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Content ArticleRisk assessment during the maternity pathway relies on healthcare professionals recognising a change in a pregnant woman/person’s circumstances that may increase the level of risk. Risk assessments are undertaken during the numerous contacts pregnant women/people have with a team of healthcare professionals throughout the maternity pathway. This thematic review draws on findings from the Healthcare Safety Investigation Branch's (HSIB's) maternity investigation programme to identify key issues associated with assessing risk during pregnancy, labour and birth (known as the ‘maternity pathway’). It examined all reports undertaken by the HSIB maternity investigation programme from April 2019 to January 2022, with the aim of identifying key learnings about risk assessment. A total of 208 reports that had made findings and recommendations to NHS trusts about risk assessment during the maternity pathway were included. The review identified an overarching theme around the need to facilitate and support individualised risk assessments for pregnant women/people to improve maternity safety. Within this, seven specific ‘risk assessment themes’ within the maternity care pathway were identified as commonly appearing in HSIB reports. These seven themes require a focus from the healthcare system to help mitigate risks and enable NHS trusts and clinicians to deliver safe and effective maternity care to pregnant women/people.
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Content ArticleThe Harmed Patients Alliance (HPA) was founded to highlight and promote restorative approaches to healthcare harm. To support their campaign for action, HPA carried out a survey of 44 people asking how those harmed by their contact with healthcare felt about the response, and what impacts this had on them. They were also asked what could have been done differently.
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Content ArticleVictoria Vallance, Director of Secondary and Specialist Care, provides an update on the Care Quality Commission (CQC)’s ongoing national maternity inspection programme and offers early insight into the emerging themes, including good practice examples to support wider learning across all trusts.
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Content ArticleFor people who have sensory impairments or learning disabilities, understanding complex medical information presents a barrier to access. The Accessible (AIS) Information Standard, introduced in 2016, gives disabled people and people with sensory loss the legal right to receive health and social care information and communications in a format that works for them. In 2018, two years after the AIS became law, Karl, who is blind and relies on braille and assistive technologies to access information and communication about his healthcare and appointments, contacted his local Healthwatch to tell them he was having ongoing issues accessing his healthcare information and communications. This case study tells Karl's story and highlights why considering patients' individuals accessibility needs is so important.
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Content ArticleThis document offers advice and guidance for people with Long Covid who are having difficulties communicating with others as a result of their symptoms. It explains how Long Covid can impair communication by affecting speech, language and voice. It also outlines how many people are affected by Long Covid-related communication issues, explains how speech and language therapists can help and offers simple tips on how to improve communication with Long Covid.
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Content ArticleThis report from the King's Fund looks at the reality of caring for acutely ill medical patients at the NHS front line and asks how care in hospitals can be improved. It comprises a series of essays by frontline clinicians, managers, quality improvement champions and patients, and provides vivid and frank detail about how clinical care is currently provided and how it could be improved. The essays are introduced and summarised by Chris Ham and Don Berwick and the report serves as the starting point of an ongoing appreciative inquiry into improving care processes, particularly for acutely ill medical patients.
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Content Article
Diabetes Type 1: S.T.I.G.M.A. (Revolve Comics)
Patient Safety Learning posted an article in Diabetes
Type 1: S.T.I.G.M.A. is the third issue in the type 1 diabetes comic series. Here, the focus is on stigma and on the risk that can be posed to people with type 1 diabetes if blood sugar levels fall too low… Supported by the NHS. -
News Article
GPs say parents need clearer strep A advice
Patient Safety Learning posted a news article in News
GP leaders have urged the government to put out clearer advice for parents about when to seek help over potential strep A infections. Prof Kamila Hawthorne, of the Royal College of GPs, said many surgeries were struggling with the extra demand on top of existing pressures. The government should consider "overspill" services for surgeries unable to cope, she said. Since September, 15 UK children have died after invasive strep A infections. This includes the death of one child in Wales, and one in Northern Ireland. There have been no deaths confirmed in Scotland. The UK Health Security Agency figures (UKHSA) show there have also been 47 deaths from strep A in adults in England. Most strep A infections are mild, but more severe invasive cases - while still rare - are rising. Prof Hawthorne, said: "We do not want to discourage patients who are worried about their children to seek medical attention, particularly given the current circumstances. "But we do want to see good public health messaging across the UK, making it clear to parents when they should seek help and the different care options available to them - as well as when they don't need to seek medical attention." Read full story Source: BBC News, 8 December 2022 -
News ArticleVoices offer lots of information. Turns out, they can even help diagnose an illness — and researchers in the USA are working on an app for that. The National Institutes of Health is funding a massive research project to collect voice data and develop an AI that could diagnose people based on their speech. Everything from your vocal cord vibrations to breathing patterns when you speak offers potential information about your health, says laryngologist Dr. Yael Bensoussan, the director of the University of South Florida's Health Voice Center and a leader on the study. "We asked experts: Well, if you close your eyes when a patient comes in, just by listening to their voice, can you have an idea of the diagnosis they have?" Bensoussan says. "And that's where we got all our information." Someone who speaks low and slowly might have Parkinson's disease. Slurring is a sign of a stroke. Scientists could even diagnose depression or cancer. The team will start by collecting the voices of people with conditions in five areas: neurological disorders, voice disorders, mood disorders, respiratory disorders and pediatric disorders like autism and speech delays. This isn't the first time researchers have used AI to study human voices, but it's the first time data will be collected on this level — the project is a collaboration between USF, Cornell and 10 other institutions. The ultimate goal is an app that could help bridge access to rural or underserved communities, by helping general practitioners refer patients to specialists. Long term, iPhones or Alexa could detect changes in your voice, such as a cough, and advise you to seek medical attention. Read full story Source: NPR, 10 October 2022
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News Article
UK doctor invents digital flashcards to help COVID-19 patients understand staff
Patient Safety Learning posted a news article in News
A coronavirus patient’s terrifying hospital experience inspired an NHS doctor to create a flashcard system to improve communication with medical staff wearing face masks. Anaesthetist Rachael Grimaldi founded CARDMEDIC while on maternity leave after reading about a COVID-19 patient who was unable to understand healthcare workers through their personal protective equipment (PPE). Her system enables medical staff to ask critically ill or deaf coronavirus patients important questions and share vital information on digital flashcards displayed on a phone, tablet or computer. The idea went from concept to launch on 1 April in just 72 hours and is now being used by NHS trusts and hospitals in 50 countries across the world. Read full story Source: The Guardian, 25 April 2020 Read the 'Story behind CARDMEDIC', written by Rachael for the hub -
News Article
NHS data sharing failure ‘exasperating and could cause error’
Patient Safety Learning posted a news article in News
Significant concerns about the NHS’ refusal to share data with councils have emerged in a letter from a leading council chief executive and clinical commissioning group accountable officer. Steven Pleasant, chief executive of Tameside Metropolitan Borough Council and accountable officer of Tameside and Glossop CCG, said the failures are “becoming increasingly exasperating”, in a letter intended for the Ministry of Housing, Communities and Local Government’s shielding sounding board. Steven said he understands NHS Digital has decided the most recent version of the list cannot be shared with councils even though it is being shared with police, fire, voluntary organisations and companies offering logistical support. “I am sure that you will appreciate that this is counterproductive and frustrating given that local authorities are leading and coordinating the response to the most vulnerable in communities,” he wrote. He also raised concerns about how the NHS’ shielded patients team is passing on to councils information about people needing additional support — for instance, if the recipient’s food parcel stock is running low, requiring the council to step in. Welfare concerns and medication information could also need to be passed on. Mr Pleasant said although his council had asked for this information to be provided via email, staff “have been told by the NHS shielding team that they do not have permission to do this and that details can only be provided verbally over the phone”. “We believe this significantly increases the chances of error and presents significant risk… around incorrect information being captured,” he wrote. Read full story Source: HSJ, 21 April 2020 -
News Article
Hancock: Staff should be free to speak out over coronavirus concerns
Patient Safety Learning posted a news article in News
NHS staff should “feel free” to speak out about problems like protective equipment shortages, Matt Hancock has said, despite many having been warned not to do so. The health and social care secretary told the daily coronavirus briefing on 21 April that it’s “totally normal” for NHS staff to raise concerns about personal protective equipment shortages in their areas and said “transparency is important”. HSJ has heard from multiple senior local NHS leaders that they have been given strong warnings not to communicate externally about the COVID-19 response, with national officials seeking to closely grip information given to the media. There have been several reports of healthcare professionals having been “gagged” by hospitals and NHS bodies, with some reports of threats of disciplinary action if they raise concerns on social media or speak to journalists. Read full story Source: HSJ, 21 April 2020 -
News Article
Women in labour being refused epidurals, official inquiry finds
Patient Safety Learning posted a news article in News
Women in labour are being refused epidurals in breach of official guidelines, a government inquiry has found. In findings reported by the Guardian, an investigation by the Department of Health and Social Care also found that women may not be being kept fully informed that if they choose to give birth at home or in a midwife-led unit they may have to be transferred if they want an epidural. Failing to make women aware of that possibility would also be in breach of National Institute for Health and Care Excellence (NICE) guidelines. As a result of the inquiry, the Health Minister Nadine Dorries will write to all heads and directors of midwifery and medical directors at NHS trusts this week to remind them of the NICE guidance regarding pain relief during childbirth and to ensure it is being followed. Clare Murphy, Director of external affairs at the British Pregnancy Advisory Service, said the “results of the government’s inquiry are sadly not surprising”. She added: “We have spoken with many women who have been so traumatised by their experience of childbirth that they are considering ending what would otherwise be wanted pregnancies. Pain relief is sometimes treated as a ‘nice extra’ rather than an integral part of maternity care, and women and their families can suffer profoundly as a result." Read full story Source: Guardian, 3 March 2020 -
News Article
‘Shameful’ data reveals NHS treatment of minority ethnic staff
Patient Safety Learning posted a news article in News
Five years after launching a plan to improve treatment of black and minority ethnic staff, NHS England data shows their experiences have got worse. Almost a third of black and minority ethnic staff in the health service have been bullied, harassed or abused by their own colleagues in the past year, according to “shameful” new data. Minority ethnic staff in the NHS have reported a worsening experience as employees across four key areas, in a blow to bosses at NHS England, five years after they launched a drive to improve race equality. Critics warned the experiences reported by BME staff raised questions over whether the health service was “institutionally racist” as experts criticised the NHS “tick box” approach and “showy but pointless interventions”. Read full story Source: The Independent, 18 February 2020 -
News Article
NHS Staff Survey 2019
Patient Safety Learning posted a news article in News
Today the results of the National NHS Staff Survey 2019 are out. This is of the largest workforce surveys in the world with 300 NHS organisations taking part, including 229 trusts. It asks NHS staff in England about their experiences of working for their respective NHS organisations. The results found that 59.7% of staff think their organisation treats staff who are involved in an error, near miss or incident fairly. While an improvement on recent years (52.2% in 2015) work is needed to move from a blame culture to one that encourages and supports incident reporting. It also found that 73.8% of staff think their organisation acts on concerns raised by patients/service users. It is vital that patients are engaged for patient safety during their care and there is clear research evidence that active patient engagement helps to reduce unsafe care. Patient Safety Learning has recently launched a new blog series on the hub to develop our understanding of the needs of patients, families and staff when things go wrong and looking at how these needs may be best met. -
News ArticleAn NHS trust has been criticised for advising pregnant women to stay at home for as long as possible during labour to increase the chances of a “normal birth”. University Hospitals Bristol NHS Trust also suggested mothers should avoid having epidurals or inductions and should try to have a home birth. The advice has been described as “shocking” by experts, who said the guidance was contrary to evidence and could be “dangerous” for mothers and babies. Others criticised the language used by the trust which suggested women who needed medical help were somehow “abnormal”. Earlier this month, the Bristol trust paid out £5.8m in compensation to the family of a six-year-old boy after he was left brain damaged at birth following complications during labour. After being contacted by The Independent, the trust deleted the childbirth advice from its website and accepted it was “outdated”. Read full story Source: The Independent, 13 February 2020
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News ArticleThe former police chief who investigated mental health services in a crisis-hit health board was “shocked” by the poor working relationships and “blame shifting” he uncovered. David Strang, who led the independent inquiry into the issues in NHS Tayside, said staff felt isolated and unsupported and people complained about each other’s practices without coming together to sort the issues out. He described asking staff questions based on information he had received and being met with the response: “Who told you?” He added: “A lot of staff felt there was a real blame culture and that risk and blame fell to the front line.” Read full story (paywalled) Source: 6 February 2020, The Times
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News Article
Pregnant women must be respected by medics, says regulator
Patient Safety Learning posted a news article in News
Mothers-to-be must be respected and listened to by medics, regulators have said, after warnings that pleas for pain relief in labour have been ignored. The intervention by the Nursing and Midwifery Council (NMC) follows an investigation by The Sunday Telegraph. Last week it was revealed that six NHS trusts were in breach of medical guidance which says pain relief should be provided at any point of labour if it is requested. Women said they were told “‘It’s not called labour for nothing, it’s meant to be hard work” as doctors refused their pleas. The findings prompted the Health Secretary to order an investigation. Today Andrea Sutcliffe, Chief Executive of the NMC, which regulates nurses and midwives said such actions should not be tolerated. In a letter to The Telegraph she said: "As the regulator for nursing and midwifery professionals, we know that all women deserve to have their views, preferences and decisions respected during pregnancy and birth." The watchdog recently published updated standards for midwives, which she said underlined this point. "Enabling women to make safe, informed decisions about the care they receive, including choices about pain relief during birth, is at the heart of our new Future Midwife Standards," the Chief Executive continued. Ms Sutcliffe said midwives should work "in partnership" with women in labour. "While midwives don’t administer epidurals, they do play a key role in helping women to make informed choices and advocating on their behalf to make sure those choices are understood and respected by the wider care team," she said. Read full story Source: The Telegraph, 2 February 2020 -
News Article
Report reveals the impact of Freedom to Speak Up
Patient Safety Learning posted a news article in News
A new report published by the National Guardian’s Office reveals that the perception of the speaking up culture in health is improving. An annual survey, conducted by the National Guardian’s Office, asked Freedom to Speak Up Guardians, and those in a supporting role, about how speaking up is being implemented in their organisation. The results reveal details about the network’s demographics and their perceptions of the impact of their role. Headlines from the survey include a measure of whether those in speaking up roles think their work is making a difference, with 76 per cent agreeing or strongly agreeing – compared to 68 per cent last year. They also reported that awareness of the guardian role is improving. “It’s really important we listen to guardians in order to understand the impact Freedom to Speak Up is making,” said Dr Henrietta Hughes OBE, National Guardian for the NHS. “The report we are publishing today will help organisations better understand how to work with their guardians to improve their speaking up cultures.” Read full story Source: National Freedom to Speak Up, 30 January 2020 -
News Article
Lack of transparency on patient complaints risks confidence in the NHS
Patient Safety Learning posted a news article in News
Public confidence in the health service is being undermined by a lack of transparency from hospitals about patient complaints, the man who led the investigation into one of the NHS’s worst care disasters has warned. Sir Robert Francis QC, who chaired the public inquiry into the Mid Staffordshire hospital scandal, has called for a new national organisation with powers to set standards on the handling of patient complaints after research found seven in eight hospital trusts do not follow existing rules. The prominent barrister is now chair of Healthwatch England, a statutory body, which analysed 149 hospitals’ handling of complaints. Under current legislation every hospital is required to collect and report on the number of complaints they receive, what they were about and what action has been taken. Healthwatch England found just 12% of NHS trusts were compliant with all the rules. Only 16% published the required complaints reports while just 38% reported any details about learning or actions taken after a grievance. Speaking to The Independent, Sir Roberts said better reporting, including the outcome and changes made after a complaint, would create a “collaborative” environment to improving the system with patients and staff alike seeing complaints as a valuable resource. One persistent problem remained the gap, he said, between hospitals and the national Parliamentary and Health Service Ombudsman. Sir Robert argued commissioners of NHS services should be more involved. Read full story Source: The Independent, 15 January 2020 -
News Article
Miscarriage can lead to 'long-term post-traumatic stress'
Patient Safety Learning posted a news article in News
One in six women who lose a baby in early pregnancy experiences long-term symptoms of post-traumatic stress, a UK study suggests. Women need more sensitive and specific care after a miscarriage or ectopic pregnancy, researchers say. In the study of 650 women, by Imperial College London and KU Leuven in Belgium, 29% showed symptoms of post-traumatic stress one month after pregnancy loss, declining to 18% after nine months. The study recommends that women who have miscarried are screened to find out who is most at risk of psychological problems. "For too long, women have not received the care they need following a miscarriage and this research shows the scale of the problem," says Jane Brewin, Chief Executive of miscarriage and stillbirth charity Tommy's. "Miscarriage services need to be changed to ensure they are available to everyone and women are followed up to assess their mental wellbeing with support being offered to those who need it, and advice is routinely given to prepare for a subsequent pregnancy." Read full story Source: BBC News, 15 January 2020 -
News Article
Revealed: Dozens of hospitals ignoring NHS safety warnings
Patient Safety Learning posted a news article in News
Dozens of hospital trusts have failed to act on alerts warning that patients could be harmed on its wards, The Independent newspaper has revealed. Almost 50 NHS hospitals have missed key deadlines to make changes to keep patients safe – and now could face legal action. One hospital, Birmingham Women’s and Children’s Foundation Trust, has an alert that is more than five years past its deadline date and has still not been resolved. Now the Care Quality Commission (CQC) has warned it will be inspecting hospitals for their compliance with safety alerts and could take action against hospitals ignoring the deadlines. National bodies issue safety alerts to hospitals after patient deaths and serious incidents where a solution has been identified and action needs to be taken. Despite the system operating for almost 20 years, the NHS continues to see patient deaths and injuries from known and avoidable mistakes. NHS national director for safety Aidan Fowler has reorganised the system to send out fewer and simpler alerts with clear actions hospitals need to take, overseen by a new national committee. Last year the CQC made a recommendation to streamline and standardise safety alerts after it investigated why lessons were not being learnt. Professor Ted Baker, Chief Inspector of hospitals, said: “CQC fully supports the recent introduction of the new national patient safety alerts and we have committed to looking closely at how NHS trusts are implementing these safety alerts as part of our monitoring and inspection activity.” He stressed: “Failure to take the actions required under these alerts could lead to CQC taking regulatory action.” Read full story Source: The Independent, 30 December 2019 -
News Article
Kindness: an underrated currency
Patient Safety Learning posted a news article in News
Cultivation of kindness is a valuable part of the business of healthcare, discusses Klaber and Bailey in an Editorial in the BMJ. "When we reflect on the past decade, it feels as if we have made a big mistake in healthcare. We have allowed the dominant narrative to be around money, taking the focus, energy, and leadership away from our core purpose of delivering the best care possible. Balancing the books is important, especially in a tax funded system, and we have a duty to drive value for every pound we spend — but money is not the most important thing." Read full Editorial Source: BMJ, 16 December 2019 -
News Article
Concerns raised with speak-up guardians are steadily rising
Patient Safety Learning posted a news article in News
The number of concerns reported to the NHS’s Freedom to Speak Up Guardians has been steadily increasing since the guardians were introduced in England in 2017. Since April that year thousands of concerns have been reported to the guardians at NHS trusts, data from the National Guardian’s Office shows. View full story (paywalled) Source: BMJ, 19 November 2019 -
Content ArticleCommunication barriers are the number one reason Deaf people have poorer health compared to hearing people. This blog by the organisation SignHealth gives 12 tips for healthcare workers and non-clinical staff on how to communicate with Deaf people. It also describes the difficulties Deaf people face when booking appointments and describes why remote consultations are problematic for Deaf people.
