Jump to content
  • Content Count

  • Joined

  • Last visited

Steve Turner


Community Reputation

8 Novice


About Steve Turner

  • Rank

Profile Information

  • First name
  • Last name
  • Country
    United Kingdom

About me

  • About me
    I began my professional career as a nurse in 1984, eventually specialising in mental health.
    I spent a decade working on clinical systems for American giant Shared Medical Systems, progressing from project manager to Senior Strategic Services Consultant of the U.S. arm of the company.
    In 1999 I returned to work for the NHS, successfully revamping the Information and Technology department at an NHS Trust prior to a trust merger. A spell in consultancy for a large Cancer Network followed, by leading two highly successful multi-organisational projects.
    More recently I have led a successful interdisciplinary, multi-organisational prescribing project and the development of a parent held medicines record for children with complex conditions. My Associates and I have also developed, and successfully piloted, ‘patient led clinical medicines reviews’.
    In 2015, after a difficult whistleblowing experience, I founded the Turn Up The Volume! movement and speak out for patient safety through transparency, values based leadership and a just culture. (www.tutv.org.uk).
    I also teach at Plymouth University.
  • Organisation
    Care Right Now CIC
  • Role
    Managing Director

Recent Profile Visitors

928 profile views
  1. Community Post
    Some years ago I stopped writing for journals, in favour of blogging & volgging. My reasons were: I specialise in patient involvement and inclusion, so I want the work of me and my colleagues to be easily found by everyone We didn't want our work to end up behind a paywall We work across disciplines and try to bypass hierarchies, especially in promoting action learning and patient led care I can see there are some really good Open Access Journals around. So my question for us all is: Which are the best Open Access Journals? Here a link to my digital profile: https://linktr.ee/stevemedgov This is our developing model of working, a away of working in healthcare that all use and participate in:
  2. Content Article Comment
    Something happened this week which reminded me how important a public inquiry into the circumstances and aftermath following the death of Robbie Powell is for us all, and for patient safety in general. I watched the ITV docudrama 'The Pemborkeshire Murders' In this programme it was twice mentioned that Dafydd-Powis Police had previously been found to be institutionally incompetent. In my opinion, the script implied (unintentionally) that it was the media who found the Dafydd-Powis Police institutionally incompetent. In fact it was an inquiry into the handling of the Robbie Powell case by Avon and Somerset Police that made the finding of institutional incompetence. I was saddened to see this apparent misrepresentation. The Robbie Powell case is the landmark case on patent safety that too few people know about. Important patient safety learning was lost in the cover up after Robbie's Death. I agree with the English & Welsh Health Ombudsmen and support the call for a public inquiry. #robbieslaw
  3. Content Article Comment
    It's great to see people like Raymond recognised. There are many like Raymond helping keep patients & residents safe in all health systems across the world. 👍🙏 #OneTeam 🌏
  4. Content Article Comment
    It will be important to see examples of this in action. Staff praised for speaking out Changes made as a result People who victimise those who speak out for patients held to account NHS returners who spoke out in the past welcomed back Otherwise it's just words...
  5. Community Post
    I'm hoping that the Long COVID clinics link up with all initiatives for people with long term conditions. We started looking at medicines and expanded this to include ALL treatments and approaches. We're looking at how our work can link with this. Here's an early video on our work: More here: https://medicinegovorgmedlearn-innovation-event-nhs.blog/patient-education-support-sessions-helping-you-manage-your-own-care/
  6. Article Comment
    It seems wrong to me that stories of this importance are paywalled?
  7. Content Article Comment
    Worrying that 'There are few results where the majority of people reported good experiences of mental health care.' This is the element of the report that needs emphasising. Where is the action plans? How are patients / users of services being involved? How will we know when 'lessons have been learned'? Reports need to be followed up by concise plans and a summary of actions taken, and their effect. Otherwise we just go round in circles. 'Key areas for improvement Crisis care 28% of people indicated that they would not know who to contact, out of office hours in the NHS, if they had a crisis. Of those who did try to contact this person or team, almost a fifth (17%) either did not get the help they needed or could not contact them (2%). Support and wellbeing 36% of people felt they had not had support with their physical health needs. 43% said they did not receive help or advice in finding support with financial advice or benefits. 43% of people did not get help or advice in finding support for keeping or finding paid or voluntary work, but would have liked this help. Accessing care 44% of people who had received NHS therapies in the last 12 months felt they waited too long to receive them. 24% of people felt they had not seen NHS mental health services often enough to meet their needs. 59% said they were ‘definitely’ given enough time to discuss their needs and treatment.'
  8. Content Article Comment
    Click on the attachment (above) to download the interactive pdf, which has clickable links. 😀
  9. Content Article Comment
    A great initiative, simple and effective which in will share with my prescribing colleagues, locally and nationally. Thank you.
  10. Content Article
    Background From 2008 to 2014 my company ran education sessions on managing medicines in a mental health trust. In common with some other mental health trusts, the provider also looked after paediatric community services. This is not a mental health service. It covers children with complex health needs including enteral feeding tubes, ventilation, epilepsy and rapidly changing medicines. Children under the care of this service may be taking in excess of 15 different medicines per day, have complex titration regimes, emergency drugs with associated care plans, plus numerous ‘as required’ (prn) medicines. It is not unusual for children with complex conditions to be under the care of up to five different providers, and to move between three different providers in one day. For example, from a home care service to the special school, to respite care, maybe also being seen in an outpatient clinic on the same day too. As a result, parents frequently have to repeat the information on their child’s medicines every time they move to another service, or a new person is involved. Understanding the safety issues The idea for change came about because of concerns that the staff in children’s respite care were not learning what they needed about children’s medicines, as the learning was geared to the majority of staff who worked in mental health. So a new learning package for children’s staff was commissioned. Part of the work to design the learning package included a baseline assessment which was conducted with parents and staff. This soon revealed that training alone was not the answer. It showed delays in medicines information reaching GPs, workarounds for obtaining information in order to administer medicines in the houses and a general lack of confidence in the whole process. The status quo was risky and disliked by many As a result we looked at the whole system starting with the area where most concerns had been raised, which was having an up to date complete list of a child’s medicines available at all times (medicines reconciliation). The system in place for respite care involved paying a local GP (not usually from the child’s GP Practice) to write up a medicines chart for each child. The process was fraught with difficulties and delays and widely disliked by everyone directly involved. So we set about looking for a new way to manage the lists of medicines with more training and more input for the staff in the services involved. We came up with a new (and much more robust) process for medicines reconciliation in the respite care. This was fully documented in a new policy, and involved cross checking by both the staff and the parents. The “My Medicines” chart Just before this went live, we asked the parents to review and comment on it and they said ‘If you’re producing an accurate and up-to-date list of my child’s medicines, why keep it in the respite care, can’t it go with my child?’ So the "My Medicines" chart, which travels with the child, was born. The "My Medicines" process led to the design and production of a new chart which has to be signed and checked by the parents. It resulted in 40 children with complex conditions being offered a hand held paper record of their medicines (produced and validated by clinicians), which they take around with them wherever they go. Benefits and reduction of risk The new process, which continues to evolve, means that: the child’s GP is now directly involved in day-to-day medicines reconciliation (they weren’t before) the parents are always asked to check and sign the charts (they weren’t before) verbal messages about medicines are never taken incomplete (or missing) directions are rapidly rectified (never worked around). Further specific benefits of the new process include: It has reduced the risks of error, by providing full and accurate information on children’s medicine across their entire pathway. It cuts out the need for parents to keep having to repeat what medicines their child is taking to different professionals and care agencies. It frees up medical and clinical time which was previously spent chasing missing information. It has reduced the number of third part handovers and transcribing of prescription information. Looking back it’s hard to believe that the old ways of working, which caused so many difficulties (especially for frontline staff), were carried out for so long. These risky practices, or similar, are believed to still be commonplace in England. Revealing hidden incidents and near misses In evaluation phase of the project we raised 17 medicines near misses. Of these, 11 related to problems with communication of information across the child’s pathway. Resolving these has resulted in improved communication and engagement between different clinical groups and providers, and a desire from all quarters to take the project further. Previously many of these incidents were not logged or tracked across organisations. In some cases, it was only due to the vigilance of the staff and parents that they were spotted and errors avoided. Embedding change The project was well received by parents and staff and resulted in improved communication and engagement between different clinical groups and providers. This included the Consultant Paediatricians (working for the secondary care provider), who were initially sceptical. The project was less well received by the relevant medicines and prescribing committees, who were understandably concerned about who owned the “My Medicines” chart and had agreed its content. Explaining this was made more difficult because it is hard to get across the complexity of the arrangements, due to the critical nature of the children’s illnesses, in a committee setting. Working in ways that support safety I make no apologies for ensuring from the outset that it was the parents who owned the charts, which were designed by the project team (not a committee) to meet all best practice standards. It always worries me that when it comes to cross- organisational working the formal committees and systems in place can inadvertently act as a barrier to safety rather than promoting it. There is no doubt we had designed a safer process and my company was happy to take accountability for any associated risks. As a legacy of the project, a Community Paediatric Pharmacist was appointed specifically to work with this group of children. So, whatever evolves will be based on inter-disciplinary thinking and working and will have clear safety parameters. I am grateful to the enlightened thinking of the leaders who commissioned this work and supported this novel approach.
  11. Content Article Comment
    Great post, picking out the key issues. I wonder what people would want in the person specification and job description for a Patient Safety Commissioner Will there be a public consultation on this I wonder? This could really help in engaging everyone and bringing in all perspectives. Some visual reminders of what matters most:
  12. Content Article Comment
    In addition to enabling speaking out about patient safety concerns I'm hoping that staff will begin to feel freer to share more examples of best practice, and when lessons have been successfully learned, on the Patient Safety Learning Hub. There can be a reluctance to do this because of the controlling attitudes of some employers. I believe many of us have great stories of successful work, that needs to be shared. I do. Watch this space...
  13. Article Comment
    What a terrible and totally inexcusable waste of public funds. Will anyone be held to account for this failing?
  14. Content Article
    This survey has been designed to identify people’s attitudes to whistleblowing and their opinion on existing UK legislation in this matter. It provides an opportunity for the wider public to share their understanding and experience of whistleblowing and existing legislation which will help determine the creation of more effective legislation and effective protection for those who speak up, as well as to ensure that the development of new legislation in the UK is fair and equitable to all relevant parties, whistleblowers, UK public and businesses. The study is being conducted by the Centre for Financial and Corporate Integrity (CFCI) at Coventry University in collaboration with WhistleblowersUK and a report will be provided to the All Party Parliamentary Group for Whistleblowing (APPG) to assist them with relevant regulation in the field of whistleblowers’ protection. The results of the survey will also be made available to the public through relevant academic publications. The CFCI has a team of outstanding academics in the areas of corporate crime, whistleblowing and human rights. Responses to the survey will be used to expand relevant academic knowledge in these fields and inform policy-making.