Chain system.
When I first started this role there were perhaps 60 complaints a month, which seemed incredibly small to me, considering the volume of products we sell. The organisation at the time saw low complaint numbers as a good thing, but what it told me was that people didn’t see the point of complaining. Now, because people can see that we are doing something about complaints and feedback, the number of complaints is increasing, which is a very good thing! People feel it's worth their time to let us know a product isn’t good enough.
We’re currently working on making our complaints processes easier for people to use—we’ve moved from a Word document to an online form. The next thing we’re developing is a way to auto populate fields to make it quicker for frontline staff to let us know when products are not working or causing harm. Hopefully we’ll see the number of complaints increase even more!
I’ve always been driven by wanting to make a positive difference in the system, and you don’t have to be delivering care to do that. Within our sphere of influence, we can make a difference by taking proactive and responsive action to the feedback we get. We’ve gone from being an organisation that buys and sells products, to one that provides support and solutions to challenges that the frontline feeds back to us.
What patient safety challenges does your organisation face at the moment?
One of the current problems we have is supply disruption, which is a global problem as manufacturers struggle to get the raw materials they need. If health services don’t have certain products, it poses a risk to continuity of care delivery and patient safety. From a human factors perspective this is really challenging, as frontline healthcare professionals have products they are used to using that they suddenly can’t access. As an organisation, it’s an issue we are starting to tackle. We need to be considerate of the fact that although a product might do the same thing, it might look and feel different, which will affect how each member of staff uses it.
This supply disruption compounds the strain on the NHS, where we have a workforce that is exhausted and depleting, and organisations that are at full capacity. Sometimes if I look at the national picture, it becomes really overwhelming. But what we can do as an organisation is try and support the continuity of care delivery as best we can by making information much clearer. So if you work in an ICU and are used to using a certain type of tracheostomy tube that suddenly becomes unavailable, we can provide information that allows you to make an informed choice about the other products available. We can make it easier for clinicians to determine which products are suitable for their unit and staff by making the attributes of the products available really clear.
The NHS is facing the most pressure it’s ever faced, and as organisations we are going to have to work collaboratively to tackle the issues. Covid taught us that organisations—regulators, commissioners, the Department of Health and Social Care—all need to talk to each other. Routes of communication are clearer and more fluid than they have been historically.
What do you think the next few years hold for patient safety?
I like the direction we’re moving in with patient safety in terms of establishing a Just Culture. In the main, people don’t set out to hurt patients, but there are so many compounding factors that surround care delivery that result in patients being harmed or potentially being harmed. I think the direction we’re moving in with the Patient Safety Incident Response Framework (PSIRF) is the right one. It’s not about blaming and finger-pointing, but understanding the holistic components that resulted in an incident happening. Most importantly, it helps us ask ourselves as a system what we can do to mitigate it happening again.
The increasing understanding that everyone in the system has some responsibility for patient safety is also a really good thing. There has been a seismic shift in the concept of patient safety as a fundamental implicit part of any organisation that supports the delivery of care. I believe we’re moving in the right direction in terms of awareness of the importance of patient safety - it is now part of NHS Supply Chain’s performance key performance indicators (KPIs), when it wasn’t even thought about a couple of years ago. New areas of our business are really taking it on. For example, our customer relationship managers and product buyers are proactively letting the patient safety team know where they are seeing potential patient safety issues as they come across them. Before, it would never have even entered their mind.
If you could change one thing in the healthcare system right now to improve patient safety, what would it be?
Where do you start? The system is so complex, but I think we need to get to grips with people being cared for in the right place, by the right people at the right time. At the minute, what we have is a melting pot of chaos that is visibly being reported as hitting secondary care—but care is a continuum, it doesn’t start and stop. Perhaps you are having a mental health crisis and you can't get an appointment with your GP, so the police are called. Or maybe you have a fall at home because you are frail and you just need some help looking after yourself day to day. But you call an ambulance and go to where the lights are always on and you know there is a care assessment available—namely an emergency department. So secondary care ends up looking after people who would be much better served in the community, if the resources existed for these services to function effectively.
When I first started nursing 30 years ago, there were more facilities available to provide that wrap around continuum of accessible care. We had what was called at the time care of the elderly hospitals, care in the community organisations and mental health hospitals, which meant we were able to move people on safely from acute hospitals. We had access to care settings that would be able to cater for the needs of these individuals out of the acute setting and get them ready to go home safely. The drive in the mid-1990s to push “care in the community” meant that a lot of facilities were disbanded and care was moved to the home without the level of care and support that theses facilities had provided. By the late 1990s we were feeling the strain in secondary care; huge A&E waits, elective surgery waiting lists of up to 18 months, elective surgery being cancelled and so on. It feels like we've gone full circle to arrive where we are now in 2022. Due to advancements in medicine and treatment intervention, people are living much longer than they did even 30 years ago when I started my nursing career. However, with age come additional clinical complexities. I don’t know what the solution is, but the outside ends of the care delivery system—social care, mental health care and primary care—are falling apart. They are unable to support secondary care to function as it should.
Are there things that you do outside of your role which have made you think differently about patient safety?
I recently needed to access healthcare myself, and being on the receiving end highlighted just how much pressure care delivery is under. The psychological impact that has on you as a patient is significant—my sense of feeling safe as a patient was called into question.
Tell us one thing about yourself that might surprise us!
I am a resuscitation Council UK Advanced Life Support (ALS) Instructor and have been teaching doctors, nurses and allied health professionals (AHPs) ALS since 2001. I have a season ticket for Newcastle United and last October when we were playing Tottenham at home, there was a cardiac arrest. The man who was having a cardiac arrest was sitting five rows behind me. Despite the TV coverage at the time stating that it was an A&E doctor who came to the man’s rescue and saved his life it was actually me and a fellow nurse who I sit next to who were first to respond. We started CPR, got a defibrillator and got the man shocked within 90 seconds of his collapse. The gentleman survived and after a short spell in hospital was able to return to the east stand to watch the rest of the season!