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Found 17 results
  1. Content Article
    Key findings Most people had positive experiences when dealing with healthcare staff but overall coordination of care and information about it was lacking Many people said their health and needs affected their mental health and made them feel lonely Many people weren’t involved in decisions about care and treatment and were sceptical about patients becoming partners in future Many people struggled to contact the service they needed and faced long waits for an appointment Some people struggled to get any help or support at all for their health and care needs Remote consultations work for some people, but more said they preferred face-to-face appointments
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  4. Content Article
    In the letter. Professor Tim Kendall, National Clinical Director for Mental Health outlines NHS England's position that SIM or similar models must no longer be used in NHS mental health services. More specifically, the following three elements, which were all included within SIM but were not exclusive to it, must be eradicated from mental health services: Police involvement in the delivery of therapeutic interventions in planned, non-emergency, community mental health care (this is not the same as saying all joint work with the police must stop). The use of sanctions (criminal or otherwise), withholding care and otherwise punitive approaches, as clarified in National Institute for Health and Care Excellence (NICE) guidance. Discriminatory practices and attitudes towards patients who express self-harm behaviours, suicidality and/or those who are deemed ‘high intensity users’.
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    Primary care services are the front door to the NHS – they are the first port of call when we feel unwell and the main coordinator of care when we are living with ill health. The primary care team have an important role in making people feel welcomed, listened to and taken seriously. At National Voices we often hear stories from groups of people who struggle to have their communication needs met within primary care. As just one example, five years after the launch of the Accessible Information Standard, 67 per cent of Deaf people reported that still no accessible method of contacting their GP has been made available to them (Signhealth, 2022). This issue also affects other groups with specific communication needs - people who don't speak English fluently, people with learning disabilities, autistic people, people with dementia, people with low or no literacy, people who are digitally excluded, people living nomadically, people experiencing homelessness and more. We know that these experiences happen within the context of a primary care team under exceptional pressures. This workshop will bring together people with lived experience from all the groups mentioned above, as well as voluntary sector organisations, members of the primary care workforce, primary care policy leads, as well as commissioners and providers to discuss the challenges and co-produce solutions. At the workshop, we hope to build and improve understanding of: The experiences of people with diverse communication needs within primary care. The barriers primary care teams experience in meeting diverse communication needs, especially under existing pressures. Practical ways that we can embed and improve inclusive communications within the primary care setting. Register for the webinar. If you have any questions, please contact aleyah.babb-benjamin@nationalvoices.org.uk
  6. Content Article
    The lesson pack includes: Teacher guidance PDF and PowerPoint lesson plan Accompanying student worksheets and resources Parent/Carer letter template Frequently Asked Questions for teachers
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  9. Content Article
    The investigation found that misidentification of the patient, and limited access to critical information about the patient at the bedside delayed his treatment. The investigation identified factors that contributed to the event. These included: access to computer systems the display of information around the bed the sharing of information among staff to support familiarity with their patients. Findings Clinical staff are not always able to access accurate, critical patient information at bedsides to support decision making in emergencies. Patient identity wristbands are not consistently checked by staff during the undertaking of clinical tasks. The expectations of how staff should identify patients in an emergency and access critical information in relation to their care cannot always be met in practice because of limitations of technology and the work environment. Concerns around confidentiality can prevent the display of critical patient information at bedsides that may be needed to support safe care, particularly in emergencies. What and how critical patient information is displayed at the bedside varies across hospitals, with differences in positioning, visibility, readability and legibility. There is no national guidance to support consistency and visibility of critical patient information on low-technology displays (whiteboards/posters) or high-technology displays (via digital systems). Lighting on hospital wards can make it difficult for staff to see critical patient information, either through too little light, or too much light causing glare. Clinical staff consistently report difficulties accessing digital systems because of limited or poorly functioning hardware. This can result in the use of less reliable, paper-based systems for accessing critical patient information. Limited interoperability of multiple digital systems means critical patient information may not be accessible or consistent across all systems used in the care of a patient. Staff need to know which systems contain the information they need. Limited ability at a national level to influence the functionality of digital systems and their procurement means healthcare organisations are implementing systems with varying design and functionality. At the hospital level, the configuration of electronic patient record systems can introduce further safety risks where the infrastructure and staff training needs necessary for successful implementation have not been fully considered, and the needs of the clinical users have not been fully established. There is variation in the words and symbols used to indicate CPR recommendations, and in the level of understanding of CPR recommendations across hospitals, that may influence responses to cardiac arrests. Nursing handovers (where information about patients is passed between nursing staff at shift changes) may not provide the information staff need to care for their patients because of where and how they are undertaken. There is no national guidance on how best to undertake handovers of care. The implementation of electronic handover systems in clinical workplaces is limited by digital infrastructure, and systems that do not meet the needs of their users. Safety recommendations HSIB makes the following safety recommendations. Office of the National Data Guardian HSIB recommends that the Office of the National Data Guardian supports local interpretation of the Caldicott Principles to give organisations and staff the confidence to display full patient names at the bedside to support correct patient identification for safer care. NHS England HSIB recommends that NHS England develops guidance to providers, via any digital maturity assessments that are developed, to help ensure critical patient information (such as patient identifiers and cardiopulmonary resuscitation status) is available to clinical staff when accessing electronic patient record systems. HSIB recommends that NHS England provides guidance to healthcare organisations to support local design and configuration of electronic patient records to enable end users to access critical patient information (such as patient identifiers and cardiopulmonary resuscitation status). HSIB recommends that NHS England, during review of relevant Health Building Notes and Technical Memoranda, includes, as a consideration, that bedside patient information should be consistently visible. HSIB recommends that NHS England assesses the priority, feasibility, and impact of future research into what and how critical information pertaining to the emergency care of patients in the acute hospital setting can be readily and reliably accessed at a patient’s bedside. Resuscitation Council (UK) HSIB recommends that the Resuscitation Council UK clarifies and promotes expectations around the sharing, presentation, and language of cardiopulmonary resuscitation recommendations in hospital ward environments in line with the findings of this investigation. British Standards Institution (BSI) HSIB recommends that the British Standards Institution, with support from relevant stakeholders, provides symbology to standardise how information relating to a patient’s resuscitation status can be displayed in digital systems. Royal College of Nursing HSIB recommends that the Royal College of Nursing develops guidance for ward-based nursing handovers with consideration of the following: how handovers are organised, their content, the environment in which they take place and the technology needed to support them. Safety observations HSIB notes the following safety observations. It may be beneficial for healthcare organisations to provide guidance to support decisions in clinical areas that balance confidentiality and the visibility of critical patient information for patient safety. It may be beneficial for healthcare organisations to assess their information technology infrastructure needs, such as equipment availability and network coverage, to enable staff to consistently access critical patient information. It may be beneficial if the language used to refer to cardiopulmonary resuscitation recommendations is standardised and clarified through the implementation of the Recommended Summary Plan for Emergency Care and Treatment.
  10. Content Article
    Hi Mandy, can you tell us more about yourself and your role? I have worked as a Community Learning Disability Nurse and counsellor for people with a learning disability since 1995. In the last few years, my role has involved completing mortality reviews for the NHS service improvement programme LeDeR (Learning Disability Mortality Review Programme), as well as leading a project to support health initiatives and improved health outcomes for adults with a learning disability in Primary Care. What are some of the health inequalities affecting people with a learning disability? People with learning disabilities face serious health inequalities and have lower life expectancy, dying on average 25 years sooner and often from treatable and avoidable conditions. They experience higher levels of physical ill health and often present with complex and multiple health conditions, including: hearing and visual impairments epilepsy early onset dementia constipation respiratory conditions. People with a learning disability were also found to be 4.5 times more likely to die from Covid-19. They are most likely to die from respiratory related conditions but also less likely to access immunisation screening programmes, including flu. Access to National cancer screening programmes is equally poor. What are the barriers and challenges to improving outcomes? There are number of challenges when making improvements in this area. Below are a few key things to consider when seeking to design a patient-centred experience for people with learning disabilities. People with a learning disability often experience communication difficulties, which limit their ability to express pain, discomfort or feelings of being unwell. This can lead to delays or problems with diagnosis or treatment, identifying their needs or providing appropriate care. Medical appointments also often go out in written format, which is difficult for people who have limited reading ability, and this might result in missed appointments. People with a learning disability might struggle to engage with a particular test or medical intervention due to lack of understanding and fear, all of which have the potential to create additional barriers and cause delays in diagnosis and treatment. There can be confusion about mental capacity and consent amongst medical professionals. Health concerns are also sometimes attributed to the person’s learning disability and behaviour, and not fully investigated. Attending busy GP practices or vaccination centres might prove problematic due to long waits, high noise levels and lots of people. “My son would not have coped going to a hub. Having the vaccine at home by someone who knew how to talk to him was brilliant.” Parent. What can GPs practices do to improve health outcomes for people with a learning disability? Make sure your records are up to date Identification of people with a learning disability within each GP practice is key as this enables the right people to be targeted for specific learning disability initiatives, like the Learning Disability Annual Health Check or immunisations. If the patient requires any “reasonable adjustments”, such as easy read correspondence or longer appointments, this information can be flagged on the patient’s medical records. Sharing the register with Adult Social Care and regular cross-referencing data will help to support accuracy. Equip yourself with the right knowledge and networks People with a learning disability are often a very small percentage of a GP practice caseload and staff might have limited experience and understanding of their needs. Learning Disability Awareness training, as well as good access and close working relationships with the local Learning Disability Team, are essential to support person-centred care. Learning Disability Nurses are ideally placed to work alongside Primary Care and provide on-going guidance, help and support. “The learning disability liaison role has been so helpful particularly at a time when inequities for people with LD are having a spotlight shone upon them. Having someone who understands the complexities involved and can offer advice and training for our primary care teams is invaluable and has really helped to increase the physical health checks in this population and ensure good COVID vaccine uptake.” Salford GP. Build trust and make adjustments Building a relationship of trust, flexibility and giving a person with a learning disability time to express their concerns, absorb information or ask questions in a way that works for them is essential. Using accessible information to support communication, demonstration of equipment, repeat or longer appointments, availability of home visits and application of Mental Capacity Act Principles can help to improve understanding and engagement, develop trust and significantly support effective care and treatment. (Above photo: Sean Dempsey receiving his Covid vaccination) “Mandy came to my house. It helped that I already knew her. She made me feel more confident and helped me feel calm, just by being herself. It was brilliant, it will keep me safe.” Sean Dempsey. What needs to happen nationally to improve health outcomes for people with a learning disability? Mandatory Learning Disability Awareness Training has literally just been launched for all Health and Social Care staff (Oliver McGowan Mandatory Training in Learning Disability and Autism) which is huge progress. In addition, I would like to see: Investment in the recruitment, training and employment of more learning disability nurses Recruitment of Learning Disability Nurses in general medical settings e.g., hospitals and Primary Care Investment in programmes/initiatives to support application of reasonable adjustments in specific areas of care e.g., dedicated screening services for those that cannot access mainstream services (breast cancer screening, cervical cancer screening). What is the most rewarding part of your work? There is no greater feeling than seeing a person with a learning disability access a medical intervention/treatment that could improve their well-being or potentially save their life. Especially when this was initially ruled out due to concerns about complexity or engagement. It is extremely rewarding to know that each of these successes help to change and positively shape the opinions and practice of medical professionals into the future. Do you have a patient safety story to share? Are you a patient, relative or member of staff interested in improving outcomes for people with a learning disability? If you would like to share your insights, please comment below (activate your membership for free first) or get in touch with us directly by emailing content@pslhub.org
  11. Content Article
    Key points Rural and remote areas experienced problems that differentiate them from their more urban counterparts even before the Covid-19 pandemic. However, the pandemic has both exacerbated some of these challenges, as well as thrown up new ones. Covid-19 has had a more detrimental effect on hospital waiting times in rural and remote trusts than for trusts in more urban areas. In April 2020, the proportion of patients seen for their first consultant appointment for cancer fell by two-thirds (66%) in rural trusts compared with April 2019, whereas a decrease of 59% was seen in trusts located in more urban areas. Activity has fallen particularly dramatically in rural areas. Emergency admissions in April to June 2020 fell by 57% in rural trusts compared with the year before, while they fell by 45% elsewhere. The level of referral for talking therapies – via the Improving Access to Psychological Therapies (IAPT) programme – in rural areas was below half the level in April 2020 than it was a year before. The pandemic has exacerbated workforce issues in remote trusts. Remote trusts spend more on temporary staff (8% of their staffing budget) compared with other areas (6%). While the number of hospital and community health staff increased by 7% nationally in the year to June 2020, the workforce of remote trusts grew by only 5% over the same period. The underlying financial position of rural and remote services was worse than the position of more urban trusts before the pandemic started, and the pandemic may well have exacerbated this. Remote trusts’ debt was equivalent to more than half (56%) of their annual operating income in 2018/19. Remote trusts also typically do not seem to get their fair share of additional funding that goes into the NHS.
  12. Content Article
    Ten key themes Prevention Early intervention Access to quality, compassionate care Seeing the bigger picture Whole-person care Equality focus Co-production Autonomy, human rights and community support A stronger workforce Outcomes that matter Three requirements to make the vision a reality Sustained and sufficient investment Effective long-term workforce development and planning A deep commitment to large-scale reform, innovation and change
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    Recommendations Out-of-hours palliative and end of life care is currently inadequate and fragmented, and must be better valued, prioritised and strengthened. Services must be developed and provided equitably, irrespective of diagnosis, socio -demographic characteristics (e.g. age, ethnicity) and geographical area. Service development and planning must be actively informed by the voices of patients and informal carers; collaboration with patients and informal carers should be used to drive improvements in out-of-hours care, shape service development and help identify potential solutions for gaps in care. Integrated Care Systems, Health Boards and NHS Trusts, Integration Joint Boards and NHS Health Boards, and Health and Social Care (HSC) Trusts across the UK need to strategically develop, enable and support greater integration and coordination of out-of-hours services. District nurses and community nursing teams play an extensive role in providing hands-on out-of-hours care, but huge pressures on this workforce limit the care they can provide; improved workforce planning, provision, and support for community providers of out-of-hours palliative and end of life care is essential. A designated telephone line for people with palliative and end of life care needs and their informal carers should be available 24/7, in every part of the UK. Availability and use of shared care records should be audited regularly to overcome the challenges identified in using, sharing and implementing these records across the UK. Such records should be based on timely conversations about needs, wishes and preferences for care at the end of life, and include the availability of anticipatory medicines (if appropriate). The questionnaire provided in this report can be used by those with commissioning responsibilities to understand and address gaps in out-of-hours service provision and identify priorities for improvement. Research into out-of-hours care is essential for future service development and needs continued funding.
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