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Showing results for tags 'Organisational Performance'.
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Content Article
Audit Scotland: NHS in Scotland 2023 (22 February 2024)
Patient Safety Learning posted an article in NHS Scotland
The Scottish Government needs to develop a clear national strategy for health and social care to address the pressures on services, says a review by Audit Scotland. Significant changes are needed to ensure the financial sustainability of Scotland's health service. Growing demand, operational challenges and increasing costs have added to the financial pressures the NHS was already facing. Its longer-term affordability is at risk without reform. -
News Article
Scotland's NHS cannot meet growing demand, warns watchdog
Patient Safety Learning posted a news article in News
Scotland's NHS is unable to meet the growing demand for health services, a spending watchdog has warned. A review by Audit Scotland said the increased pressure on the NHS was now having a direct impact on patient safety and experience. The watchdog also claimed there was no "overall vision" for the future of the health service. The annual report on the state of Scotland's health service highlighted that the NHS was facing soaring costs, patients were waiting longer to be seen and there were not enough staff. Stephen Boyle, Auditor General for Scotland, said this had "added to the financial pressures on the NHS and, without reform, its longer-term affordability". He added: "Without change, there is a risk Scotland's NHS will take up an ever-growing chunk of the Scottish budget. And that means less money for other vital public services. "To deliver effective reform the Scottish government needs to lead on the development of a clear national strategy for health and social care. "It should include investment in measures that address the causes of ill-health, reducing long-term demand on the NHS." Read full story Source: BBC News, 22 February 2024 -
News Article
Waiting times focus ‘overshadows misconduct’, finds NHSE review
Patient Safety Learning posted a news article in News
Ambulance trusts have often prioritised capacity and response times over dealing with cases of misconduct, a review of culture in the sector for NHS England has found. The review says ambulance trusts need to “establish clear standards and procedures to address misconduct”. The work was carried out by Siobhan Melia, who is Sussex Community Healthcare Trust CEO, and was seconded to be South East Coast Ambulance Service Foundation Trust interim chief from summer 2022 to spring last year. Her report says bullying and harassment – including sexual harassment – are “deeply rooted” in ambulance trusts, and made worse by organisational and psychological barriers, with inconsistencies in holding offenders to account and a failure to tackle repeat offenders. She says “cultural assessments” of three trusts by NHSE had found “competing pressures often lead to poor behaviours, with capacity prioritisation overshadowing misconduct management”, adding: “Staff shortages and limited opportunities for development mean that any work beyond direct clinical care is seen as a luxury or is rushed. “Despite this, there is a clear link between positive organisational culture and improved patient outcomes. However, trusts often focus on meeting response time standards for urgent calls, whilst sidelining training, professional development, and research.” Read full story (paywalled) Source: HSJ, 15 February 2024 -
Content ArticleThis is an independent review commissioned by NHS England, chaired by Siobhan Melia, Chief Executive, Sussex Community NHS Foundation Trust, to support the improvement of the culture within the ambulance service. The review considers the prevailing culture within ambulance trusts in England. It considers the core factors impacting cultural norms and offers actionable recommendations for improvement. Based on insights from key stakeholders, this review has identified six key recommendations to improve the culture in ambulance trusts.
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News Article
CQC names best and worst for maternity experience
Patient Safety Learning posted a news article in News
The trusts where maternity care has deteriorated the most according to patient surveys have been identified by the Care Quality Commission. The regulator collected responses from 25,515 patients about their experiences of antenatal care, labour, birth and postnatal care across 121 trusts in February 2023. It then analysed where experiences of care were substantially better or worse overall when compared with survey results across all trusts in England. Survey responses also painted a deteriorating picture of maternity care nationally, with answers to 11 questions showing a statistically significant downward trend compared to five years ago. Five trusts were categorised as “worse than expected”, where patients’ experiences of using their services were substantially worse than the average. Read full story (paywalled) Source: HSJ, 12 February 2024 -
Content ArticleNew research shows that more independent hospitals are rated as “good” or “outstanding” than ever before, despite the challenges posed by the pandemic and the subsequent period of health system recovery. The Independent Healthcare Providers Network (IHPN) conducted a national review of quality and safety data across the sector, looking at a broad range of datasets to evaluate quality and safety in key areas, analysing data from the Care Quality Commission (CQC).
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News Article
USA: Best hospitals by specialty national rankings
Patient Safety Learning posted a news article in News
In 2023-2024, the US News Best Hospitals ranked hospitals in the USA in 15 adult specialties as well as recognised hospitals by state, metro and regional areas for their work in 21 more widely performed procedures and conditions. Of the nearly 5,000 hospitals analyzed and 30,000 physicians surveyed, only 164 hospitals ranked in at least one of the specialties. Read full story Source: US News -
News Article
NHS trust ‘abandoned’ budding paramedic who took her own life
Patient Safety Learning posted a news article in News
Rebecca McLellan, a trainee paramedic, pursuing the job she had dreamed of as a child, took her own life at the age of 24. Amid the devastation felt by her loved ones, serious questions have now emerged about the standard of care she received at Norfolk and Suffolk NHS Foundation Trust (NSFT). In notes recorded before her death last November, McLellan said that Norfolk and Suffolk NHS Foundation Trust (NSFT) had “abandoned” her in a time of need. An internal investigation has now been launched by the mental health trust, which has been dogged by safety concerns for more than a decade. Relatives of McLellan, who lived in Ipswich, Suffolk, and was being treated for bipolar disorder, are among hundreds of bereaved families who believe their loved ones were failed under the care of the trust. Her mother, Natalie McLellan, 48, said it was clear that some of her daughter’s feelings of helplessness in her final months were “shaped by their inadequacy”. “She was somebody that had it all,” said Natalie. “She had a supportive family, she had a nice flat, she had a nice car, she was doing exactly what she wanted to do in life. She had a voice, she was able to speak and advocate for herself as a medical professional. If she can’t get help, what the hell hope is there for anybody else? Recent months have seen calls for a public inquiry and criminal investigation into NSFT after bosses last year admitted to losing count of the number of patients that had died on its books. Campaigners describe the mismanagement of mortality figures as “the biggest deaths crisis in the history of the NHS”. The Times has spoken to trust staff, bereaved relatives and MPs who say that despite repeated promises of improved care the trust’s overstretched services remain unsafe and require urgent reform. Read full story (paywalled) Source: The Times, 26 January 2024 -
Content Article
Monitor: The role of boards in improving patient safety (2010)
Patient Safety Learning posted an article in Boards
Patient care inevitably raises issues of safety. Safety measures can never be failsafe, but they can always be improved. The aim of this publication is to offer guidance to boards on helping to bring about these improvements. The publication was developed by Monitor for NHS foundation trusts, though its principles apply equally to other NHS settings. It draws on evidence and best practices from UK pilot sites, and also taps the experience of healthcare providers in other developed countries who use similar principles and approaches. The field research and work with the UK pilot sites took place between October 2009 and March 2010. -
News ArticleMost key NHS targets have been missed for at least seven years across the UK, BBC News research shows. The review of records going back 20 years also reveals Northern Ireland and Wales have never met the four-hour accident-and-emergency (A&E) target. The analysis focused on the three key hospital targets, covering A&E, cancer and waiting times for planned care. In the past seven, the only one to have been met is the A&E target in Scotland - and that was during lockdown in 2020, when the number of visits to A&E plummeted. All four nations said improving waiting times was a priority and investment was being made. But King's Fund think tank chief analyst Siva Anandaciva said the findings should "act as a wake-up call". "These are the key totemic targets," he said. "The length of time they have been missed is incredible." Patients groups warned the delays were putting patients at risk. Patients Association chief executive Rachel Power said the analysis showed the NHS was in "permacrisis". Read full story Source: BBC News, 10 January 2024
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News Article
A&E target set to be raised, despite NHS missing lower bar
Patient Safety Learning posted a news article in News
NHS England and government are set to raise their target for four-hour A&E performance, despite most hospitals failing to meet the current ask. HSJ understands officials are likely to use 2024-25 planning guidance to raise the “interim” target for four-hour performance from the 76% which trusts were asked to hit in 2023-24. A new objective of 80% by March 2025 has been discussed, several sources said, but is not confirmed. The 76% target has not been met during any month of 2023-24 so far, and most acute trusts are consistently falling well short of it. Well-placed sources told HSJ the target was likely to be increased despite “some doubts” among senior NHSE officials. One senior NHSE source said: “The target should be increasing incrementally as overall NHS A&E performance improves, [but] it hasn’t really improved this year.” Read full story (paywalled) Source: HSJ, 5 January 2024 -
Content ArticleIn a report published in 2000 by the UK's Chief Medical Officer, it was estimated that 400 people in the UK die or are seriously injured each year in adverse events involving medical devices, and that harm to patients arising from medical errors occurs in around 10% of admissions—or at a rate in excess of 850 000 per year. The cost to the NHS in additional hospital stays alone is estimated at around £2 billion a year. This article examines system safety in healthcare and suggests a 20-item checklist for assessing institutional resilience (CAIR).
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News Article
Trust reports two ‘never events’ in area already under review for errors
Patient Safety Learning posted a news article in News
A teaching trust has reported six ‘never events’ in less than two months, including incidents in a specialty already under review for errors. The incidents occurred at University Hospitals Birmingham between 26 July and 10 September, including two wrong-side lesion biopsies in dermatology, two incorrect blood transfusions, one injection to the incorrect eye, and one misplaced nasogastric tube. The two incorrect blood transfusions involved the same patient at Heartlands Hospital and were reported after a biomedical scientist carried out a retrospective investigation into the case. On both occasions, the patient was transfused with incorrect red blood cells. It brings the total number of blood transfusion events reported at UHB to seven since 2020-21. The issue is already subject to a review by the Royal College of Physicians after Mike Bewick identified concerns in his review of patient safety at the trust. It comes after clinicians working within the haematology specialty raised multiple concerns over patient safety in 2021 and intervention from the General Medical Council over concerns around junior doctors. John Atherton, chair of UHB’s clinical quality and safety committee, told the board a preliminary review into never events had identified that “maybe we weren’t addressing these [incidents] seriously enough”. Read full story (paywalled) Source: HSJ, 1 December 2023 -
News Article
NHS in crisis as almost half of maternity wards are offering substandard care
Patient Safety Learning posted a news article in News
Almost half of all English maternity units are offering substandard care, making it one of the worst performing acute medical services in the NHS, Byline Times analysis has found. The analysis, based on inspections of English hospitals by the Care Quality Commission (CQC), found that 85 of 172 inspected maternity services in England received ratings of ‘inadequate’ (18) or ‘requires improvement (67) at their latest inspection. Some 65% of maternity wards were given subpar ratings for patient ‘safety’ one of several metrics looked at by the CQC. The findings come after the health regulator began a focused inspection programme of maternity wards last year after the a government review into the Shropshire maternity scandal, which saw 300 babies left dead or brain damaged by shoddy care. In one unit at Gloucestershire Royal Hospital, there was a shortage of midwives, not all medicines practices were safe which “potentially placed women at risk of harm” and serious incidents were not being investigated. The report found a backlog of 215 patient safety incidents that had not yet been looked into, as of March this year. Maria Caulfield, Minister for Women’s Health Strategy, told Byline Times that “maternity care is of the utmost importance to this Government” and stressed they have “invested £165 million a year since 2021 to grow the maternity workforce and improve neonatal services”. “Every parent must be able to have confidence in the care they receive when giving birth, and we are working incredibly hard to improve maternity services, focusing on recruitment, training, and the retention of midwives,” she added. Read full story Source: Byline Time, 28 November 2023 -
Content ArticleThe latest Care Quality Commission (CQC) report on the state of care in England is far from an encouraging read.1 Although the healthcare system is under serious strain, maternity services are among the areas identified as especially challenged. The problems identified in maternity care, while shocking, come as no surprise. The sector is seeing repeated high profile organisational failures and soaring clinical negligence claims, together with grim evidence of ongoing variation in outcomes, culture, and workforce challenges and inequities linked to socioeconomic status and ethnicity. In this BMJ Editorial, Mary Dixon-Woods and colleagues discuss why it's time for a fresh approach to regulation and improvement.
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News Article
Most NHS maternity units not safe enough, says regulator
Patient Safety Learning posted a news article in News
England's healthcare regulator has told BBC News that maternity units currently have the poorest safety ratings of any hospital service it inspects. BBC analysis of Care Quality Commission (CQC) records showed it deemed two-thirds (67%) of them not to be safe enough, up from 55% last autumn. The "deterioration" follows efforts to improve NHS maternity care, and is blamed partly on a midwife shortage. The Department for Heath and Social Care (DHSC) said £165m a year was being invested in boosting the maternity workforce, but said "we know there is more to do". The BBC's analysis also revealed the proportion of maternity units with the poorest safety ranking of "inadequate" - meaning that there is a high risk of avoidable harm to mother or baby - has more than doubled from 7% to 15% since September 2022. The CQC, which also inspects core services such as emergency care and critical care, said the situation was "unacceptable" and "disappointing". "We've seen this deterioration, and action needs to happen now, so that women can have the assurance they need that they're going to get that high-quality care in any maternity setting across England," said Kate Terroni, the CQC's deputy chief executive. The regulator has been conducting focused inspections because of concerns about maternity care. These findings are "the poorest they have been" since it started recording the data in this way in 2018, Ms Terroni said. Read full story Source: BBC News, 16 November 2023 -
News ArticleHospital-acquired infections, which became substantially more common during the pandemic, have returned to pre-pandemic levels, according to a new report from a US patient safety watchdog group. It's key to note, researchers say, that infection rates before March 2020 were nothing to celebrate. On top of that moderately good news, the Leapfrog Group found other metrics that measure patient safety and satisfaction have fallen significantly, likely because of hospital staffing shortages and other pandemic-era challenges. "We're encouraged and relieved to see that infections are rapidly decreasing in hospitals following the spike during the pandemic, but we remain very concerned about a number of major problems in hospitals," said Leah Binder, president and CEO of Leapfrog, an independent, national nonprofit founded by large employers and other purchasers. Patient surveys following hospital visits found declines in experiences for the second year in a row in all states. Particularly significant drops were reported in “communication about medicines” and “responsiveness of hospital staff." Preventable errors have been linked to these problems. "Hospitals need to take a hard look at what they are unnecessarily continuing post-pandemic that are not helping patients," Binder said. Read full story Source: USA Today News, 6 November 2023
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News Article
‘Controversial’ A&E policy 'showed we're all shouldering the pain', says CEO
Patient Safety Learning posted a news article in News
A high-profile shift to admitting patients from A&E to wards irrespective of bed capacity has ‘turned the dial’ for an acute trust’s emergency care, its chief executive has told HSJ. Since introducing the model in July last year North Bristol Trust has seen a significant improvement in its performance against the national target, with the number of patients seen within four hours rising from 51% to 72% in August 2023 – with a peak of 80% in April 2023. The model attracted interest from NHS England last year, as well as some concern from the Nuffield Trust over patient safety – but NBT CEO Maria Kane said the trust was “happy, on balance” with the system. She said the model “won’t be for everyone and we never claimed it would be” but she added: “Engendering whole hospital conversations about the principles of flow and understanding of [the emergency department] is something we could all do.” Read full story (paywalled) Source: HSJ, 8 November 2023 -
News Article
Struggling trust CEO says provider has ‘turned dial’ following care scandals
Patient Safety Learning posted a news article in News
A mental health trust at the centre of several care scandals has ‘turned the dial’ on improvement, its chief executive has said, following the Care Quality Commission noting some progress but retaining a ‘requires improvement’ rating The CQC said earlier this month that improvements had been made at some services at Tees Esk and Wear Valleys Foundation Trust, including for its forensic secure inpatient service, where the rating was raised from “inadequate” to “good”. But the improvements were not enough to shift its overall “requires improvement” rating. Chief executive officer Brent Kilmurray argued the CQC report was evidence the trust was going in the right direction following a number of highly critical reports relating to patient deaths, but he also told HSJ it was a “challenge” for the trust to “tell a balanced story around where we are making progress”. TEWV has recently admitted care failings relating to the deaths of two inpatients in 2019 and 2020, following prosecution from the CQC. The trust will go on trial for alleged failings relating to another death in February next year. Read full story (paywalled) Source: HSJ, 6 November 2023 -
News ArticleNHS bosses are using misleading figures to hide dangerously poor performance by A&E units in England against the four-hour treatment target, emergency department doctors claim. Some A&Es treat and admit, transfer or discharge as few as one in three patients within four hours, although the NHS constitution says they should deal with 95% of arrivals within that timeframe. How well or poorly A&Es are doing in meeting the 95% target is not in the public domain because the data that NHS England publishes is for NHS trusts overall, not individual hospitals. That means official figures are an aggregate of performance at sometimes two A&Es run by the same trust or include data for any walk-in centres, minor injuries units or urgent treatment centres that a trust also operates. Forty-eight trusts have two A&Es and many also run at least one of the latter. The Royal College of Emergency Medicine (RCEM), which represents A&E doctors, wants that system scrapped. It is urging NHS England to start publishing data that shows the true performance of every individual emergency department against the 95% standard. “The current data is misleading,” Dr Adrian Boyle, the college’s president, told the Guardian. “It’s a good example of a lack of transparency and also of performance incentives. Being open about the long delays in some A&Es would shine a light in some dark places.” Read full story Source: The Guardian. 28 October 2023
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News ArticleDerby and Burton’s maternity services are now among the “most challenged in England”, requiring national involvement to boost improvements. The University Hospitals of Derby and Burton NHS Foundation Trust joins 31 other NHS trusts across England which are now under closer scrutiny aimed at improving the quality of maternity services. A report from the trust details that it asked to be added to the national NHS England Maternity Safety Support Programme (MSSP) "voluntarily". Midwifery and obstetric improvement advisors have now been allocated to the trust to spend two days a week on the trust’s sites and also to provide “virtual” assistance. A letter to Stephen Posey, the trust’s chief executive, sent by Sascha Wells-Munro, the deputy chief midwifery officer for NHS England, details that the organisation’s addition to the national support programme comes after a number of concerning reports – not just its request. It references the Healthcare Safety Investigation Branch report, published in February, which highlighted the cases of seven women and their babies between January 2021 and May 2022, with three mothers and a baby dying and four mothers suffering extreme consequences. Read full story Source: Derbyshire Live, 13 September 2023
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News ArticleSeven trusts have been added to NHS England’s list of providers with the worst elective and cancer problems, putting the number of organisations in the ‘tier 1’ group back into double figures – and five leaving it, HSJ has learned. Since last summer, NHS England has put trusts considered most “at risk” of missing recovery trajectories into “tiers” for either elective or cancer performance, or both. The list has changed significantly for quarter three of this year, despite only a few months passing since the last rankings were revealed in August. HSJ understands this is due to system-level agreements and some national factors, including the impact of ongoing industrial action on elective activity. The number of trusts in the most challenged “tier 1” group for both elective and cancer performance has increased from eight to 11, with seven new providers entering this tier and five leaving. Read full storySource: HSJ, 9 October 2023
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Content ArticleHarold Pedley, known as Derek, attended his GP surgery during the late afternoon on 21.12.22 and after spending most of that day feeling unwell with symptoms including abdominal pain and vomiting. He was appropriately referred to the hospital and travelled there with his friend after his GP had discussed his case with doctors. Due to a lack of available beds in the assessment unit, Derek needed to remain in the emergency department. Following his arrival at 20.07 hours, doctors were not notified of his attendance. He remained in the emergency department waiting area for almost two hours during which time due to significant pressures faced by the department he was not assessed or spoken to by a medical professional. At 21.59 hours a triage nurse called for him. By then, Derek had been unresponsive for some time and had died, his death confirmed at 22.26 hours. A subsequent post mortem examination revealed he died from the effects of non-survivable extensive small bowel ischaemia caused by a significantly narrowed mesenteric artery. His death was contributed to by heart disease.
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Content ArticleIn 2008, five ‘serious untoward incidents’ occurred on a small maternity unit in a hospital in the UK. The prevailing view, held by clinical staff, hospital managers, and executives, was that these events were unconnected and did not signal systemic failures in care. This view was maintained by the testimony of staff and governance procedures which prevented the incidents from being considered together. Drawing on the inquiry report of the Morecambe Bay Investigation (2015), Dawn Goodwin examines how the prevailing view was built and dismantled, eventually being replaced with a very different description of events. Overturning this view required affected parents to engage with governing bodies and legal processes, challenge clinical staff, lobby for inquests, and mobilise social media and the national press. Tracing how different descriptions of events weaken or gather force as they travel through different forums, processes, and are presented to different audiences, she explores the sociology of knowledge around establishing failures of care.
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Content ArticleThe results of the latest annual survey of hospital inpatients published by the Care Quality Commission (CQC) show patient satisfaction levels have remained largely static since 2021, but indicate a longer term decline in most areas compared to previous years.People were eligible to take part in the survey if they stayed in hospital for at least one night during November 2022 and were aged 16 years or over at the time of their stay.The survey highlights growing frustration with waiting times and reveal that four in ten people scheduled for planned treatment said their health deteriorated while waiting to be admitted.An A-Z list of inpatient survey results by NHS trust can be found here.
