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Millions of people with mild depression in England should be offered therapy, exercise, mindfulness or meditation before antidepressants, according to the first new NHS guidelines in more than a decade. Under draft guidance, the National Institute for Health and Care Excellence (NICE) recommends the “menu of treatment options” be offered to patients by health professionals before medication is considered. Currently, those with mild depression are offered antidepressants or a high-intensity psychological intervention, such as cognitive behavioural therapy (CBT). The shake-up forms part of the first new recommendations to identify, treat and manage depression in adults since 2009. According to the Office for National Statistics (ONS), about one in six (17%) adults experienced some form of depression this summer. The rate is higher than before the pandemic, when 10% of adults experienced it. Younger adults and women are more likely to be affected, the ONS found. A 2019 review showed 17% of the adult population in England (7.3 million people) had been prescribed antidepressants in the year 2017-18. Dr Paul Chrisp, director of the centre for guidelines at NICE, said: “The Covid-19 pandemic has shown us the impact depression has had on the nation’s mental health. People with depression need these evidence-based guideline recommendations available to the NHS, without delay.” Nav Kapur, professor of psychiatry and population health at the University of Manchester and chair of the guideline committee, said: “As a committee we have drawn up recommendations that we hope will have a real impact on people who are suffering from depression and their carers. In particular we’ve emphasised the role of patient choice – suggesting that practitioners should offer people a choice of evidence-based treatments and understanding that not every treatment will suit every person.” Read full story Source: The Guardian, 23 November 2021

Press release: 23 November 2021 We are pleased to announce that Patient Safety Learning is now a member of National Voices, the leading coalition of health and social care charities in England. Members of National Voices work together to strengthen the voice of patients, service users, carers, their families and the voluntary organisations that work for them. Commenting on today’s announcement, Patient Safety Learning’s Chief Executive Helen Hughes said: “We are delighted to have joined National Voices. To reduce avoidable harm in health and social care we all need to work in partnership to identify patient safety concerns, highlight where changes are needed and share good practice, to help deliver the systemic change required to create a patient-safe future. We look forward to working closely with partners in National Voices going forward to help improve patient safety.” Notes to editors: Patient Safety Learning is a charity and independent voice for improving patient safety. We harness the knowledge, insights, enthusiasm and commitment of health and social care organisations, professionals and patients for system-wide change and the reduction of avoidable harm. National Voices is the leading coalition of health and social care charities in England. We have more than 180 members covering a diverse range of health conditions and communities, connecting us with the experiences of millions of people. We work together to strengthen the voice of patients, service users, carers, their families and the voluntary organisations that work for them.

Patient and Public Voice (PPV) partners play a crucial role in specialised services and are represented across the board on NHS advisory groups and governance structures to ensure that the views of patients, carers and the public are at the heart of what we do. Specialised Services are currently recruiting to a range of vacancies for PPV partners, all of which can be found here. NHS England and NHS Improvement are committed to promoting equality and inclusion to ensure that our PPV partners reflect and represent our diverse population, and particularly encourage people from Black, Asian and Minority Ethnic (BAME) backgrounds to apply. Read more Source: NHS England/Improvement

Patient Safety Learning Press Release 10th December 2020 Today the Independent review of maternity services at Shrewsbury and Telford Hospital NHS Trust published its first report on its findings.[1] The report made recommendations for actions to be implemented by the Trust and “immediate and essential actions” for both the Trust and the wider NHS. The Review was formally commissioned in 2017 to assess “the quality of investigations relating to new-born, infant and maternal harm at The Shrewsbury and Telford Hospital NHS Trust”.[2] Initially it was focused on 23 cases but has been significantly expanded as families have subsequently contacted the review team with their concerns about maternity care and treatment at the Trust. The total number of families to be included in the final report is 1,862. These initial findings are drawn from 250 cases reviewed to date. This is another shocking report into avoidable harm. We welcome the publication of these interim findings and the sharing of early actions that have been identified to make improvements to patient safety in NHS maternity services. We commend the ambition for immediate responses and action. Reflecting on the report, there are a number of broad patient safety themes, many of which have been made time and time again in other reports and inquiries. A failure to listen to patients The report outlines serious concerns about how the Trust engaged and involved women both in their care and after harm had occurred. This was particularly notable in the example of the option of having a caesarean section, where there was an impression that the Trust had a culture of wanting to keep the numbers of these low, regardless of patients’ wishes. They commented: “The Review Team observed that women who accessed the Trust’s maternity service appeared to have little or no freedom to express a preference for caesarean section or exercise any choice on their mode of deliver.” It also noted a theme in common with both Paterson Inquiry and Cumberlege Review relating to the Trusts’ poor response to patients raising concerns.[3] The report noted that “there have also been cases where women and their families raised concerns about their care and were dismissed or not listened to at all”. The need for better investigations Concerns about the quality of investigations into patient safety incidents at the Trust is another theme that emerges. The review reflected that in some cases no investigation happened at all, while in others these did take place but “no learning appears to have been identified and the cases were subsequently closed with it deemed that no further action was required”. One of the most valuable sources for learning is the investigation of serious incidents and near misses. If these processes are absent or inadequate, then organisations will be unable to learn lessons and prevent future harm reoccurring. Patient Safety Learning believes it is vital that Trusts have the commitment, resources, and frameworks in place to support investigations and that the investigators themselves have the right skills and training so that these are done well and to a consistently high standard. This has not formed part of the Report’s recommendations and we hope that this is included in their final report. Lack of leadership for patient safety Another key issue highlighted by the report is the failure at a leadership level to identify and tackle the patient safety issues. Related to this one issue it notes is high levels of turnover in the roles of Chief Executive, executive directors and non-executive directors. As part of its wider recommendations, the Report suggests trust boards should identify a non-executive director who has oversight of maternity services. Good leadership plays a key role in shaping an organisations culture. Patient Safety Leadership believes that leaders need to drive patient safety performance, support learning from unsafe care and put in place clear governance processes to enable this. Leaders need to be accountable for patient safety. There are questions we hope will be answered in the final report that relate to whether leaders knew about patients’ safety concerns and the avoidable harm to women and their babies. If they did not know, why not? If they did know but did not act, why not? Informed Consent and shared decision-making The NHS defines informed consent as “the person must be given all of the information about what the treatment involves, including the benefits and risks, whether there are reasonable alternative treatments, and what will happen if treatment does not go ahead”.[4] The report highlights concerns around the absence of this, particularly on the issue of where women choose as a place of birth, noting: “In many cases reviewed there appears to have been little or no discussion and limited evidence of joint decision making and informed consent concerning place of birth. There is evidence from interviews with women and their families, that it was not explained to them in case of a complication during childbirth, what the anticipated transfer time to the obstetric-led unit might be.” Again this is another area of common ground with other recent patient safety reports such as the Cumberlege Review.[5] Patient Safety Learning believes it is important that patients are not simply treated as passive participants in the process of their care. Informed consent and shared decision making are vital to respecting the rights of patients, maintaining trust in the patient-clinician relationship, and ensuring safe care. Implementation for action and improved patient safety In its introduction, the report states: “Having listened to families we state that there must be an end to investigations, reviews and reports that do not lead to lasting meaningful change. This is our call to action.” Responding with an official statement in the House of Commons today, Nadine Dorries MP, Minister for Mental Health, Suicide Prevention and Patient Safety, did not outline a timetable for the implementation of this report’s recommendations. In 2020 we have seen significant patient safety reports whose findings have been welcomed by the Department of Health and Social Care but where there has subsequently been no formal response nor clear timetable for the implementation of recommendations, most notably the Paterson Inquiry and Cumberlege Review. Patient Safety Learning believes there is an urgent need to set out a plan for implementing the recommendations of the Ockenden Report and these other patient safety reports. Patients must be listened to and action taken to ensure patient safety. [1] Independent review of maternity services at Shrewsbury and Telford Hospital NHS Trust, Ockenden Report: Emerging findings and recommendations form the independent review of maternity services at Shrewsbury and Telford Hospital NHS Trust, 10 December 2020. https://www.ockendenmaternityreview.org.uk/wp-content/uploads/2020/12/ockenden-report.pdf [2] Ibid. [3] The Right Reverend Graham Jones, Report of the Independent Inquiry into the Issues raised by Paterson, 2020. https://assets.publishing.serv...; The Independent Medicines and Medical Devices Safety Review, First Do No Harm, 8 July 2020. https://www.immdsreview.org.uk/downloads/IMMDSReview_Web.pdf [4] NHS England, Consent to treatment, Last Accessed 16 July 2020. https://www.nhs.uk/conditions/consent-to-treatment/ [5] Patient Safety Learning, Findings of the Cumberlege Review: informed consent, Patient Safety Learning’s the hub, 24 July 2020. https://www.pslhub.org/learn/patient-engagement/consent-and-privacy/consent-issues/findings-of-the-cumberlege-review-informed-consent-july-2020-r2683/

No single solution will stop the virus’s spread, but combining different layers of public measures and personal actions can make a big difference. It’s im­por­tant to un­der­stand that a vac­cine, on its own, won’t be enough to rapidly ex­tin­guish a pan­demic as per­ni­cious as Covid-19. The pan­demic can­not be stopped through just one in­ter­ven­tion, be­cause even vac­cines are im­per­fect. Once in­tro­duced into the hu­man pop­u­la­tion, viruses con­tinue to cir­cu­late among us for a long time. Fur­ther­more, it’s likely to be as long as a year be­fore a Covid-19 vac­cine is in wide-spread use, given in­evitable dif­fi­cul­ties with man­u­fac­tur­ing, dis­tri­b­u­tion and pub­lic ac­ceptance. Con­trol­ling Covid-19 will take a good deal more than a vac­cine. For at least an­other year, the world will have to rely on a mul­ti­pronged ap­proach, one that goes be­yond sim­plis­tic bro­mides and all-or-noth­ing re­sponses. In­di­vid­u­als, work-places and gov­ern­ments will need to con­sider a di­verse and some­times dis­rup­tive range of in­ter­ven­tions. It helps to think of these in terms of lay­ers of de­fence, with each layer pro­vid­ing a bar­rier that isn’t fully im­per­vi­ous, like slices of Swiss cheese in a stack. The ‘Swiss cheese model’ is a clas­sic way to con­cep­tu­al­ize deal­ing with a haz­ard that in­volves a mix­ture of hu­man, tech­no­log­i­cal and nat­ural el­e­ments. This article can be read in full on the WSJ website, but is paywalled. The illustration showing the swiss cheese pandemic model is hyperlinked to this hub Learn post.

Talking Medicines, a social intelligence company for the pharmaceutical industry, has secured £1.1 million funding deal to scale up its AI-based platform for measuring patient sentiment. Tern, an investment company specialising in the Internet of Things (“IoT”), is the lead investor in a syndicated funding round alongside The Scottish Investment Bank, Scottish Enterprise’s investment arm. Led by CEO Jo Halliday alongside co-founders Dr Elizabeth Fairley and Dr Scott Crae, Talking Medicines will use the funds to support the launch and roll-out of a new AI data platform, which will translate what patients are saying into intelligence by providing a global patient confidence score by medicine. As part of these plans, the business intends to immediately recruit 9 new employees to the NLP data tech team. Formed in 2013 to create new ways of capturing the voice of the patient, the Glasgow-based firm uses a combination of AI, machine learning and Natural Language Processing (NLP) tech tools to capture and analyse the conversations and behaviours of patients at home, with the aim of transforming big pharma’s understanding of patient sentiment. Through mapping the patient voice from social media and connected devices to regulated medicine information, it is able to build data points to determine trends and patterns of patient sentiment across medicines. The round brings the total raised by the firm to £2.5m, including three previous seed funding rounds with previous investors including impact investor SIS Ventures and the Scottish Investment Bank. Talking Medicines CEO Halliday, said: “This investment will scale our team and the development of our AI, ML, NLP tech tools to translate what patients are saying into actionable pharma grade intelligence through our global patient confidence score by medicine.”

A qualitative study of Twitter hashtags revealed power hierarchies can damage the patient experience and clinician relationship. In an analysis of a popular Twitter hashtag, researchers found that patients largely take umbrage when they feel their doctor does not believe their ailment or knowledge about their healthcare, and when they perceive a power hierarchy between themselves and their clinician. Although not as many patients are using Twitter to get peer feedback on certain providers (the Binary Fountain poll showed only 21% of patients do this), the social media website still holds a lot of power, researchers from the University of California system explained. Twitter is a large platform that hosts social discourse. Healthcare professionals use Twitter to disseminate public health and patient education messages and to network, while 61% of patients use Twitter to learn more about their health, as well. Read full article Source: Patient Engagement HIT, 29 October 2020

In late July 2019, Sara Ryan tweeted asking families with autistic or learning disabled children to share their experience of “sparkling” actions by health and social care professionals. She was writing a book about how professionals could make a difference in the lives of children and their families. "These tweets generated a visceral feeling in me, in part because of the simplicity of the actions captured. Why would you not ring someone after a particularly difficult appointment to check on them? Isn’t remembering what children like and engaging with their interests an obvious way to generate good relationships? Telling a parent their child has been a pleasure to support is commonplace, surely?" Sara's own son, Connor, was left to drown in an NHS hospital bath while nearby staff finished an online Tesco order. "Certain people, children and adults, in our society are consistently and routinely positioned outside of 'being human', leading to an erasure of love, care and thought by social and healthcare professionals. They become disposable." What has become clear to Sara is how much the treatment of people and their families remains on a failing loop, despite extensive research, legislative and policy change to make their lives better, and potentially transformative moments like the exposure of the Winterbourne View scandal. At the heart of this loop are loving families and a diverse range of allies, surrounded by a large cast of bystanders who, instead of fresh eyes, have vision clouded by ignorance and sometimes prejudice. "To rehumanise society, we need more people with guts and integrity who are prepared to step up and call out poor practice, and to look afresh at how we could do things so much better with a focus on love and brilliance." Read full story Source: The Guardian, 27 October 2020 Sara Ryan's book: Love, learning disabilities and pockets of brilliance: How practitioners can make a difference to the lives of children, families and adults

The Care Quality Commission (CQC) has revealed a new strategy that will place more emphasis on a patient’s experience of care and seek to get a better grip on ”care settings where there’s a greater risk of a poor culture going undetected”. Ian Trenholm, chief executive of the CQC told HSJ the CQC’s new approach would be informed by the belief that ”people’s experience of care is driven as much from the way different providers will interact with each other – both public sector, private sector, third sector - in a place as much as it by the individual performance of individual providers.” He repeated his pledge, made to HSJ in August, that the CQC would endeavour to make inspections less time consuming for providers. An important part of the CQC’s increased focus on patients’ experience of care would be taking more effort to determine the quality of services whose users may have trouble expressing their views, said Mr Trenholm. Read full story (paywalled) Source: HSJ, 27 May 2021