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Patient Safety Learning

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  1. Event
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    Climate change has been recognised as the “biggest global health threat of the 21st Century”. Healthcare is one of the most significant contributors to greenhouse gas emissions and there are steps which healthcare professionals and organisations can and should be taking to tackle this issue. In 2020, the NHS set out a bold ambition to become the world’s first carbon net zero national health system by 2045. The Safety For All campaign is hosting a webinar on the topic of sustainability where attendees will have the opportunity to hear from the Chair of the ABHI’s Sustainability Group and Chair of the Sustainable Healthcare Coalition. The webinar is free to attend and open to everyone with an interest in the importance of sustainability in healthcare. Speakers: Michelle Sullivan and Fiona Adshead. Register
  2. Content Article
    Matters of Concern The medical professionals who work in a hospital emergency department are routinely expected to do so when the OPEL 4 applies, a recognition they are performing their roles when the hospital is “unable to deliver comprehensive care, and patient safety is at risk”. Such pressures may serve to leave the Emergency Department unable to triage patients such as Derek, and have no time to notify the doctors expecting his arrival (in this case doctors on the Surgical Assessment Unit) who are consequently left unaware that a patient has in fact arrived, all of which serves to place vulnerable patients such as Derek Pedley at serious risk. There is a risk that the pressures on hospitals become so significant they are used as a default explanation for levels of patient care that fall below what they would wish to deliver. The coroner found that the hospital Trust did not seek to do so in this case, but it seems there is a risk this could happen. The pressures are indeed significant, but ultimately this case involves a 90 year old man with what appears to be an acute medical problem finding himself attending his local emergency department, not being spoken to / triaged by a medical professional for almost two hours, and dying by the time he is called for. There is a clear risk that puts patients at risk and it would be remiss of me not to raise it. Finally, it is relevant to point out that Derek had not moved for some time before a medical professional called for Derek. The coroner formed the view that there had been a reluctance on his friend’s part to request assistance due to the pressures staff were clearly under, but also because he had already handed in Derek’s paperwork and was expecting some assistance imminently which did not arrive. It is felt that Derek and his friend thought as they knew doctors had discussed his case with his GP and that his attendance was expected they did not need to raise a concern until it was too late. In actual fact, such are the pressures Emergency Departments are working under, this may not be the case. Unless GPs are provided with a realistic picture about how quickly their patients may be seen once they arrive at hospital (even if they have been in communication with the hospital doctors) their patients may arrive at hospital expecting to be seen quickly, when in reality this may not be the case particularly when the department is under significant pressures.
  3. News Article
    Millions of people wrongly believe they are allergic to penicillin, which could mean they take longer to recover after an infection, pharmacists say. About four million people in the UK have the drug allergy on their medical record - but when tested, 90% of them are not allergic, research suggests. The Royal Pharmaceutical Society says many people confuse antibiotic side-effects with an allergic reaction. Common allergic symptoms include itchy skin, a raised rash and swelling. Nausea, breathlessness, coughing, diarrhoea and a runny nose are some of the others. But antibiotics, which treat bacterial infections, can themselves cause nausea or diarrhoea and the underlying infection can also lead to a rash. And this means people often mistakenly believe they are allergic to penicillin, which is in many good, common antibiotics. These are used to treat chest, skin and urinary tract infections - but if people are labelled allergic, they are given second-choice antibiotics, which can be less effective. Read full story Source: BBC News, 28 September 2023
  4. News Article
    More than half of staff at a hospital trust that has been under fire for its "toxic culture" have said they felt bullied or harassed. The findings come from an independent review commissioned by University Hospitals Birmingham (UHB) NHS Trust. It has been at the centre of NHS scrutiny after a culture of fear was uncovered in a BBC Newsnight investigation. UHB has apologised for "unacceptable behaviours". It added it was committed to changing the working environment. Of 2,884 respondents to a staff survey, 53% said they had felt bullied or harassed at work, while only 16% believed their concerns would be taken up by their employer. Many said they were fearful to complain "as they believed it could worsen the situation," the review team found. Read full story Source: BBC News, 27 September 2023
  5. Content Article
    The review found that, despite significant challenges in staff experience at the Trust, many staff remain committed and proud to provide care to the population they serve. Staff experience at the Trust needs dedicated and continued focus to make positive shifts to a working environment where all staff feel safe, heard, and valued. The review team found a challenging staff experience that has manifested itself over a long period of time, has largely continued unchecked, and has created a culture where for many, an adverse working environment has become normalised. There is currently not a single defining culture at the Trust, but there are commonalities of experience. The culture is comprised of many individual views and interpretations which means staff experience the Trust in different ways. For many of the staff who engaged with the review, their experience of working in the Trust is compromised, with a range of concerns. These include not feeling valued and respected, often not feeling safe at work, and not connected to the wider organisation in which they serve. Staff also reported not feeling included and not having a voice that is heard and acted upon. For some staff this has impacted on their wellbeing. Going forward, the Board must acknowledge the culture at UHB needs to significantly improve. The Board, supported by senior management and staff, must create the conditions for change. This should include zero tolerance for poor behaviour so staff feel they can contribute, collaborate, have their voice heard, and feel their work is valued. Staff should be empowered to lift their heads up and enabled to do the right thing. Empowerment should not be simply handing off responsibility to staff, but listening and engaging in co-production, development, and improvement. The four fundamental shifts the review recommend are: A shift to openness and transparency. A shift to valuing people and ensuring equity and inclusion . A shift to ensuring culture directly connects to effective patient care. A shift to ensuring a physically and psychologically safe working environment.
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    This Westminster Health Forum conference focuses on key priorities and next steps for dentistry in England. Delegates will discuss next steps for service recovery following pandemic disruption, with funding from the Government last year aimed at managing backlogs. Policy-makers and dentistry stakeholders will assess findings from the Health and Social Care Select Committee inquiry published in the summer, which looked at accessibility to NHS dentistry, the Dental Contract and the workforce. Sessions in the agenda will look at next steps, including issues around workforce retention and the future sustainability of the profession. The Westminster Health Forum conference will also be an opportunity to discuss the 2022-2023 contract reform agreements, focusing on impact so far and the way forward as integrated care systems implement their responsibilities for commissioning dentistry services - as well as the role of dentistry within development of ICSs, and prospects for further development and support for dentistry. Delegates will look at priorities for delivering efficient oral healthcare and the wider drive to improve prevention, including the impact of pooled budgets, and priorities for building dental teams. Overall, areas for discussion include: service restoration: addressing backlogs in balance with safety and infection control - balancing routine appointment catch-up with delivering emergency dental care - the impact of funding. dental contract reform: possible outcomes and implications for the sector - providing clarity following prototype practices being dropped - impact of the pandemic. workforce: assessing reform to dentistry education and training - progress since the Advancing Dental Care Review - concerns around retention and the future sustainability of the profession. integrated care: the role of dentistry within ICSs, as well as the wider focus on prevention - changes to commissioning - the impact of pooled budgets on dentistry. accessibility: identifying and overcoming barriers to access - improving the availability of services - addressing health inequalities. integrated oral care: the role of dentistry in preventative healthcare - the impact of commissioning changes. professional regulation: the priorities and outlook for reform for the dentistry profession - options for streamlining and efficiency - standards and support for the sector. Register
  7. News Article
    Health experts are calling for a “feminist approach” to cancer to eliminate inequalities, as research reveals 800,000 women worldwide are dying needlessly every year because they are denied optimal care. Cancer is one of the biggest killers of women and ranks in their top three causes of premature deaths in almost every country on every continent. But gender inequality and discrimination are reducing women’s opportunities to avoid cancer risks and impeding their ability to get a timely diagnosis and quality care, according to a new Lancet Commission on women, power and cancer. The largest report of its kind, which studied women and cancer in 185 countries, found unequal power dynamics across society globally were having “resounding negative impacts” on how women experience cancer prevention and treatment. Gender inequalities are also hindering women’s professional advancement as leaders in cancer research, practice and policymaking, which in turn perpetuates the lack of women-centred cancer prevention and care, the report adds. It is calling for a new feminist agenda for cancer care to eliminate gender inequality. Read full story Source: The Guardian, 26 September 2023
  8. Content Article
    The Lancet Commission on women, power and cancer was created to address urgent questions at the intersection of social inequality, cancer risk, and outcomes, and the status of women in society. It is calling for a new feminist agenda for cancer care to eliminate gender inequality. “The impact of a patriarchal society on women’s experiences of cancer has gone largely unrecognised,” said Dr Ophira Ginsburg, a senior adviser for clinical research at the National Cancer Institute’s Centre for Global Health and a co-chair of the commission. “Globally, women’s health is often focused on reproductive and maternal health, aligned with narrow anti-feminist definitions of women’s value and roles in society, while cancer remains wholly underrepresented. “Our commission highlights that gender inequalities significantly impact women’s experiences with cancer. To address this, we need cancer to be seen as a priority issue in women’s health, and call for the immediate introduction of a feminist approach to cancer.”
  9. News Article
    A mental health trust has denied charges relating to the death of a teenage inpatient but admitted care failings relating to two other cases. Tees, Esk and Wear Valleys Foundation Trust is being prosecuted by the Care Quality Commission over alleged failures to provide safe care in relation to deaths at three of its hospitals. TEWV has (on 26 September) pleaded not guilty to a charge relating to the death of 18-year-old Emily Moore, who took her own life at Lanchester Road Hospital in Durham in February 2020. The case will go to trial in February 2024. TEWV is accused of breaching regulation 12 of the Health and Social Care Act, which requires providers to ensure people receive safe care and treatment. However, the trust has admitted to regulation 12 failings in relation to the deaths of two other inpatients – Christie Harnett, 17, who took her own life at the former West Lane Hospital in Middlesbrough in June 2019, and an unnamed woman who died in November 2020 at Roseberry Park Hospital, Middlesbrough. The trust will be sentenced at a later date in relation to these cases. Last year, an NHS England-commissioned report found “systematic” failings in care. Read full story (paywalled) Source: HSJ, 26 September 2023
  10. News Article
    MSPs are set to vote on a new law to establish a patient safety commissioner. The bill to create an "independent public advocate" for patients will go through its final stage on Wednesday. Public Health Minister Jenny Minto has said the commissioner would be able to challenge the healthcare system and ensure patient voices were heard. The Scottish government has been told the new watchdog must have the power to prevent future scandals. In 2020, former UK Health Minister Baroness Julia Cumberlege published a review into the safety of medicines and medical devices like Primodos, transvaginal mesh and the epilepsy drug sodium valproate. She told the House of Lords: "Warnings ignored. Patients' concerns ignored. A system that seemed unwilling or unable to listen let alone respond, unwilling or unable to stop the harm." Her findings led to the recommendation for a patient safety commissioner. Speaking ahead of the vote on the Patient Safety Commissioner for Scotland Bill, Ms Minto said the watchdog would listen to patients' views. "I think it's a really important role for us to have in Scotland," she said. "There's been a number of inquiries or situations where the patient's voice really needs to be listened to and that's what a patient safety commissioner will do." Read full story Source: BBC News, 27 September 2023
  11. Content Article
    The plan focuses on three key areas: prevention, equality and support. It sets out concrete policies they want to see adopted as part of a ten-year, cross-government mental health strategy. Prevention: By effectively addressing social determinants, like poverty and discrimination, and environmental factors, including housing and pollution, more of us can have better mental health. Investing in more powerful public health infrastructure is also key to preventing illness and promoting better health. Equality: Discrimination and disadvantage mean that risks to mental health are much higher in some groups, such as racialised communities. And people with mental health difficulties are often treated less well in society, including in the social security and justice systems. Building a mentally healthier nation requires concerted action to tackle these inequalities and close the health gaps between different groups. Support: Everyone should be able to get timely access to local mental health services when they first need them. By properly resourcing these services, minimising the use of coercion and widening access, especially for children and young people, we can majorly improve people’s mental health outcomes.
  12. News Article
    A consultant obstetrician has claimed he was sacked from his hospital for raising whistleblowing concerns about patient safety over fears they would cause “reputational damage”. Martyn Pitman told an employment tribunal in Southampton that managers dismissed his concerns and he was “subjected to brutal retaliatory victimisation” after he criticised senior midwife colleagues. He said: “On a daily basis there was evidence of deteriorating standards of care. We were certain that the situation posed a direct threat to both patients’ safety and staff wellbeing. Concern was expressed that there was a genuine risk that we could start to see avoidable patient disasters.” Rather than addressing these, Pitman said the trust had considered it “the path of least resistance to take out [the] whistleblower”. Pitman was dismissed this year from his job at the Royal Hampshire County hospital (RHCH) in Winchester, where he had worked as a consultant for 20 years. He is claiming he suffered a detriment due to exercising rights under the Public Interest Disclosure Act. He said he “fought against [an] absolute barrage of completely unprofessional assaults on me” after he raised concerns about foetal monitoring problems that resulted in the death of a baby and the delivery of another with severe cerebral palsy. Read full story Source: The Guardian, 26 September 2023
  13. News Article
    The message that vaping is 95% safer than smoking has backfired, encouraging some children to vape, says a top health expert. Dr Mike McKean treats children with lung conditions and is vice-president for policy at the Royal College of Paediatrics and Child Health. He says the 2015 public messaging should have been clearer - vapes are only for adults addicted to cigarettes. Evidence on the possible health risks of vaping is still being gathered. In an exclusive interview with the BBC, Dr McKean said: "Vaping is not for children and young people. In fact it could be very bad for you," although he stresses that it is not making lots of children very sick, and serious complications are rare. "Vaping is only a tool for adults who are addicted to cigarettes." He says the 95% safe messaging was "a very unwise thing to have done and it's opened the door to significant chaos". "There are many children, young people who have taken up vaping who never intended to smoke and are now likely addicted to vaping. And I think it's absolutely shocking that we've allowed that to happen." Read full story Source: BBC News, 26 September 2023
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  16. News Article
    Police forces in parts of the UK have stopped answering urgent calls related to mental health even before alternative support is available to people, under a policy designed to free up officers’ time, MPs were told last week. The move means many vulnerable people are being left without help in areas where the necessary services and arrangements with other agencies are not yet in place, warned Sarah Hughes, chief executive of the mental health charity Mind. Giving evidence to the House of Commons health select committee on Tuesday 19 September, Hughes said, “We know of local Mind and local trust partners who are already experiencing people having no response because the police are saying they no longer respond to mental health calls.” The policy, Right Care, Right Person, which was developed by Humberside Police over nearly three years, is being rolled out in England and Wales from the end of October at varying speeds. Backed by the government and police representative bodies, it aims to ensure that patients in a mental health crisis are treated by the most appropriate agency, rather than have police act as default responder, when they may not be best suited to help. But the Royal College of Psychiatrists is among the organisations to have raised concerns over the levels of preparation and resourcing for the policy and the absence of evaluation of clinical outcomes or benefits and harms to the population. Read full story (paywalled) Source: BMJ, 25 September 2023
  17. News Article
    Thousands of people with asthma and other lung problems are going undiagnosed because most GPs in England do not offer tests for them, according to a new report. The failure to diagnose and start treating people with breathing problems threatens to create “a deluge of hospital admissions this winter” when the NHS is under intense pressure. Sarah Woolnough, the chief executive of charity Asthma and Lung UK, said: “The abysmal lack of testing and patchy basic care is causing avoidable harm to people with lung conditions and the NHS.” The report, which the Charity Commissioned from consultants PricewaterhouseCoopers, found that most GP surgeries in England do not provide basic lung function tests. Patients’ inability to access a test to check if they have asthma or chronic obstructive pulmonary disease (COPD) represents a “crisis in care” that could lead to many being hospitalised this winter “as respiratory viruses take hold and people struggle to heat their homes”, Asthma and Lung UK added. Read full story Source: The Guardian, 26 September 2023
  18. News Article
    After the government announced a five-year suicide prevention strategy and prepares to launch a national investigation in mental health services next month, one patient explains why NHS care is failing her. Nicola Brokenshire says she has been in and out of inpatient care with autism and resulting mental health problems for around 10 years "Each time I go into hospital I lose hope," says Nicola. The 28-year-old peers out from under the brim of her cap. She is eloquent and thoughtful. She cares deeply about her family, but her arms and legs are patterned with scars from self-harm, and she admits she doesn't want to live. Nicola has been in and out of inpatient care with autism and resulting mental health problems for around 10 years. She says the experience has taught her more destructive ways to hurt herself and she has become more motivated to do so when she doesn't get the support she needs.
  19. Content Article
  20. Event
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    This webinar is open to DoF's/CFOs and deputies only. On average 11,000 deaths a year are classed as avoidable with that number probably tripling in the years following the pandemic. Patient Safety Learning is a charity and independent voice for improving patient safety. They harness the knowledge, enthusiasm and commitment of healthcare organisations, professionals and patients for system-wide change and the reduction of preventable harm. They provide a wealth of free resources on the hub and they are on a mission to align leadership and frontline delivery of care; ensuring that patient safety is a core purpose in the development of integrated care. ICSs present a significant opportunity to drive improvements in patient safety in local health systems across the NHS. However, patient safety remains the ‘elephant in the room’ in the development of ICS roles and responsibilities. Helen will bring a unique perspective to this session as an ex-NHS finance director, she understands the pressure and conflicting priorities faced by NHS leaders. But with between 13 – 15% of yearly spending being attributed to patient safety issues. Not only morally is this an issue that needs to be addressed but getting it right can also have a big impact on the bottom line. This is the second webinar running as part of the HFMA Connect network. Join this supportive community dedicated to assisting NHS finance leaders like you, being run in collaboration with the HFMA Hub partnership. This new network facilitates knowledge sharing and looks to assist directors of finance, chief finance officers and deputies as they navigate the current challenges facing the NHS. Register
  21. Content Article
  22. News Article
    A hospital trust failed to send out 24,000 letters from senior doctors to patients and their GPs after they became lost in a new computer system, the BBC has learned. Newcastle Hospitals warned the problem, dating back to 2018, is significant. The BBC has been told the problems occurred when letters requiring sign-off from a senior doctor were placed into a folder few staff knew existed. The healthcare regulator has sought urgent assurances over patient safety. Most of the letters explain what should happen when patients are discharged from hospital. But a significant number of the unsent letters are written by specialist clinics spelling out care that is needed for patients. It means that some crucial tests and results may have been missed by patients. Staff have been told to record any resulting incidents of patient harm and ensure these are addressed. Following a routine inspection by the regulator - the Care Quality Commission (CQC) - in the summer, staff at the trust raised concerns about delays in sending out correspondence. A subsequent review of the trust's consultants revealed that most had unsent letters in their electronic records. Read full story Source: BBC News, 26 September 2023
  23. News Article
    A coroner has warned that a private hospital is relying on NHS ambulances to transport patients despite “being fully aware” of the pressures on the ambulance service and resulting delays. The warning came at the end of an inquest into a patient who died after a 14-hour wait for an ambulance to transfer him from the private Spire hospital in Norwich to the NHS-run Norfolk and Norwich university hospital a few minutes’ drive away. The last two years have seen a succession of inquests relating to ambulance delays. But in the latest case Jacqueline Lake, senior coroner for Norfolk, expressed concerns over Spire hospital’s use of NHS ambulances when complications and emergencies mean its patients need NHS care. “Spire Norwich hospital does not deal with multi-disciplinary and emergency treatment at its hospital and transfers patients requiring such treatment to local acute trusts, usually the Norfolk and Norwich university hospital,” Lake wrote in a prevention of future deaths (PFD) report. “Spire Norwich hospital continues to rely on EEAST [East of England Ambulance Service NHS Trust] to transport such patients to the acute hospital, being fully aware of the demands placed on the EEAST generally and the delays which occur as a result.” Research suggests that nearly 600 patients were urgently transferred from private healthcare to NHS emergency care in the year to June 2021 across the UK – around one in a thousand private healthcare patients. But previous analysis by the Centre for Health and the Public Interest (CHPI) thinktank found that some private hospitals were transferring more than one in every 250 of their inpatients to NHS hospitals. ‘“Transferring unwell patients from a private hospital to an NHS hospital is a known patient safety risk which all patients treated in the private sector face – including the increased numbers of NHS patients who are now being treated in private hospitals because of government policy,” said David Rowland, director of the CHPI. “And despite numerous tragedies and despite the fact that politicians and regulators are fully aware of this risk, nothing has been done to address it.” Read full story Source: The Guardian, 23 September 2023
  24. Content Article
    Matters of Concern Spire Norwich Hospital called the ambulance service on 6 August 2022 at 18.16 hours. The call was coded as a Category 3 call, requiring a response within 2 hours. The Spire Hospital were told the response would be 6 hours. The ambulance service was called again at 23.45 hours and the call was again coded as a Category 3 call. The ambulance service was called again on 7 August 2022 at 07.38 hours and the call was now coded as a Category 2 call, requiring a response within 40 minutes and with an average time of 18 minutes. Due to continuing demand on the ambulance service, an ambulance did not become available until 08.16 hours. The ambulance arrived on scene at 08.26 hours. The time between calling the ambulance service and an ambulance arriving was in excess of 14 hours. Evidence was heard as to the very high call demand overnight on 6th August 2022 and with regard to the significant pressure the healthcare system was and remains under. Evidence was also heard as to the steps being taken by EEAST in an attempt to deal with this pressure on the healthcare system. Despite the steps being taken by the EEAST, considerable delays in attending to calls continue. Spire Norwich Hospital does not deal with multi-disciplinary and emergency treatment at its hospital and transfers patients requiring such treatment to local acute Trusts, usually the Norfolk and Norwich University Hospital. Spire Norwich Hospital continues to rely on EEAST to transport such patients to the acute hospital, being fully aware of the demands placed on the EEAST generally and the delays which occur as a result. At the inquest Spire Norwich Hospital placed great reliance on now being part of an lnterfacility Transfer Group led by the Norfolk and Norwich University Hospital working with the EEAST to look at a pathway in respect of inter hospital transfers. The evidence of EEAST was that this pathway was not expected to reduce delays in inter hospital transfers. This concern has been raised at previous inquest.
  25. Content Article
    The importance of data on patient safety So where will the investigation start? As with all reviews, it will start with data collection – gathering evidence from national partners, staff, patients and families – to understand the risks to mental health patients and learn what and how to change to drive safety. Good data is fundamental to safety. The recommendations in Strathdee’s report made this link clear: “The aim of improving mental health information and information systems is ultimately about keeping patients safe and providing consistently high quality, evidence-based therapeutic treatments that enable patients to achieve the outcomes they need to have the quality of life they want back in their communities.”[1] However, the type of data you collect is important. Strathdee found: “patients and families and clinical teams told us that the [healthcare] system is not measuring what matters. They do not consider we [NHS England] are measuring what will truly have an impact on patient safety and outcomes.”[1] Inpatient mental healthcare: a digital desert? But what if this data is sparse. In mental healthcare, objective, longitudinal data about “patient and clinician reported progress” is limited, especially in inpatient settings. Professor Dan Joyce explains: “As a psychiatrist working on inpatient wards, I often found that I would only have limited time per week with each patient, so the information I had about how a patient was doing was formed from those short contacts, which may not be indicative of their overall progress. Information that would help me understand how a patient was doing – which would be automatically available in a general hospital – was really limited.” Without technology to support them, time-strapped staff may find data collection a burden. And data is likely to be unstructured and incomplete, particularly if it is collected as handwritten notes on paper forms. Dan provides an example of this challenge: “I was responsible for a patient with bipolar affective disorder. We knew him well and had often admitted him in a manic state. We knew that he would often stop taking his regular medication that maintained his wellness, so we put him back on his usual stabilising medication as this had been proven to work previously. But after 10 days, we were still struggling to contain symptoms of mania. It was clear to me that he was not sleeping and resting. So I asked the nursing team to complete a sleep inventory. However, after two weeks, it was clear that staff were simply too busy to observe and collect this detailed information. So on a night shift, I sat with him for some time, observing his activity around sleeping. I was able to confirm that his sleep was significantly dysregulated around sleep initiation, so with that data we were able to adjust his care plan to 'reset' his sleep and he showed a marked recovery. The data was essential in being able to provide the right care”. In general inpatient healthcare, staff will have a plethora of technology to support data collection, which not only reduces the burden on them, but provides a rich source of data to track patient improvement or deterioration, responses to care and to support learning. In contrast, inpatient mental healthcare appears to be a digital desert; however, at the same time, the Strathdee report found some clinicians were spending half of their time entering data. This paradoxical situation results in what Strathdee summarised as being: “Too much data collection is about activity and processes and too little about patient experience, what therapeutic treatments are provided, and the ‘real time’ patient and clinician reported progress and outcomes.”[1] Limited patient-focused data restricts the ability to gain actionable insights that are fundamental to providing better care. For example, less information about how a person is doing will: Significantly limit the ability to inform personalised care plans, such as how someone reacts to specific interventions. Impact the ability to understand specific risks – relevant to the patient – and put in place appropriate risk management, such as a falls risk management plan for frail patients. Impact the ability to understand if the patient is responding to care or deteriorating, and whether that necessitates changes to care as noted in our example above. Limit the ability to characterise a patient’s condition and understand what does and does not work to learn how to improve the care for other patients with similar presentations or conditions. With high staff vacancy rates (around 20%) on inpatient mental health wards[2] and increasing demand, it’s not surprising that in many cases where safety has been compromised, the CQC's reports point to insufficient staffing. But increased staffing is not a quick fix, especially if these staff must rely on existing processes and data for understanding how the care they provide impacts on a patient's wellbeing and recovery. Investing in staff training, recruitment and retention is essential to improve safety but it will take a long time. Which is no doubt why cross-governmental parties have called on technology to help.[3] “Embracing innovation will keep the NHS fit for the future…. That's why smart use of tech is a key part of our NHS Long Term Workforce Plan.” Steve Barclay, Secretary of State for Health. Entering the era of AI No one can have failed to notice the flood of interest in AI, particularly in healthcare. Its use in physical healthcare is already providing significant advances; for example, using image analysis to diagnose strokes[4] or assess mammograms; using virtual assistants to book appointments or use in remote monitoring supporting people in virtual wards. It also has tremendous potential as a tool for improving safety.[5] But contemporary AI is fundamentally a data-driven technology, requiring large, purposefully-curated and representative data. So if we are not collecting the right data, we cannot even begin to apply recent technological advances to develop algorithms that will either assist with detailed analysis of complex data or help automate prone-to-human-error and mundane tasks that free up specialist healthcare professionals to do what they do best. Investment in technology to support and improve data collection that enables the advances that data-driven technology could bring would, therefore, seem like a no brainer. But you can’t just “lift and shift” tech from the general healthcare setting into mental healthcare. Unlike the familiar investigations of general medicine, such as an ECG, MRI imaging or vital sign measurements, improving our understanding of how to help people with mental illness may involve new technology that exposes tensions between the needs of professionals and the rights of individuals. Emerging technology – and how best to deploy it in sensitive healthcare settings such as mental health – provides new challenges for healthcare that are only now being realised and addressed. But the opportunity to significantly improve safety and how patients are treated effectively is worth it and we should not shy away from the challenge if we are to bridge the gap between physical and mental healthcare. Technology is not a panacea but it is a tool that can, when implemented carefully, support safer care. As former CNIO for NHS England, Professor Natasha Phillips wrote recently in a very personal blog: “The reality is we cannot be there all the time with our patients and so we must harness all the technology available to support and keep them safe. I truly believe that access to timely information and the use of data as clinical decision support, artificial intelligence and robotic process automation can enable us to target care more effectively and be more purposeful and person centred in our time with patients.”[6] References Department of Health and Social Care: Independent report. Rapid review into data on mental health inpatient settings: final report and recommendations. 28 June 2023. Committee of Public Accounts. Progress in improving NHS mental health services. Sixty-Fifth Report of Session 2022–23. UK Parliament. 21 July 2023. Policy Mogul. Wes Streeting speech to NHS Confederation. 14 June 2023. Department of Health and Social Care and The Rt Hon Steve Barclay MP. Press release. Artificial intelligence revolutionising NHS stroke care. 27 December 2022. Bates DW, Levine D, Syrowatka A, et al. The potential of artificial intelligence to improve patient safety: a scoping review. Nature 2021; 4(54). Natasha Philips. Summer of change. LinkdedIn. 4 September 2023.
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