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Content ArticleThe second annual Safety For All conference was held at the Royal College of Physicians in London on Tuesday 5th December 2023. Over 100 members of the healthcare community attended this event, including occupational health professionals, patient safety experts, frontline staff, patients and academics. The conference was hosted by the Safer Healthcare and Biosafety Network and Patient Safety Learning as part of the Safety For All campaign, supported by B. Braun, BD, Boston Scientific and Stryker. Attendees had the opportunity to hear from two keynote speakers: Lynn Woolsey, UK Deputy Chief Nurse at the Royal College of Nursing and Dr Henrietta Hughes, Patient Safety Commissioner for England. The conference was chaired and facilitated by Dr Rob Galloway, A&E Consultant at Brighton and Sussex Hospital NHS Trust, with a welcome introduction from Dr Ian Bullock, CEO of the Royal College of Physicians. There were a number of panel sessions and presentations throughout the day which are summarised in the attachment below, including on sustainability, antimicrobial resistance and antibiotic underdosing, violence at work, clinical communications, human factors, implementing the Patient Safety Incident Response Framework (PSIRF), and women's health and the menopause.
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Content ArticleLeadership walkarounds (LWs) have been promoted in practice as means to drive operational, cultural and safety outcomes. This systematic review in BMJ Open Quality aimed to evaluate the impact of LWs on these outcomes in the US healthcare industry. The authors found only positive association of LWs with operational and perception of cultural outcomes.
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News ArticleFormer Prime Minister Boris Johnson is scheduled to provide evidence at the Covid Inquiry on the 6 and 7 of December. Long Covid is one of the most catastrophic consequences of the pandemic and it deserves a prominent place in the discussions during this critical phase of the inquiry. The Long Covid Groups will be delivering a letter to No.10 Downing Street today, urging attention to the unique challenges faced by those with Long Covid. Read the letter and sign the petition
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News Article
NHS trust under investigation accused of hypocritical email to staff
Patient Safety Learning posted a news article in News
The boss of a hospital trust being investigated by police for alleged negligence over 40 patient deaths has been accused of sending a hypocritical email urging staff to have the courage to raise concerns despite the dismissal of whistleblowing doctors. The investigation, Operation Bramber, was sparked by two consultants who lost their jobs after raising concerns about deaths and patient harm in the general surgery and neurosurgery departments of the Royal Sussex County hospital in Brighton. In an email to staff on Friday, the chief executive, George Findlay, said the trust was committed to learning from its mistakes. He said: “When things do go wrong, we must be open, learn and improve together. That openness is how we give people courage to raise concerns and make a positive difference to patient care.” James Akinwunmi, a consultant neurosurgeon who was unfairly dismissed by the trust in 2014 after he raised the alarm about patient safety, said Findlay’s email was “laughable”. He told the Guardian: “Whistleblowers, including myself, have done exactly what he is encouraging in the email and they were sacked for it, so you can draw your own conclusions. I suspect what they are doing is damage limitation. Instead, they should be dealing with surgeons who have been a problem for years.” Another more recent whistleblower, who did not want to be named, expressed incredulity at Findlay’s claim that he wanted to encourage staff to raise concerns. They said: “The email is hypocritical. How can staff have the ‘courage to raise concerns’ after what has happened to those who have? Those brave enough to blow the whistle about patient safety have been sanctioned, lost their job and had their lives destroyed.” Read full story Source: The Guardian, 3 December 2023 -
News Article
Minister: There’s systemic racism in the NHS
Patient Safety Learning posted a news article in News
A health and social care minister privately said there was ‘systemic’ racism within the NHS and called for an investigation into it. Helen Whately told Matt Hancock of her belief in a private message which was today shown to the covid public inquiry. An inquiry hearing with Mr Hancock – who said he agreed with the point – was shown an exchange between Ms Whately, then care minister, and Mr Hancock in June 2020. The Guardian had reported the previous day that an internal report had found systemic racism at NHS Blood and Transplant. Ms Whately, who is now minister of state covering social care and urgent and emergency services, said: “I think the Bame next steps proposed are important but don’t go far enough. There’s systemic racism in some parts of the NHS, as seen in NHSBT.” She added: “Now could be a good moment to kick off a proper piece of work to investigate and tackle it.” Read full story (paywalled) Source: HSJ, 1 December 2023 -
News Article
Health secretary told to intervene over ‘systemic’ ambulance deaths
Patient Safety Learning posted a news article in News
Ministers must intervene over systemic failures which are “too big for hospital or ambulance trusts to fix on their own” and have led to multiple preventable deaths, a senior coroner has warned. In a move usually considered rare for such an official, Cornwall and Isles of Scilly coroner Andrew Cox has written to the Department of Health and Social Care a second time over ongoing delays to ambulance responses and long ambulance handovers in the area. Last year he warned the NHS was “broken” after he ruled ambulance and emergency care delays contributed to the deaths of four people. Now, he has sent a similar report on the same types of failings in the deaths of John Seagrove, Pauline Humphris, and Patricia Steggles at Royal Cornwall Hospital to new health secretary Victoria Atkins. Mr Cox wrote: “I set out in my [prevention of future death report] last year my understanding of the reasons for the difficulties that are continuing in the Cornwall & Isles of Scilly coroner area. I do not believe those reasons will have changed significantly. ”The challenges are systemic in nature. They are too big for a single doctor, nurse or paramedic to fix. They are too big for either the hospital trust or the ambulance trust to fix on their own.” Read full story Source: HSJ, 1 December 2023 -
News Article
Infected blood: Tory rebellion expected on payouts amendment
Patient Safety Learning posted a news article in News
The government faces a rebellion with at least 30 Tories backing an amendment to extend interim payouts to more victims of the infected blood scandal. Up to 30,000 people were given contaminated blood products in the 1970s and 80s. Thousands have died. A Labour amendment will be brought on Monday calling for a new body to be set up to administer compensation. More than 100 MPs, including Tories Sir Robert Buckland, Sir Edward Leigh and David Davis, are backing the move. In a letter sent to Chancellor Jeremy Hunt, shadow chancellor Rachel Reeves called the scandal "one of the most appalling tragedies in our country's recent history." She added: "Blood infected with hepatitis C and HIV has stolen life, denied opportunities and harmed livelihoods." She praised Theresa May, who set up the Infected Blood Inquiry when she was prime minister in 2017. But she warned: "For the victims, time matters. It is estimated that every four days someone affected by infected blood dies." The chancellor, himself a former health secretary, told the inquiry in July that the government accepted the moral case for compensation. But he said no final decisions could be made before the inquiry publishes its findings - now expected in March next year. In August 2022, the government agreed to make the first interim compensation payments of £100,000 each to about 4,000 surviving victims and bereaved widows. But inquiry chairman Sir Brian Langstaff, said in April this year that the parents and children of victims should also receive compensation and also called for a full compensation scheme to be set up immediately. The Commons Speaker will decide on Monday which amendments to the bill MPs will vote on. But the government has said it will not be supporting the amendment. A Department of Health spokesperson said: "We are deeply sympathetic to the strength of feeling on this and understand the need for action. However, it would not be right to pre-empt the findings of the final report into infected blood." Read full story Source: BBC News, 3 December 2023 -
News Article
People with Covid discharged to care homes over fears for NHS, inquiry told
Patient Safety Learning posted a news article in News
People with Covid-19 were discharged to care homes over fears about the NHS getting “clogged up”, the pandemic inquiry has heard. Professor Dame Jenny Harries, England’s deputy chief medical officer during the pandemic and now head of the UK Health Security Agency, told the inquiry of how an email she sent in mid-March 2020 described the “bleak picture” and “top line awful prospect” of what needed to happen if hospitals overflowed. Discharging people to care homes – where thousands of people died of Covid – has been one of the central controversies when it comes to how the Government handled the pandemic. On Wednesday, the Covid inquiry was read an email exchange between Rosamond Roughton, an official at the Department of Health, and Dame Jenny on March 16 2020. Ms Roughton asked what the approach should be around discharging symptomatic people to care homes, adding: “My working assumption was that we would have to allow discharge to happen, and have very strict infection control? Otherwise the NHS presumably gets clogged up with people who aren’t acutely ill.” Ms Roughton added that this was a “big ethical issue” for care home providers who were “understandably very concerned” and who were “already getting questions from family members”. In response, Dame Jenny emailed: “Whilst the prospect is perhaps what none of us would wish to plan for, I believe the reality will be that we will need to discharge Covid-19 positive patients into residential care settings for the reason you have noted. “This will be entirely clinically appropriate because the NHS will triage those to retain in acute settings who can benefit from that sector’s care. “The numbers of people with disease will rise sharply within a fairly short timeframe and I suspect make this fairly normal practice and more acceptable, but I do recognise that families and care homes will not welcome this in the initial phase.” Read full story Source: The Independent, 29 November 2023 -
News Article
Trust leaders raise alarm over ‘mad’ approach to scrutiny of maternity services
Patient Safety Learning posted a news article in News
The management of fragile maternity services is being hamstrung by a lack of clear standards and direction from government and regulators, trust chairs and chief executives have told HSJ. Kathy Thomson, the retiring chief executive of Liverpool Women’s Foundation Trust, told HSJ that a major overhaul of regulation and oversight of maternity care was needed. She warned that trust leaders were confused about what was expected of their stewardship of maternity services. Much of the increased scrutiny of the sector was coming from people with little knowledge and experience of maternity care, and maternity was beset by too many initiatives which “somebody thinks are a nice thing to do”. Ms Thomson’s comments were echoed by a wide range of other NHS leaders (see ’damaging confidence’ below). Ms Thomson told HSJ: “How clear are we nationally about the real ask of maternity services? Are we going to say it’s the ten NHS Resolution (NHSR) safety standards, which are really tough to achieve and which we agonise over? Or is it the CQC standards, because they will often take a different view around very similar issues? “We’ve had that this year after we’ve been assessed as compliant by NHSR, but then had to re-provide evidence after we’ve been criticised by the CQC for something… and then NHSR have written back to say we’re still fully compliant. “So, should you put your time and energy into the NHSR standards, or do you spend the time on the more subjective drivers? Because we can’t keep doing all of it and having different parts of the NHS saying this is what you need to do or expecting something different.” Read full story (paywalled) Source: HSJ, 30 November 2023 -
Content ArticleHospital leaders need to embed a safety culture across their organisations - read the latest guest blog on the Patient Safety Commissioner website from Maria Caulfield, the minister for mental health and women's health strategy. Maria gives three examples of how we are advancing patient safety across our NHS.
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Content ArticleCancer Research UK has set out how the next UK Government could dramatically improve cancer outcomes and prevent 20,000 cancer deaths a year by 2040. 'Longer better lives: A manifesto for cancer research and care' has been developed with the insights of cancer patients and experts from across health, life sciences, government and academic sectors. The charity said that huge strides have been made in beating cancer – with survival in the UK doubling over the last 50 years. But it warned that with NHS cancer services in crisis and around half a million new cancer cases each year expected by 2040 – this hard-won progress is at risk of stalling. With the UK lagging behind comparable countries when it comes to cancer survival, the charity is calling on all political parties to make cancer a top priority in their party manifestos.
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Content Article
Developing cultural change in healthcare: Part 1 – by Dawn Stott
Dawn Stott posted an article in Good practice
If we are to continue improving healthcare services, then developing cultural change in healthcare is crucial. Improving the quality of care, reducing medical errors and, ultimately, enhancing patient outcomes is essential for the future. Transforming the culture within healthcare organisations requires a comprehensive approach that involves leadership commitment, employee engagement, continuous education and a focus on patient-centred care. In a two-part blog for the hub, Dawn Stott, Business Consultant and former CEO of the Association for Perioperative Practice (AfPP), talks about the strategies that can help you develop cultural change in your organisation. In part one, Dawn sets out the steps to develop a programme of change to support you to achieve good solutions. -
Content ArticleProductivity is misunderstood at every level in the NHS, not least because the leadership so often use the word to mean something entirely different. So what is it and what are the big misunderstandings about it? In his LinkedIn post, Stephen Black discusses what productivity is and what misunderstandings are feeding the problem.
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Content ArticleHospital and health system CEOs have a lot of issues dominating their thoughts, including questions about navigating financial, operational and workforce challenges in the industry. Some of these problems may not have an obvious or immediate solution, leaving leaders with unanswered questions. To gain more insight into executives' top concerns, Becker's asked hospital and health system leaders to share the questions they need answered right now.
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Content ArticleThe healthcare workplace is a high-stress environment. All stakeholders, including patients and providers, display evidence of that stress. High stress has several effects. Even acutely, stress can negatively affect cognitive function, worsening diagnostic acumen, decision-making, and problem-solving. It decreases helpfulness. As stress increases, it can progress to burnout and more severe mental health consequences, including depression and suicide. One of the consequences (and causes) of stress is incivility. Both patients and staff can manifest these unkind behaviours, which in turn have been shown to cause medical errors. The human cost of errors is enormous, reflected in thousands of lives impacted every year. The economic cost is also enormous, costing at least several billion dollars annually. The warrant for promoting kindness, therefore, is enormous. Kindness creates positive interpersonal connections, which, in turn, buffers stress and fosters resilience. Kindness, therefore, is not just a nice thing to do: it is critically important in the workplace. Ways to promote kindness, including leadership modelling positive behaviours as well as the deterrence of negative behaviours, are essential. A new approach using kindness media is described. It uplifts patients and staff, decreases irritation and stress, and increases happiness, calmness, and feeling connected to others.
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Content ArticleNHS England has outlined plans to develop an improvement approach - NHS IMPACT - to support continuous improvement. There are also ambitions for integrated care systems (ICSs) to become ‘self-improving systems’. This report, written and researched by Sir Chris Ham and jointly commissioned by the NHS Confederation, the Health Foundation and the Q community, reviews the experience of a number of ICSs identified as being at the forefront of this work, focusing on the approaches they have taken and the results achieved.
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Content ArticleThe current NHS ‘cost improvement model’ is not sufficient to meet financial constraints, but an allocative efficiency approach being applied at Mersey Care Foundation Trust offers hope, its leaders argue. "34% of expenditure in health and care is attributable to just 8% of complex households, which raises real questions about the efficiency and effectiveness of our combined expenditure, and the waste of resources caused by the multiple contacts we offer to the same people and families without really addressing the root causes of their problems."
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News Article
ICSs told to prepare ‘nuclear’ service cuts as NHSE plays ‘hardball’
Patient Safety Learning posted a news article in News
Health systems are still struggling to meet their financial plans, despite hundreds of millions being raided from investment budgets to help balance the books. Senior leaders in most regions said the cash falls short of their existing financial gaps. Earlier this month, NHS England announced that £800m would be made available to integrated care systems (ICSs) to offset the additional cost of strikes. HSJ understands ICSs reported a combined deficit that was £1.5bn worse than planned in the six months to October, which implies a gap of several hundred million pounds unless systems can report substantial surpluses for the second half of the year. HSJ spoke to senior sources in all seven regions, with more than half saying their systems would still fail to deliver breakeven, despite the funding transfers. A source in the South East said their system’s share of the funding “won’t touch the sides”, adding that NHSE was playing “hardball”. Another local source said they had identified a set of “nuclear options” to balance the books, but these would be “catastrophic for quality of care and/or nigh-on impossible to deliver”. Read full story (paywalled) Source: HSJ, 22 November 2023 -
Content Article
Thirlwall Inquiry
Mark Hughes posted an article in Other reports and inquiries
The Thirlwall Inquiry has been set up to examine events at the Countess of Chester Hospital and their implications following the trial, and subsequent convictions, of former neonatal nurse Lucy Letby of murder and attempted murder of babies at the hospital. This website provides information about inquiry team, terms of reference and publications relating to this. -
Content ArticleThis is the protocol for a Campbell systematic review. The main aim of this systematic review was to identify whether hospital leadership styles predict patient safety as measured through several indicators over time. The second aim was to assess the extent to which the prediction of hospital leadership styles on patient safety indicators varies as a function of the leader's hierarchy level in the organisation.
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Content ArticleWith Whitehall paymasters showing less faith in the organisations that hold the budgets for health and social care in England, Mark Dayan describes five ways that such tensions behind the scenes can impact on the running of services: Promising and planning. Ministerial direction. Frontline first. Too much too late. Enough already.
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Content ArticleThe government recently published terms of reference for the Thirlwall Inquiry following the crimes committed by former neonatal nurse Lucy Letby while working for the Countess of Chester Hospital NHS Foundation Trust. As well as examining the detail of the offences, the inquiry will also probe whether the trust’s culture, management, governance structures and processes contributed to the failure to protect babies. In the wake of this tragedy, it became apparent that staff had sounded the alarm about Lucy Letby, but that their concerns were not acted on. The case has propelled the issue of NHS management structures and the regulation of managers back into the headlines and made it the subject of political debate.
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News Article
NHS failing to prioritise those in most need, says departing ICB chief
Patient Safety Learning posted a news article in News
The NHS should better track patients with the greatest clinical need so they can move to the front of the queue for treatment, a former government waiting list tsar has said. Anthony “Mac” McKeever told HSJ the health service could improve how it works through its elective backlog by using a system introduced during the covid pandemic to prioritise the most pressing cases. He said a “large chunk” of cases were still not given a code to say how long they are considered to be able to wait for surgery, which is at the heart of this process. Mr McKeever retired as Mid and South Essex Integrated Care Board chief executive this month following nearly five decades in the health service, including as a trust leader. Although Mr McKeever said he only knew the regional situation for the East of England, he would be “very surprised” if the national picture was any different. Waiting list expert Rob Findlay agreed this was a reasonable assumption. Read full story (paywalled) Source: HSJ, 17 November 2023 -
Content ArticleA substantial barrier to progress in patient safety is a dysfunctional culture rooted in widespread disrespect. Leape et al. identify a broad range of disrespectful conduct, suggesting six categories for classifying disrespectful behaviour in the health care setting: disruptive behaviour; humiliating, demeaning treatment of nurses, residents, and students; passive-aggressive behaviour; passive disrespect; dismissive treatment of patients; and systemic disrespect. At one end of the spectrum, a single disruptive physician can poison the atmosphere of an entire unit. More common are everyday humiliations of nurses and physicians in training, as well as passive resistance to collaboration and change. Even more common are lesser degrees of disrespectful conduct toward patients that are taken for granted and not recognised by health workers as disrespectful. Disrespect is a threat to patient safety because it inhibits collegiality and cooperation essential to teamwork, cuts off communication, undermines morale, and inhibits compliance with and implementation of new practices. Nurses and students are particularly at risk, but disrespectful treatment is also devastating for patients. Disrespect underlies the tensions and dissatisfactions that diminish joy and fulfilment in work for all health care workers and contributes to turnover of highly qualified staff. Disrespectful behaviour is rooted, in part, in characteristics of the individual, such as insecurity or aggressiveness, but it is also learned, tolerated, and reinforced in the hierarchical hospital culture. A major contributor to disrespectful behaviour is the stressful health care environment, particularly the presence of “production pressure,” such as the requirement to see a high volume of patients.
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News Article
Forcing medical staff to work during strikes could harm care, NHS Providers says
Patient Safety Learning posted a news article in News
Forcing some medical staff to work through industrial action under new anti-strike laws could end up harming patient care, hospital trust leaders have said, as ministers claimed their new measures would keep public services running over Christmas. NHS Providers, which represents hospital, mental health and ambulance trusts, said there was a significant risk it would damage relationships between staff and employers that are already very challenged, in a way that could affect patients. In a submission to the consultation on minimum service levels in hospitals, it said: “Our key concern is that rather than strengthening services as intended, the legislation proposed would worsen relationships between employers and staff, and between trusts and local union representatives to the longer-term detriment of patient care.” Read full story Source: The Guardian, 17 November 2023
