Patient-Safety-Learning

Recommendations Keep the focus on patients: Co-design digital solutions with patients. Run electronic medicines product information (ePI) pilots to validate solutions within a variety of real-life settings and platforms, for example, hospital, community, NHS website and app. Work with patients, pharmacists and HCPs to identify digital ePI use cases, including use cases for HCP-facing medicines information and prompts for interacting with patients. Specifically focus on co-designing solutions for patients who have difficulty accessing information or who have particular needs, such as patients with cognitive or sensory differences, health literacy or digital literacy needs. Co-develop a digital-first approach to provide ePI, ensuring that no patient is left behind. Provide appropriate training for HCPs to help them identify health and digital literacy needs and proactively ensure alternative access where ‘digital exclusion’ is identified. Optimising the impact of technology by: Demonstrating trustworthiness through development of good governance, transparency, privacy and security. Focusing on defining the problem, gathering evidence, and conducting small tests of change. Explore working with NHS England to implement structured ePI and develop standards and funding for a sustainable digital model. Over time, making ePI an integral part of the digital health landscape so that technology providers can build innovative solutions which address the needs identified in this report – establishing the UK as a global leader in this arena. Supporting patients to make best use of ePI as it becomes available. With a multi stakeholder roadmap approach, evolving towards personalised medicines product information, connecting with the electronic health record. Ensure strong connections with regulation & policy setters: Review legislation and regulation to identify potential adaptation in support of patient and carbon-friendly digital first approaches. Strengthen the real-world evidence base to understand how medicines information impacts on patient activation, adherence and outcomes. Obtain government support at the highest level to implement these recommendations.

Key findings Nearly 1 in 10 people have skipped medication in the past year due to the cost of prescriptions. Of this group, 30% now have other physical health problems in addition to their original health condition, 37% now have other mental health problems in addition to their original health condition, and over half (53%) have had to take time off work as a result of worsening health. 1 in 10 (9%) report being unable to collect their prescription due to the cost in the last 12 months. 38% of respondents became aware of the Prescription Prepayment Certificate more than a year after their diagnosis with a long term condition. Around a third (35%) have had the duration of their prescription changed, meaning they’re paying more frequently for their medicines. Recommendations The report makes the following recommendations: The UK Government should commit to freezing the charge for 2024. Recommend that prescribers stop reducing the duration of prescriptions - as this prices people out of affording their vital medicines. Conducts an independent review of the prescription charge exemption list urgently. The review should examine the benefits to the health of the citizens in Northern Ireland, Scotland and Wales of scrapping the charge, and also take into account health inequalities. Scrap their plans to align prescription charges with the state pension age. Ensure information about prescription charge entitlements (including the low income scheme and PPCs) are provided to all those with long term conditions when they are diagnosed with their condition. This information should also be given out when medicines are dispensed and reviewed. Materials covering these topics should also be displayed at all GP surgeries and pharmacies.

Findings While national guidance says that a patient’s risk of harm should not be stratified into categories such as high, medium or low, such stratification remains common in many trusts. This is because other methods of assessing and documenting risk are not available, and because staff fear being blamed if a patient comes to harm without a risk assessment, including risk stratification, having been completed. Current research only demonstrates a link between menopause and low mood, and not between menopause and more severe mental health symptoms. Women are frequently prescribed antidepressant medication when hormone replacement therapy may be a more appropriate treatment for their symptoms. Menopause is not routinely considered as a contributing factor in women with low mood who are assessed by mental health services, and staff do not receive training in this area as standard. While there is a significant amount of national guidance relating to family engagement when treating patients with mental health conditions, mental health practitioners often find it difficult to know how and when to engage with families with complicated relationships or when the patient withdraws their consent for information sharing. There is a lack of training in this area to support staff with decision making. National guidance raised the upper age limit for referral to the Early Intervention in Psychosis pathway in 2016. Some trusts continue to prioritise younger patients for a variety of reasons – including funding, capacity and misconceptions about whether an older person can actually be experiencing a true first episode of psychosis in later life. Safety recommendations HSIB has made four safety recommendations as a result of this investigation. NHS England: HSIB recommends that NHS England works with appropriate stakeholders, including experts with appropriate experience, to create guidance on culture change. A quality improvement programme should also be developed to support practitioners in undertaking psychosocial assessments that are in line with guidance from the National Institute for Health and Care Excellence. Person-centred safety planning should be embedded within the process. Care Quality Commission (CQC): HSIB recommends that the Care Quality Commission evaluates the way in which it reviews how community mental health services assess risk of harm, to ensure its inspections are in line with the latest national guidance. National Institute for Health and Care Excellence (NICE): HSIB recommends that the National Institute for Health and Care Excellence evaluates the available research relating to the risks associated with menopause on mental health and if appropriate, updates existing guidance. Royal College of Psychiatrists (RCPsych): HSIB recommends that the Royal College of Psychiatrists forms a working group with relevant stakeholders to identify ways in which menopause can be considered during mental health assessments. Safety observations HSIB has made the following safety observations: It may be beneficial for mental health organisations to have a dedicated liaison officer who acts as a point of contact for both families and clinicians when navigating involvement in a patient’s care and decision making. It may be beneficial for organisations to involve families in care planning and assessments, and that practitioners are appropriately trained in working with families. It may be beneficial for education bodies to develop training programmes in safety planning and psychosocial assessments, once NHS England has provided guidance on how such assessments should be conducted. It may be beneficial for mental health organisations to ensure their Early Intervention in Psychosis referral process is in line with the national guidance, and that staff are clear about the upper age limit of patients accepted onto the pathway. Safety actions HSIB has noted the following safety action: NHS England has written to all mental health trusts in England to highlight the importance of taking a person-centred approach to psychosocial assessments and safety planning. The communication asks trusts to move away from risk assessment tools that stratify an individual’s risk of suicide or self-harm.