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Content ArticleThe NHS in England’s annual budget is £161 billion. Yet across the sector there is huge cause for concern, including the still-growing backlog, workforce issues, the state of the estate and the relentless demand on primary care. In this blog, ex-NHS strategic health authority chief executive Mike Farrar and Health Policy Insight editor Andy Cowper look at how these issues can be tackled to provide an NHS that meets the needs of the population. They cover the following subjects: Politics, policy and prevention System working and pivoting to prevention - how to shift resources Building a compelling case for change Moving towards less top-down-ism Being clear about what an ICS is for Culture change and mindsets shifts Resourcing change
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News Article
As a black man I wasn't included in cancer stats
Patient Safety Learning posted a news article in News
What started as a shoulder ache led to a whirlwind diagnosis of stage four cancer and a rare genetic mutation for Spike Elliott. But his journey also highlighted a worrying ethnicity data gap in our health system. It comes as research by one charity shows just how few patient records include ethnicity information in Wales. The Welsh government said it was working to improve the diversity of data collection and health research. One oncologist said it meant assumptions were made about how patients will respond, despite there being "clear differences" in how certain cancers affect different racial groups. "I was given a life expectancy of 6 to 12 months. That was statistically supported. "But I was alarmed when I was made aware that the statistics don't include the BAME (Black, Asian and Minority Ethnic) community. "Because what was my outcome then?" Read full story Source: BBC News, 21 June 2023 -
News ArticleThe government should ‘relieve’ GP practices of being the sole controller for their patients’ data, a senior NHS England director has said. Tim Ferris, NHSE director of transformation, said it was a “challenge” that GP practices acted as the sole controllers of their patients’ data. Dr Ferris, whose background is as a primary care doctor in the US, was giving evidence to a Lords committee on integration of primary and community care today. He was asked whether it was time to revisit legislation on the control of GP patient data. He said: “Thirty years ago when the law was created, it made more sense. But I think it might no longer be fit for purpose… The idea that if I were a GP in this country, if I had legal liability for the exchange of data, I would be worried about that.” Dr Ferris agreed there would be merit to the committee recommending the government “relieve” GPs of the sole responsibility for data protection, and their data controller status. Read full story (paywalled) Source: HSJ, 20 June 2023
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Content ArticleThe government has published its mandate to NHS England. This mandate is intended to apply from 15 June 2023 until a new mandate is published. NHS England has a duty to seek to achieve the objectives in the mandate. The Secretary of State keeps progress against the mandate under review, setting out his views in an annual assessment which is laid in Parliament and published. The government will agree with NHS England how it should report on overall progress against the mandate to support the Secretary of State in keeping this under review. This will include reporting at agreed intervals on other delivery expectations listed beneath the objectives.
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News Article
Trust insists ‘our data is correct’ despite waiting list ‘grip’ concerns
Patient Safety Learning posted a news article in News
An external review of waiting list management at a large acute trust has found several serious problems – including ‘pop-up’ patients and thousands of cancelled appointments each week – but concluded they were no worse than would be found at ‘most NHS trusts’. The review appears to have been triggered after University Hospitals of the North Midlands declared unexpected increases in the number of 78-week and 104-week waiters earlier this year, while the government and NHS England have been intensively performance managing these measures. The independent report by independent consultant Wendy Baines states: “The review found no evidence of deliberate irregularities in the management of waiting times. “Although as the case for most NHS trusts, the capacity to misrepresent the ‘true’ volume of waiters at a certain point in time is significant. “Managing this risk by minimising the capacity for errors through training, the right pathway administration systems and tools, and the ability to monitor data quality through a defined set of process assurance measures is key. Whilst UHNM possesses these components, they are not necessarily working in cohesion to provide the assurance and oversight needed to manage patient waiting times.” Read full story (paywalled) Source: HSJ, 13 June 2023 -
Content ArticleAchieving an evidence-based practice not only depends on implementation of evidence-based interventions, but also requires de-implementing interventions that are not evidence-based, also known as low-value care (LVC). This is quite a new topic and knowledge is lacking concerning how de-implementation and implementation processes and determinants might differ. This scoping review identified 10 studies describing theoretical approaches that have been used concerning de-implementation of LVC. The findings point to the need for more research to identify the most important processes and determinants for successful de-implementation of LVC, and to explore differences between de-implementation and implementation.
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Content Article
Health Inequality Data Repository (WHO)
Patient_Safety_Learning posted an article in Health inequalities
Launched in April 2023 by WHO, the Health Inequality Data Repository contains datasets of disaggregated data covering diverse topics and dimensions of inequality, from a variety of publicly available data sources. It aims to make disaggregated data more accessible and navigable to diverse global audiences. -
Content Article
The National Institute for Health and Care Research (NIHR) Evidence Collections draw together evidence from important NIHR-funded and wider research. They aim to help people in policy and practice understand recent important research in a topic area. The most recent Collection is Maternity services: evidence for improvement. In this blog, one of the Collection's authors, Candace Imison, describes how it was framed by the findings from a recent investigation into failings in East Kent Hospitals’ maternity services. She focuses on some key messages from evidence on how to identify poor performance and provide effective board governance and oversight. -
Content ArticleIn January 2023, the Health and Social Care Select Committee opened an inquiry into Prevention. An interdisciplinary group of six academics, clinicians, and a coroner from the University of Oxford, the University of Birmingham, and London made a submission to that inquiry. They made their submission to the Prevention inquiry after reading and analysing more than 4,000 PFDs and working with coroners and bereaved families, which has highlighted that more must be done in health and social care to learn lessons from preventable deaths. Their full submission has now been published which included a table summarising 12 of their research studies relating to preventable deaths and providing recommendations. We have extracted the table which highlights several patient safety concerns and system safety recommendations.
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Content Article
Patient survey: Halfloop medical device app
Patient Safety Learning posted an article in Apps for health and care
Halfloop are a team of senior doctors and developers building a digital platform where patients can store information securely about their medical implants and share their progress and outcomes securely with their clinical team. They would like to hear your views by asking you to complete their short survey. -
Content Article
This is part of our series of Patient Safety Spotlight interviews, where we talk to people working for patient safety about their role and what motivates them. Maureen discusses the important role of professional standards in building a patient safety infrastructure, the need to reframe safety as a positive idea and her experience of implementing learning processes during her time as a GP. -
Content ArticleThis study in the Journal of Patient Safety outlines the development of the Leapfrog composite patient safety score. The researchers aimed to develop a composite patient safety score that provides patients, healthcare providers and healthcare purchasers with a standardised method to evaluate patient safety in general acute care hospitals in the United States. The study concluded that the composite score reflects the best available evidence regarding a hospital’s efforts and outcomes in patient safety.
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Content Article
NHS Impact resources
Patient Safety Learning posted an article in NHS England
NHS Impact ‘improving patient care together’ is the term NHS England is using for the new single, shared NHS improvement approach. This includes the five components which form the ‘DNA’ of all evidence-based improvement methods, which underpin a systematic approach to continuous improvement: Building a shared purpose and vision. Investing in people and culture. Developing leadership behaviours. Building improvement capability and capacity. Embedding improvement into management systems and processes. When these 5 components are consistently used, systems and organisations create the right conditions for continuous improvement and high performance, responding to today’s challenges, and delivering better care for patients and better outcomes for communities. -
News Article
'Hidden' rise in blood clot deaths 'breaking families' warns charity
Patient Safety Learning posted a news article in News
Thrombosis UK has warned that deaths involving blood clots are higher than expected as it called for more transparency over the work hospitals are doing to reduce the risk for patients. Before the pandemic hit, hospitals were regularly publishing data on the number of patients who had been risk assessed for blood clots. In March 2020, the NHS in England took the decision to suspend the data collection on venous thromboembolism (also known as VTE) risk assessments to “release capacity in providers and commissioners to manage the Covid-19 pandemic”. But the data collection and publication is yet to resume. The charity said the data shows how many VTE cases are missed in hospitals. One bereaved man described how his mother died last year after the condition was missed. Tim Edwards, 42, said healthcare workers missed signs of the condition while Jennifer Edwards, 74, was in hospital on the south coast. Despite having many symptoms of a pulmonary embolism she was discharged home and died three days later. Mr Edwards said: ““My mother’s symptoms were missed from her admission to hospital right up to her time in the cardiology department. “She was discharged and passed away three days after phoning the NHS with shortness of breath. She should not have died. I took it upon myself to enquire about the circumstances surrounding her death and was overwhelmed by the lack of care taken. “Sadly, I know this is not an isolated case.” Read full story Source: Wales Online, 12 May 2023 Further reading on the hub: Pulmonary embolism misdiagnosis – a systemic problem (a blog from Tim Edwards) Independent review of pulmonary embolism fatalities in England & Wales – recent trends, excess deaths, their causes and risk management concerns (Tim Edwards) Jenny, and why we must learn from her misdiagnosis of pulmonary embolism National Voices: Pulmonary embolism misdiagnosis - a blog by Helen Hughes. -
News Article
Figures show maternal death rate race disparity
Patient Safety Learning posted a news article in News
Figures showing the risk of maternal death being almost four times higher among women from black ethnic minority backgrounds compared with white women in the UK have been published. The figures, which relate to 2019 - 2021, have been released by MBRRACE-UK, a collaboration involving the University of Leicester. The MBRRACE-UK collaboration (Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries), led from Oxford Population Health's National Perinatal Epidemiology Unit, looked at data on women who died during, or up to six weeks after, pregnancy between 2019 and 2021 in the UK. The report showed the risk of maternal death in 2019 - 2021 was almost four times higher among women from black ethnic minority backgrounds compared with white women. Marian Knight, professor of Maternal and Child Population Health at Oxford Population Health and maternal reporting lead, said: "Persistent disparities in maternal health remain. "It is critical that we are working towards more inclusive care where women are listened to, their voices are heard, and we are acting upon what they are telling us." Read full story Source: BBC News, 11 May 2023 -
Content ArticleIn England and Wales, coroners are required to write Prevention of Future Deaths reports when a death is deemed preventable so that action is taken to avert similar deaths. Since July 2013, Prevention of Future Deaths reports have been openly available via the Courts and Tribunals Judiciary website (https://www.judiciary.uk/prevention-of-future-death-reports/). However, their presentation to date have been insufficient to identify trends and learn lessons. The authors of this paper designed a web scraper to create the Preventable Deaths Tracker. On 22 June 2022, 4001 PFDs were scraped, analysed, and compared to the Office of National Statistics’ preventable mortality statistics. This commentary, published in Medico-Legal Journal, summarises the key findings and offers recommendations to improve the Prevention of Future Deaths system so lessons can be learnt to avert preventable deaths.
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Content ArticleThis white paper from CEMBooks aims to unpick some of the deeper issues surrounding bed block and emergency department crowding from the perspective of a frontline medic with two decades of emergency and flow management experience. It aims to provide a greater understanding of the factors influencing the current situation and the measures used to define it followed by some practical implementable solutions.
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Content ArticleFor decades the NHS has collected routine data on millions of patients. In a world where big data has increasing value, the UK has an opportunity to truly leverage its health data assets to benefit people in the UK and across the world—both through better health and through the generation of more research and development and economic growth. This report by the Institute of Global Health Innovation at Imperial College London provides a broad overview of the UK’s health data policy landscape. It identifies strategic and technical recommendations to move towards a health data policy ecosystem that allows clinical, societal or financial value to be more readily extracted from patient data.
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Content ArticleThe Primary Care Patient Measure of Safety (PC PMOS) is designed to capture patient feedback about the contributing factors to patient safety incidents in primary care. It required further reliability and validity testing to produce a robust tool intended to improve safety in practice. This study led to a reliable and valid 28-item PC PMOS that could enhance or complement current data collection methods used in primary care to identify and prevent error.
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EventIt is now clear that hormone pregnancy test Primodos, the epilepsy drug sodium valproate, and that pelvic mesh causes avoidable harm to many thousands of women and children. Yet recognising these potential harms took many years, and it is still the case that the service does not know the identities of all those affected or potentially affected. The main reason is lack of data. Knowing which patients have received which medicines and devices where, and quickly connecting longer-term outcomes, has traditionally been somewhere between impossible and extremely slow and difficult. Unnecessary harm has often been the result. So how can the NHS solve this issue? What do we know about the traditional challenges with traceability in healthcare and the shortcomings of current data collection techniques? How can it be ensured that the right products are being used for the right patient? What approaches and technologies might solve these challenges, ensuring that the right products are being used for the right patient? How could this fit into wider digital transformation work, and resulting data best be used to improve patient safety and outcomes? This HSJ webinar, run in association with GS1 UK, will bring together a small panel to consider the answers to these important questions. Register
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News ArticleThe NHS must start sharing figures on mental health checks for pregnant women and new mothers amid gaps in hospital data, top doctors warn. One in six NHS trusts is not able to say whether they screen pregnant women for mental health issues at all, despite national guidelines recommending these checks be done at 10 weeks. Suicide has been recorded has one of the leading drivers in post-natal deaths. The findings come as the latest NHS figures show 51,000 women accessed specialist perinatal mental health services in the 12 months prior this fell short of a target for the NHS to see 66,000 mothers in 2022-23. Access levels have. however, improved from 31,000 a year in March 2022. The Royal College of Psychiatrists has called for NHS England to “urgently” publish data on every hospital in the country showing whether they are carrying out this vital screening. Last November the latest national report into maternal deaths, from researchers led by Oxford University, found suicide was again the leading cause of direct deaths in women a year after the end of their pregnancy. Read full story Source: The Independent, 4 May 2023
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Content ArticleIn 2002, a dedicated group from Pennsylvania passed the Medical Care Availability and Reduction of Error (MCARE) Act, the most robust state-level legislation of its kind. Its legacy remains 21 years later. In this interview with the journal Patient Safety, Pennsylvania's Patient Safety Authority chair, Dr Nirmal Joshi, discusses ways care has improved, what challenges persist, and how to achieve the unachievable—true culture change.
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Content Article
In this blog, Patient Safety Learning considers key patient safety issues relating to complications from surgical mesh implants, highlighting further sources of opinion and research on the hub. -
Content ArticleTargets have been applied to a wide range of public services over the past 40 years. This report analyses whether targets improve the performance of public services and the reasons for this, making recommendations on when and how government should set targets. It focuses on national targets and examines what evidence there is for how they have affected how efficiently public money is turned into outcomes for the public.
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Content ArticleThe CVDPREVENT Audit has published its third annual audit report covering the audit period up to March 2022. The report provides insight into the impact of the Covid-19 pandemic on primary care services, when diagnosis and management of hypertension were significantly disrupted. It also compares the national position against key ambitions identified as milestones for the prevention of cardiovascular disease (CVD) and the detection and management of atrial fibrillation, blood pressure and cholesterol. It also includes findings relating to diagnoses of chronic kidney disease and diabetes, lifestyle and health inequalities, as well as a number of recommendations to support the prevention of cardiovascular disease.
