HelenH
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Everything posted by HelenH
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B0bdc530c5699988bcac7941fa0471c8Thanks Sue for your comment and sorry to hear that you’ve had direct personal experience of these issues. I think the saddest part of your response for me was ‘There can be no dissenting, no admission of problems or bad practice and this usually results in the removal of both the person raising concerns and the manager who acknowledged it.’ We are destined to repeat errors and harm patients unless we challenge the status quo. Alarming also what you say about the role and approach of professional bodies. Would you like to share more? You’d be very welcome to contact me direct on this. Maybe that’s something we can explore and highlight on the hub? Thanks again for your insight and comment [email protected]
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Community PostHi Nik, Thanks for your post. How gruesome, I'm so sorry. We know that many women similarly report this intense pain and just have no idea what they're going to experience when they agree to the procedure. We've been working with the amazing women at Hysteroscopy Action to build on their campaigning to demand safer and pain free care with women being fully informed before they consent. @Claire Cox and I have been a little deflected with the pandemic but we're very keen to re-active our work on this important issue. Thanks for sharing. We must stop this happening. Helen
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B0bdc530c5699988bcac7941fa0471c8One of the most powerful responses I’ve heard to the pandemic. Wonderful insight and advice. Thank you, Sally. I’m going to share widely. Helen
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Community PostThanks David. I’ve promoted on my FB and LinkedIn accounts too. Hope you’re well and safe. Helen
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Community PostThink I’d do the same! Need a clinician’s input here @Claire Cox what do you think?
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B0bdc530c5699988bcac7941fa0471c8Well said Kathy. Some of this is resourcing but much of this is prioritisation that doesn’t put patient and staff safety as a core purpose. Lessons must be learned
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B0bdc530c5699988bcac7941fa0471c8‘There are not any showers for nurses at work.’ Outrageous. We have to care for staff. No staff safety, no patient safety
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B0bdc530c5699988bcac7941fa0471c8Great that Royal Free have recognised the necessity of supporting staff at this very difficult time. Wondeful that your skills, energey and compassion are being released to support this. Please do keep us in touch with insights into how its all going. I'm sure there's valuable learning that others can benefit from. Best wishes, Helen
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Community PostThere is much that is well intentioned in this framework. I think there is much that will not achieve the aims and may result in serious unintended consequences. I'm drafting a blog to kick off discussion.
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B0bdc530c5699988bcac7941fa0471c8James says 'If our understanding of, and our systems for, patient feedback are limited to seeing it simply as data, concerns, compliments, or even stories, then I think we are missing this bigger picture. Feedback is a relationship. It is one way that people receiving a service can express their care, in return, for those who provide it, and for others who will use it. It is an expression of the values of equality and mutuality which lie at the heart of our health service. Our current approaches to patient feedback recognise little of this – and it is time they did.' Absolutely. Completely agree
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B0bdc530c5699988bcac7941fa0471c8Brilliant as ever @MartinL I learn so much from your insights and advice. I wonder whether the NHSI Patient Safety Incident Response Framework will reflect this wisdom? https://improvement.nhs.uk/resources/future-of-patient-safety-investigation/
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Community PostInteresting there’s a bbc 3 and bbc 2 programme on SW London MH Trust tonight
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B0bdc530c5699988bcac7941fa0471c8Thank you. 'it is up to the investigator/team to establish the facts including obtaining information from those involved' Absolutely. One of the challenges that we hear is whether such people/teams have the capacity to respond as you outline. Commitment and knowledge does need to be matched with sufficient resources to investigate, learn and then take action. Any insights that you have of good practice, we'd love to hear from you - in a blog or sharing policies, SOPs, guidance etc. Helen
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B0bdc530c5699988bcac7941fa0471c8I think collectively that many have forgotten that reporting is about learning and taking action to prevent errors and harm. It’s not an activity my it’s own right! It’s also part of caring for and an accountability to staff, saying that we your concerns matter and we’re going to take them seriously. Danielle, I love your suggestions. We’re going to be collating examples of great practice to share and we’ll start with these! If you’ve more detailed information or would write a blog on what you do and the impact it has, that would be wonderful. [email protected]
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Community PostHi Claire, this must have been awful for everyone. Is this a legal requirement, that a consultant must sign a form?
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B0bdc530c5699988bcac7941fa0471c8I've just re-read. Too good a series just to read once. My favourite quote on this one is 'Scheduling 12-hour days – well it keeps investigators in work.' Sadly, I think 12 hour shifts are becoming the norm in healthcare. And that excludes the journey to and from work.
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B0bdc530c5699988bcac7941fa0471c8Thank you again for your insight, commitment and bravery. Good questions for Boards., leaders, CQC and Healthwatch to ask too: "Are staff allowed to Speak Up and report safety incidents?" "Are the reports followed up and lessons shared without victimising the person who reported it?" Staff should be allowed for sure. But ideally they should be encouraged and welcomed. Helen
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B0bdc530c5699988bcac7941fa0471c8Thanks for your insights Sue. Congratulations and good luck with the role. Will be great for there to be more of you! Please keep in touch as the role develops, we'd love to hear your journey and reflections for others to learn from. Helen
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B0bdc530c5699988bcac7941fa0471c8Hi David, a very good point. And a general one about the role of NHSI with regard to patient safety and incident reporting. NHSI is leading on replacing the now outdated NRLS. How will this inform learning and action? Will all risks reported be analyses and transparently reported. Will this be accompanied by the insight from Trusts that have responded with improvement action and advice for others #share4safety What do people think? @Clive Flashman
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Community PostHi Jon, thanks for kicking this off. We’re going to be sharing a blog on this shortly and to help inform discussions. I met briefly with the Academy of Medical Royal Colleges on this yesterday so have some insight to contribute. Btw the consultation response is limited to 500 characters as they want themes not detailed comments. Personally I don’t think this is appropriate stakeholder engagement and consultation on such a vital contribute to patient safety. Patient Safety Learning will update and tweet soon. @Sue Hignett Definitely one for you to review Helen
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B0bdc530c5699988bcac7941fa0471c8Thank you Martin, much rich insight here. NHS Improvement is developing a new Serious Incident Framework. I do hope that this work reflects on: 'HFs in the first sense is a study of basic processes. Investigations are always about these basic processes – seldom about how someone felt about someone else and about how these senses interacted with the environment, the equipment and the system or method of working.' There is criticism that current approaches to investigation prioritise 'process over outcome.' Let's hope that changes soon.
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Community PostHi Jon I've heard directly from Aidan that there won't be an implementation plan as such for the NHSI PS strategy, they're just getting on with it. Aidan says they are reporting back through the National Quality Board. I met with Ted Baker this morning from CQC, he jointly chairs the NQB. I said there were a lot of interested people in the service (clinicians, ps and risk managers in providers and commissioners) who want to know what the NHSI PS strategy implementation means for them and in particular the incident framework. I'd also heard at a meeting with @Amelia from Browne Jackson that the framework will be released to pilot sites only at this stage and only wider after pilot evaluation. Would love to know more if anyone else has any insights to share. Thanks for raising Jon, sorry I can't help more with the answers. Helen
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B0bdc530c5699988bcac7941fa0471c8Dear anonymous HCA, Thank you for sharing your experience with us. What a shocking and distressing account; both for the residents of the home and for yourself. Would you be willing to speak with the CQC? Colleagues there have already been very responsive to another whistle blower who contacted us. I'm sure that the CQC would be keen to know the details of the home so that they can follow up. Here are links to CQC's site should you or anyone else want to report poor care. https://www.cqc.org.uk/contact-us/report-concern/report-concern-if-you-are-member-staffhttps://www.cqc.org.uk/give-feedback-on-care It may be that there is a professional regulation concern. The NMC state that 'they exist to enable better and safer care. One of the ways we do this is by acting when someone tells us they have a concern about a nurse, midwife or nursing associate which could put the safety of patients at risk, or damage the public’s confidence in the nursing or midwifery professions.' ...... and that 'If you feel uncomfortable about contacting the employer, or you don't know who the employer is, or it seems as though the public might be at risk, then we would encourage you to go ahead and make the referral to us.' https://www.nmc.org.uk/concerns-nurses-midwives/concerns-complaints-and-referrals/making-a-referral-to-us/ I hope that's helpful. With very best wishes, Helen
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