Clive Flashman

Confidentiality is frequently seen as a key barrier to clinicians working effectively with the family and friends of people experiencing a mental health crisis. This half day interactive course examines misconceptions about confidentiality and information sharing and offers suggestions for ways to develop your practice to offer more support and information to family and friends carers so that they are more confident about what they can reasonably do to keep their family member safe. We use the term family carers to mean anyone who is significant to the patient, including biological and non biological family and friends who may or may not live in the same household or even the same country. WHO SHOULD ATTEND This course is suitable for anyone working in Health and Social Care whose work brings them into direct contact with someone experiencing a mental health crisis. This includes psychiatrists, nurses, ED service leads, social workers, occupational therapists who have all benefitted from this training. Price: £234 More information and booking link here.

There is a great deal of professional and statutory guidance that expects clinicians to involve the families of people during and following an acute mental health crisis. And yet, Coroner’s Prevention of Future Deaths reports, and investigations following homicides when the perpetrator had a diagnosed mental illness, regularly point to the lack of meaningful engagement of the family, the failure to listen to their views, experiences and needs, or to offer them support and information to keep their family member safe. Martha’s rule, which is to be extended to mental health services, will also require good working relationships with families. Making Families Count Life Beyond the Cubicle project was funded by NHS England (HEE South East Region legacy funds). The project’s resources were co-created with patients, family carers and clinicians, tested in eleven NHS Trusts, and independently evaluated. The resources have been shown to encourage clinicians to work well with family and friends in order to improve care, avoid harm and reduce deaths. This training is offered to support Trusts and social care agencies to embed effective working with family carers across their workforce. It is participative and interactive, and explores the key reasons clinicians find it challenging to work well with family carers, with time to share and explore good practice and share experiences of approaches taken to improve patient care and family involvement. The Life Beyond the Cubicle eLearning resources are available free to health and social care professionals via the NHS England eLearning platform. NHS Trusts can download the modules and upload them to their own Learning and Development system. WHO SHOULD ATTEND This course is suitable for anyone working in Health and Social Care whose work brings them into contact with people experiencing mental health crises, and whose role offers opportunities to facilitate group discussions and learning. Price: £354 More information and booking link here.

Good and clear communication between clinicians, patients/service users and family carers are vital for establishing and maintaining effective working relationships that can keep people who are experiencing mental health crises safe. This interactive half day course uses audio and video case studies and scenarios to explore common barriers to effective communications and what can be done about them. We use the term family carers to mean anyone who is significant to the patient, including biological and non biological family and friends who may or may not live in the same household or even the same country. WHO SHOULD ATTEND This course is suitable for anyone working in Health and Social Care whose work brings them into direct contact with someone experiencing a mental health crisis. This includes but is not limited to psychiatrists, nurses, ED service leads, social workers, occupational therapists and peer support workers. Price: £234 More information and booking link here.

Good and clear communication between clinicians, patients/service users and family carers are vital for establishing and maintaining effective working relationships that can keep people who are experiencing mental health crises safe. This interactive half day course uses audio and video case studies and scenarios to explore common barriers to effective communications and what can be done about them. We use the term family carers to mean anyone who is significant to the patient, including biological and non biological family and friends who may or may not live in the same household or even the same country. WHO SHOULD ATTEND This course is suitable for anyone working in Health and Social Care whose work brings them into direct contact with someone experiencing a mental health crisis. This includes but is not limited to psychiatrists, nurses, ED service leads, social workers, occupational therapists and peer support workers. Price: £234 More information and booking link here.

The new NHS England guidance Staying Safe from Suicide; confirms that risk cannot and should not be measured using risk scales, and that any such scales are dangerously misleading. A more helpful and hopeful perspective is to think about the safety of people who might at times feel suicidal. This includes engaging in collaborative safety planning with patients and their family carers. This interactive half day course uses video and audio case studies to examine why safety planning is so important, and explores practical ideas about how meaningful and feasible safety planning can be carried out with family carers. Price: £234 More information and booking link here.

The new NHS England guidance Staying Safe from Suicide; confirms that risk cannot and should not be measured using risk scales, and that any such scales are dangerously misleading. A more helpful and hopeful perspective is to think about the safety of people who might at times feel suicidal. This includes engaging in collaborative safety planning with patients and their family carers. This interactive half day course uses video and audio case studies to examine why safety planning is so important, and explores practical ideas about how meaningful and feasible safety planning can be carried out with family carers. Price: £195 & VAT (£234) More information and booking link here.

Digital Health Rewired 2026 is the UK’s biggest digital health expo, bringing together everyone using digital and data to improve health and care. Held on 24-25 March at The NEC Birmingham, the event gathers NHS leaders, care providers, researchers, academics, start-ups, suppliers, and innovators to explore how digital technology supports productivity, equity, and better outcomes. With speakers, inspiring NHS case studies, and cutting-edge solutions, Rewired offers valuable learning and networking opportunities. Whether you’re shaping policy, delivering care, or building digital tools, Rewired is your chance to connect, learn, and lead in transforming health and care through digital innovation and collaboration. Register your place here. Find the full programme here. Follow updates via #Rewired26.

This blog highlights confusion and anxiety among NHS staff following the rollout of Microsoft Copilot, which many learned about only after gaining access. In the first part, a Patient Safety Manager describes their panic on discovering that Copilot could see confidential files, with little guidance provided to them on what is safe or permitted. They felt NHS advice was vague and risk-shifting, leaving staff uncertain and exposed. Patient Safety Learning's Chief Digital Officer, Clive Flashman invited wider engagement on the issue, revealing inconsistent rollouts across Trusts and a lack of clear, practical support. A LinkedIn discussion drew major attention, prompting resource sharing and calls for stronger national coordination, clearer rules, and better training to ensure safe, confident use of AI tools. In the second part of this blog, Clive offers his insights on these issues, reflects on the wider response and shares some useful links. The senior patient safety manager who shared their concerns with Patient Safety Learning has chosen to remain anonymous, but has given their permission for us to publish their first person reflections. Last week, an email landed in my inbox from “the NHS” announcing that Copilot had officially launched — and that it was free for all NHS staff to use. I’ll admit, I was curious and a bit excited. We hear a lot about AI transforming healthcare, and if there’s something that could make our paperwork lighter and free up more time for patients, I’m all for it. But then reality set in. I clicked the link, logged in with my NHS email, and suddenly there it was: everything. Our shared documents, HR folders, Duty of Candour letters, meeting notes, even files that contained sensitive patient information. My first reaction wasn’t amazement — it was panic. Had I just exposed confidential NHS data to the internet? Was this even allowed? I shut it down immediately and emailed our Information Governance (IG) team. The response I received said: “The NHS uses Copilot for administrative and support tasks, such as drafting emails, summarising meetings, and creating documents in Microsoft 365 applications, to free up staff time for patient care. No patient or staff data should ever be included in Copilot. Staff will be responsible if they choose to input patient or staff information into Copilot.” Reading that, it almost sounded as if the reply had been written by Copilot itself — formal, factual, but not particularly helpful. I still didn’t know what I could safely do on it, or how it might genuinely help me in my day-to-day work. From a front-line perspective, this rollout has felt confusing. We’re constantly reminded about data security and confidentiality — now we’re being handed a tool that seems to see everything, with no real explanation of how it works, what’s off-limits, or how to use it effectively. I can see the potential. If Copilot can really help summarise meetings, draft letters, or tidy up reports, that could save precious hours. But right now, without clear NHS-specific training or guidance, it feels risky to experiment. What staff like me need is practical direction, not just reassurances. We need: Clear, accessible rules about what can and can’t be entered. Examples of everyday, safe tasks Copilot can genuinely help with. Transparency about where the data lives and how it’s protected. Real-world demos showing how it supports our roles — clinical, admin, or managerial. Until then, many of us will continue to tread carefully — not because we fear new technology, but because we understand how critical it is to protect patient data. Feeling alone and uncertain about where to turn, I reached out to Patient Safety Learning — an organisation I trust to listen and take my concerns seriously. If Copilot is meant to help us fly, someone needs to show us where the cockpit is. Patient Safety Learning's response (Clive Flashman, Chief Digital Officer) The first thing I did was reach out to some other NHS frontline staff at other organisations to ask how the rollout of CoPilot had been done at their organisations. Every rollout described was from my perspective, ‘sub-optimal’. My response to the Patient Safety Manager was along the lines of “essentially, your documents are all held in the MS cloud (Azure) and CoPilot is a search/ assistant tool residing in the same space. No information is leaving the MS cloud and it shouldn’t change the role-based access controls that determine what you and others can and can’t see within it.” So, I was able to reassure the Patient Safety Manager that there shouldn’t be an Information Governance issue that should be of concern to them. However, what about the clinical data that CoPilot enables the manager to review? This could include legitimate folders and documents containing things like: complete and draft investigations and reviews into patient safety incidents complaints correspondence and reports coroner’s inquest investigations and submissions to court reports to Trust Quality & Safety Committees and Board reports Many, if not all of these, would contain sensitive patient and staff information. This was at odds with the Trust’s response of "no patient or staff data should ever be included in Copilot. Staff will be responsible if they choose to input patient or staff information into Copilot." Understandably the Patient Safety Manager was concerned that they hadn’t been given any guidance on the use of such data. They felt concerned and vulnerable that using CoPilot to help with administrative efficiency for their role could be personally compromising. This felt a very blaming approach, ‘you get it wrong, and you’re culpable.’ I wasn’t sure who would be able to guide me best on this, so we decided that we’d connect with the NHS hive mind and I wrote a LinkedIn post about this. The post highlighted that more needed to be done to support NHS staff in understanding and using CoPilot – and also understanding what it should not be used for. I asked what others were doing and for their advice. The interest in that post was electric. So far it has had just over 40,000 views and hundreds of reactions and comments. The lead person for CoPilot rollout in NHS England became involved in the conversation, as did people from Microsoft. There were differing views on how the rollouts had been handled, and given the fact that this was all done locally, that’s not surprising. The NHS England had done a significant amount of work with the initial proof of concept (30,000 users) and writing use cases and benefits models (as well as apparently a DCB0129 – where is that?). However, I think the fact that the implementation was largely left to local NHS organisations was a mistake, given the uncertainty and variability in responses we’ve seen. I think that communication briefings should have been handled locally, by arranging webinars, training sessions, FAQ lists etc. It would have been helpful for resource packs to have been developed centrally and informed by the pilot. If this id happen, many frontline staff haven’t seen these resources or made use of them. I updated the LinkedIn post to capture the resources that had been shared in the comments (and in some direct messages to me). If other people have useful resources they’d like to share, please do comment below with the links, or you can email our team at [email protected]. Thank you to all those that shared their experiences, helpful resources and their commitment to ensure every staff member is secure in how they use and benefit from CoPilot. Sherwood Forest Hospitals have a 'Responsible use of M365 Copilot for NHS.net Connect' Guide: https://www.sfh-tr.nhs.uk/media/sajavs1n/co-pilot-responsible-use-of-co-pilot.pdf Resources from Microsoft: https://adoption.microsoft.com/en-gb/copilot/ Staff training resources: https://livesend.microsoft.com/ls/1a365ac1-986b-4ff7-9be0-b9e3a7309501/MQEQhnztYeaVOYy6#/ Microsoft end user self-paced learning: https://support.microsoft.com/en-gb/microsoft-365-copilot An example of role-based training provided by Microsoft (this one is for Clinical Administrators): https://msit.events.teams.microsoft.com/event/3c0b9862-fcc4-4994-b6ce-4d8024900191@72f988bf-86f1-41af-91ab-2d7cd011db47 M365 Copilot and M365 Copilot Chat (Web) Acceptable Use Policy: https://comms-mat.s3.eu-west-1.amazonaws.com/Comms-Archive/M365+Copilot+Acceptable+Use+Policy+v1.1.pdf Data Protection Impact Assessment - NHS.net Connect (formerly NHSmail) M365 Copilot : https://comms-mat.s3.eu-west-1.amazonaws.com/Comms-Archive/NHS.net+Connect+Microsoft+365+Copilot+DPIA+v2.0+(GA).pdf We hope that you find this blog of interest, and it might help the NHS reflect on the balance of directing and supporting Trusts in future AI and technology rollouts. And with so much more promised in the 10 Year Plan, let’s all consider how we can support front line staff to optimise the opportunities for productivity improvement.

The advance of artificial intelligence (AI) has seen the emergence of digital diagnostic tools, with some claiming a more accurate diagnosis than a human. But what challenges does this present to patient safety? In this blog, Clive Flashman, Patient Safety Learning's Chief Digital Officer, looks at some of these new digital tools that are becoming  increasingly available not only to clinicians but also for patients, and highlights some of the risks that they bring and considerations that need to be thought through. This blog has been published as part of a series for World Patient Safety Day 2024 and the theme of Improving diagnosis for patient safety. #WPSD24, World Patient Safety Day 2024, WPSD 2024. Why diagnosis is important When you have been feeling unwell for a while despite the over-the-counter remedies that you’ve bought, you try and make an appointment to see your GP. Note that I said ‘try’; getting a GP appointment these days is a bit like a long distance run, with no guarantee that you will cross the finish line anywhere near the time you’d hoped for. When you do see your GP, they will draw on their medical school training, their years of experience, their knowledge of you as their patient (or at least what the medical record they hold about you contains) and, from all of that, determine what might be wrong with you. They might need some additional evidence before confirming that diagnosis—so they might request that you have a blood test or an MRI, etc. Once those results are back, you will be contacted again by the GP (or one of their staff) to tell you what that means for you. Was the original diagnosis correct? Has it changed? How will you be treated? Diagnosis is the starting point for therapeutic treatment The diagnosis is the starting point for therapeutic treatment. Get that wrong and, like a long line of dominos, everything else will fall out of place. We are reliant on this diagnosis to make our recovery (if that is possible) or to at least return to some form of wellness. It is pivotal in the patient’s care pathway and there are around 1.5 million[1] primary care consultations a day, of which 45% are with a GP. It is also critical that the diagnostic test is carried out and the results delivered promptly to give a timely and more accurate diagnosis. Sadly, as of May 2024, 1.66 million[2] people are on the waiting list for a diagnostic test—the highest figure since the current data series started being collected in January 2006. A new model for diagnoses In recent years, advances in AI have seen the emergence of digital diagnostic tools. Perhaps the most well known of these is Babylon Health, once valued at $4.2 billion, which collapsed in 2023 having already pulled out of the NHS contracts it had previously won.[3] Its main competitor for general AI-driven health diagnosis is Ada Health, which features a link to a medical journal (Rheumatology International) on its website that claims that “Ada was more accurate than physicians in suggesting the correct final diagnosis (54% of cases vs physicians' 32%)”.[4] Personally, I’m not sure that even a 54% diagnostic accuracy rate is that great, but compared to an awful 32% for human doctors, it is clearly an improvement. One of the most successful areas where AI has been involved in diagnosis is in the interpretation of medical images. Typically, two radiographers would review the same X-ray and come to individual conclusions about what is being shown, then compare those conclusions to make a final judgement. Studies have shown that where one of those radiographers is replaced by an AI equivalent, the diagnostic accuracy rate is at least as good if not better than before.[5] Many of these tools are for use by clinicians. They are expected to overlay their own judgement on top of the recommendations provided by the digital solution. However, increasingly digital diagnostic tools are being aimed at both patients and clinicians (Ada Health being the most obvious one). For example: MiiCare - blends smart home surveillance, an AI-driven voice assistant and vital signs monitoring to create a unique at-home virtual care solution. Healthy.io – offers standardised digital wound management services that help clinicians make better care decisions using the smartphone camera to accurately capture wounds and analyse their progress. Qure.ai – uses AI algorithms for medical imaging to identify and localise abnormalities on X-rays, MRI and CT scans. Odin Vision – helps clinicians to detect and diagnose polyps during colonoscopy procedures. PocDoc – looks to leverage the ubiquity of smartphones, turning them into personal diagnostic devices able to detect a range of major diseases from a pinprick of blood. Zio by iRhythm – helps clinicians and patients to quickly spot and confirm heart arrythmias. Binah.ai – uses the smartphone camera to calculate vital signs. Its software looks at the region around the eyes, where the skin is a bit thinner, and analyses the light reflecting off blood vessels back to the lens. Canary Speech – uses the same underlying technology as Amazon’s Alexa to analyse patients’ voices for mental health conditions. eMoodie Minds – a digital-first mental health assessment tool. Feebris – used with a digital stethoscope for earlier diagnosis of childhood pneumonia. Home: the new setting for diagnostic tests With the increasing availability of home-based tests from companies such as Thriva, PocDoc, Pinpoint (blood testing) and Healthy.io (urinalysis) —which can all link to smartphone apps to leverage AI algorithms, potentially support diagnoses and track conditions — diagnostic testing at home is becoming more prevalent. This frees up clinician time and clinic space. However, it relies on the patient to perform the test accurately and submit the reading in a complete, timely and accurate manner. Regulatory and ethical guardrails There are a significant number of hurdles that digital health technology suppliers in the UK have to jump before their solutions can be used by doctors or patients. The Medicines and Healthcare Products Regulatory Agency (MHRA) sets strict guidance on the evidence that is required and, in some cases, software will be classed as a medical device[6] and treated with the same regulatory rigour. NICE expects digital health technologies to have involved patients and healthcare professionals in their design and testing, and also to have gathered increasing amounts of evidence about efficacy.[7] This can be anything from a simple impact evaluation to a full randomised control trial, depending on the level of clinical judgement and recommendations the digital solution will be providing. NHS England demands that all NHS buyers of digital health technologies will complete a clinical safety case[9] for each solution they buy and also to complete the DTAC (Digital Technology Assessment Criteria), which considers: clinical safety (again) data protection clinical assurance interoperability usability and accessibility. Challenges However, patients are not trained how to interpret health data[8] and are also potentially at risk if seeing a diagnosis for the first time without adequate support in place. People who are newly diagnosed with a condition generally want to talk it through with a clinician, discuss treatment options, understand the impact it may have on their lives. Being left alone with your diagnosis, and having to then proactively make appointments to discuss it, is not what patient groups might consider the best approach to patient-centred care. Passive data collection, such as through a clinically certified wearable device or skin patch, can be relied upon to provide reasonably accurate data. However, where the patient is expected to conduct their own diagnostic test using their phone, or gathering blood or urine, the reliability of the data collected might be lower. There are also people who are not able to use these types of technologies or tests at home. They may be one of a group of people who are digitally excluded or have impairments (fine motor skills, cognition, visual, etc.) that mean that they cannot use the necessary items. In the same way that many people hate the push by supermarkets to move to self-checkouts where the burden is placed on the shopper to scan their own goods, some people also recoil at the thought of having to do their own medical tests and interpret the results. Conclusion It is inevitable that we will move to see more digital health diagnostics used by healthcare professionals and patients. However, we should not forget that this will not be appropriate for some people and offer other options for them to gain a formal diagnosis. People using digital diagnostic tools should be able to call on support where they need it and the guardrails that we have in place should be continuously reviewed so that they deal with new and innovative technologies before they cause significant harm to users. It is my view that these tools should be smart enough to recognise when a new (significant) diagnosis has been given to the patient and, in those cases, immediately contact a clinician to advise that support should be provided. If that cannot be done, then new diagnoses of this nature should not be communicated directly to a patient. References BMA. Pressures in general practice data analysis, 26 July 2024. Kirk-Wade E, Harker R, Stiebahl S. NHS key statistics: England. House of Commons Library, 16 July 2024. The Fall of Babylon Is a Warning for AI Unicorns. Wired, 19 September 2023. Graf M, Knitza J, Leipe J, et al. Comparison of physician and artificial intelligence-based symptom checker diagnostic accuracy. Rheum Int, 2022:42(12):2167-2176. doi: 10.1007/s00296-022-05202-4. Epub 2022 Sep 10. King's College London. AI trained on X-rays can diagnose medical issues as accurately as doctors, 11 December 2023. MHRA. Guidance. Software and AI as a Medical Device Change Programme - Roadmap. Medicines and Healthcare products Regulatory Agency, 14 June 2023. NICE. Evidence standards framework (ESF) for digital health technologies. NIHR Evidence: Health information: are you getting your message across? June 2022; doi: 10.3310/nihrevidence_51109 NHS England. Digital clinical safety assurance, v 1.1, 28 July 2023. Share your insights What do you think about the digital developments in health that Clive talked about in this blog? Do you have an experience to share as a patient, or as someone who works in this area? If you'd like to share your insights around digital health and patient safety, get in touch with the team at [email protected]. Have you been affected by a late diagnosis? Or perhaps you have insights to share on diagnostic safety through the work that you do. If you would like to write a blog or share your thoughts, experiences or resources through the hub please get in touch with our team at [email protected] or add your comments to our community forum page.