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This guidance aims to support integrated care boards (ICBs) in planning and commissioning services to manage infectious disease outbreaks. With over 10,000 outbreaks managed annually in England, these incidents can strain NHS resources and exacerbate health inequalities, especially among vulnerable populations.ICBs are responsible for developing health plans, managing budgets, and arranging services. The guidance emphasises the importance of activities like diagnostic testing, clinical assessment, vaccination, and post-exposure chemoprophylaxis to prevent illness and reduce transmission.Clear prior arrangements with providers are crucial for timely responses and minimizing disruptions to routine services.This guidance is intended to help ICBs prepare their response to infectious disease threats up to and including NHS incident response level 2, ranging from individual exposures to localised outbreaks.It should be used alongside national legislation and policy and operationalised through commissioning arrangements with local providers in conjunction with local outbreak plans and multiagency memorandums of understanding.

Richard has a learning disability and has spent time in hospital. His mum shares his story through this video about their journey to find the Right Care in the Right Place.

Infant mental health describes the social and emotional wellbeing and development of children in the earliest years of life. It reflects whether children have the secure, responsive relationships that they need to thrive. However, services supporting infant mental health are currently limited; only 42% of CCGs in England report that their CAMHS service will accept referrals for children aged 2 and under. This briefing by the Parent-Infant Foundation is aimed at commissioners looking to set up specialist infant mental health support. The guidance covers the following areas: What is infant mental health? Why does infant mental health matter? What are specialised parent-infant relationships teams? What infant mental health provision exists in the UK? Who needs infant mental health support? What impact has COVID-19 had on infant mental health?

In 2021, cybersecurity attacks on healthcare providers in the US reached an all-time high, with one study indicating that more than 45 million people were affected by these attacks in 2021 – a 32% increase on 2020. This report published by the Office of Senator Mark R Warner outlines the risk to patient safety posed by cyberattacks and proposes ways to improve federal leadership, enhance healthcare providers' preparedness for cyber emergencies and establish minimum cyber hygiene practices for healthcare organisations.

This series of short guides aims to help providers and commissioners better understand the use of patient insight and to use it effectively in delivering local services. These topics are covered in the guides: Seeking feedback in distressing or highly emotional situations Writing an effective questionnaire Building greater insight through qualitative research Helping people with a learning disability to give feedback How and when to commission new insight and feedback Insight – what is already available? The National Patient Reported Outcome Measures (PROMS) programme

With 1.4 million people providing 50 or more carer hours a week for a partner, friend or family member, carers make a significant contribution to society and the NHS. NHS England has developed 37 commitments to carers spread across eight key priorities, that have been developed in partnership with carers, patients, partner organisations and care professionals. Some of the areas covered include: raising the profile of carers education and training person-centred coordinated care primary care This webpage contains information on: Supporting carers in general practice: a framework of quality markers How to identify and support unpaid carers Supporting commissioners End of year progress summary

This report is aimed at people who are working with those who have a learning disability, in the role of commissioners or providers of services. It was produced on behalf of the Hampshire Safeguarding Adults Board by a multi-agency group and seeks to understand why people with a learning disability are at greater risk of choking, looking at what can be done locally in Hampshire to improve outcomes for people who are at risk of choking, in any care setting. The report makes a number of recommendations based on common sense and good practice. Recommendations Adults with a learning disability should be supported to take up annual health checks. Adults with a learning disability should be supported to attend a dentist for regular check ups. Social workers, as part of their annual review of placements, must check that individuals are receiving dental checks. All Primary Care Services in Hampshire are provided with information and web links for the National Patient Safety Agency (NPSA) ‘Ensuring safer practice for adults with learning disabilities who have dysphagia’. Health Commissioners ensure that there is sufficient Speech and Language Therapy resource within the community to respond to requests for assessment of learning disability clients identified as at risk of choking. The consent of the person with learning disability must be obtained before any medical investigation or assessment is carried out. All services providing for clients with a learning disability should use an Eating and Drinking Difficulties Screening Tool, which will indicate whether a choking risk exists and a referral to the GP is needed. All services providing for clients with a learning disability, who have a known risk of choking, should use the appropriate documentation in order to ensure the appropriate referrals are made. All Services providing for clients with a learning disability should ensure that they follow the instructions provided by the Speech and Language Therapist following an assessment. All services providing for clients with a learning Disability who are at risk of choking as a result of challenging behaviour or deliberate self- harm, should refer the individual to the Learning Disability Health Team for a formal assessment. If staff or carers identify that someone is at risk of choking from food or other objects in their mouth, a Mental Capacity Act assessment needs to be considered to support appropriate decision making. If clients, as a result of their behaviours and the consequent risk of choking, are prevented from accessing areas within a residential setting then an application should be considered from the care provider to the Supervising Authority (Local Authority) under the Mental Capacity Act Deprivation of Liberty Safeguards. If staff or carers identify that someone is at risk of choking, they must consider a referral to an advocacy organisation for an advocate to support the person with decision making in relation to eating and drinking plans. All carers and staff should be involved in the care planning process for people at risk of choking, particularly those who will be implementing the plan. Staff should be aware of the consequences of not following an agreed eating and drinking care plan. Care plans to support people at high risk of choking should be reviewed at least every 6 months or after any change in the person’s health or care. Staff induction training in all learning disabilities settings should include choking recognition and First Aid treatment of choking. All trainers to increase the emphasis on responding to choking incidents in First Aid training for services that provide care for people with learning disabilities. In line with the NPSA recommendation, regular practices or drills for staff around responding to a choking incident should be carried out as part of First Aid response training. The Group recommend a standard training matrix which should be used by all those providing care for those with a learning disability. The four Hampshire Safeguarding Adults Boards should seek to influence the Department of Health to consider a national data collection about choking deaths in people with a learning disability in order to understand the problem and guide improved practice. All Primary Care Services in Hampshire are sent the NPSA Learning Disability Dysphagia Protocols for GPs. The four Hampshire Safeguarding Adults Boards undertake a communications campaign to raise awareness around the issues of choking. A ‘Health passport’ is developed for every person with a learning disability to ensure that information around health risks including risk of choking is available to be shared between providers, with the person’s consent. All choking incidents involving people with a learning disability should be reported and investigated appropriately.

Independent Healthcare Providers Network (IHPN) has released a report on Community Health Services called 'What does good look like', which includes an overview of community health services in England, along with sixteen case studies from IHPN member organisations.   The case studies cover areas including workforce, service demand, quality, commissioning challenges, and what is new in the community services space.

In this Byline Times article, the family of 18 year-old Mollie McAinsh describe her treatment in an NHS hospital after they sought help for her life-limiting ME. Millie developed the condition after a viral illness in 2019 and became increasingly unwell. When she was no longer able to feed herself, she was admitted to the Royal Lancaster Infirmary, where her family believed she would have a feeding tube fitted and then be sent home. However, while in hospital her mother was banned from visiting and Millie was sectioned under the Mental Health Act. The article looks at the issues facing people with severe ME and examines the history of how the illness has been perceived, which many believe has resulted in the wrong treatment being offered to ME patients.

When was the last time your board discussed procurement and its role in your strategy for improving health outcomes? It’s been four months since Heather Tierney-Moore took over as interim chair of NHS Supply Chain and in this blog she reflects on the world of NHS procurement, where it has come from and where it might be going.

When the pandemic began, many nations’ emergency stockpiles came into the spotlight—and were found wanting. Twenty months later, Jane Feinmann asks what happened, and if procurement has got any better.

This observational study in The Lancet Public Health analysed the effects of outsourcing health services to private, for-profit providers. The authors evaluated the impact of outsourced spending to private providers on treatable mortality rates and the quality of healthcare services in England, following the 2012 Health and Social Care Act. The authors found that: an annual increase of one percentage point of outsourcing to the private for-profit sector corresponded with an annual increase in treatable mortality of 0·38% in the following year. changes to for-profit outsourcing since 2014 were associated with an additional 557 treatable deaths across the 173 CCGs in England. They conclude that private sector outsourcing corresponded with significantly increased rates of treatable mortality, potentially as a result of a decline in the quality of health-care services.

Making it Real is a framework for how to do personalised care and support for people who work in and access health, adult social care and housing services.  The framework is built around six themes that support co-production between people, commissioners and providers: Wellbeing and independence Information and advice Active and supportive communities Flexible and integrated care and support When things need to change Workforce

This independent external quality assurance review looks at the independent investigation into the care and treatment of mental health service user Mr M at Greater Manchester Mental Health NHS Foundation Trust.

The Patient Association's response to the PHSO: Complaint Standards Framework. Summary of core expectations for NHS organisations and staff. See also Patient Safety Learning's response to the framework.

The NHS has recently conducted a consultation on its updated Standard Contract for use in 2020/21. Once finalised this contract is published by NHS England and used by commissioners to contract for all healthcare services other than primary care services. The contract is regularly updated to reflect changes in legislation, policies and technical improvements. In this year’s consultation there have been several changes proposed that specifically relate to patient safety and in this blog we outline the main patient safety changes proposed and detail Patient Safety Learning’s formal consultation response. Medical Examiners of Deaths Proposed Change: We propose to include a new requirement for acute providers (NHS Trusts and Foundation Trusts only) to establish a Medical Examiner’s Office, in accordance with guidance published by the National Medical Examiner. The Office will, initially, review those deaths occurring on the Trust’s premises and not referred to the coroner, ensuring that the certification of death is accurate and scrutinising the care received by the patient before death. Patient Safety Learning supports this proposal. We welcome the decision to make the establishment of a Medical Examiner’s Office a requirement for acute providers. This proposal was first recommended following the Shipman Inquiry (2002-2005) and recent media coverage has revealed that a significant number of NHS trusts have still yet have appoint a Medical Examiner. Medical Examiners can play a key role in improving patient safety in cases where the patient’s death was the result of avoidable harm. They can provide vital insights into these cases and help to identify effective remedial actions to prevent their recurrence, as well as sharing this information for wider learning beyond their specific trusts. Patient Safety Incident Response Framework Proposed Change: The NHS Patient Safety Strategy indicates that the current NHS Serious Incident Framework and Never Events Policy Framework will be replaced, over the next two years, by a new single Patient Safety Incident Response Framework. To accommodate and signpost this planned change, we propose adding a specific reference to “successor frameworks” to the existing requirements relating to the current Frameworks. Patient Safety Learning supports the proposal to update requirements. We welcome the review of these frameworks and the development of a new Patient Safety Incident Response Framework (PSIRF). However, we have concerns about the delay in its release, which was initially expected towards the end of 2019 and now instead subject to a limited release this year with pilot organisations, rather than being shared more widely. We are also concerned about the lack of stakeholder engagement in this process, particularly for patients and families. Despite providing a valuable source of information when incidents occur, they are often not included in investigation processes. The failure to include and listen to patients and families in investigations can often result in more harm and increasing the likelihood of complaints and litigation. In updating these processes therefore it is vital their views are taken into account. National Patient Safety Alerts Proposed Change: The National Patient Safety Alerting Committee is establishing new, co-ordinated and accredited arrangements for the issuing of National Patient Safety Alerts to providers. We propose to include a new requirement for providers to ensure that they can receive each relevant National Patient Safety Alert, identify appropriate staff to coordinate and implement actions required within the timescale the Alert prescribes, and confirm and record when those actions have been completed. Patient Safety Learning supports this proposal. We welcome steps to ensure providers have appropriate arrangements in place to coordinate and implement actions required by national patient safety alerts and record when these have been completed. A recent report by Action Against Medical Accidents, An organisation losing its memory?, has indicated that a number of trusts have experienced significant delays in introducing safer practices highlighted by national patient safety alerts. They found in many cases that the trusts experiencing delays ‘indicated that they were in the process of improving internal systems for overseeing the implementation of patient safety alerts’. It is a positive step to see this is now being added to the NHS Standard Contract as a formal requirement for them to do so. However, we have concerns beyond the scope of these contractual obligations that this process does not appear to be monitored at a national level. While these measures place specific responsibilities on providers, we are not clear on what, if any, oversight arrangements will be put in place to accompany these. We think such national monitoring and public reporting is essential and would look for this to be implemented as a priority. Patient Safety Specialists Proposed Change: The NHS Patient Safety Strategy envisages the establishment of a network of patient safety specialists, one in each provider, to lead safety improvement across the system. We therefore propose to include a requirement on each provider to designate an existing staff member as its Patient Safety Specialist. Patient Safety Learning supports this proposal. We support this proposal in principle but have reservations about how this will be implemented in practice. The requirement to appoint a Patient Safety Specialist, as set out in the NHS Patient Safety Strategy, currently lacks detail about the nature of this role. What do we mean by a ‘Safety Specialist’? What knowledge and training should they have? Will the appropriate governance arrangements be in place to make sure their voice is heard by the organisation’s leadership? We think these arrangements should be specified, resourced, monitored and transparently reported. We will be responding to the separate consultation on this which opened on the 30 January 2020 in more detail. Common sources of harm to patients in hospital/Safety Thermometer Proposed Change: Feedback suggests that the existing Contract requirements on use of the Safety Thermometer are creating too great a bureaucratic burden, and not facilitating learning. We therefore propose to remove the specific requirements relating to use of the Safety Thermometer and, instead, introduce a higher-level obligation on acute providers to ensure and monitor standards of care in the four clinical areas which the Safety Thermometer addresses – venous thromboembolism, catheter-acquired urinary tract infections, falls and pressure ulcers. At Patient Safety Learning we believe that the health and social care system should develop models for measuring, reporting and assessing patient safety performance. This data should be gathered centrally and then used for learning and to implement actions that improve care. With regards to the removal of Safety Thermometer requirement, while we recognise that it has been noted that this has not been effective in facilitating learning, we would expect the newly proposed measures to follow these principles. We would also expect patient safety measurement to apply to all NHS organisations, rather than being an obligation limited to acute providers.

Commissioning is the continual process of planning, agreeing and monitoring services. Commissioning is not one action but many, ranging from the health-needs assessment for a population, through the clinically based design of patient pathways, to service specification and contract negotiation or procurement, with continuous quality assessment. There is no single geography across which all services should be commissioned: some local services can be designed and secured for a population of a few thousand, while for rare disorders, services need to be considered and secured nationally.

This guidance wriiten by the Royal College of Nursing, is for health care professionals, service providers and those involved with planning and commissioning services. It sets out the RCN’s perspective on contemporary and future children and young people’s nursing services in the home and community setting. It also underlines the increasingly crucial role played by community children’s nurses as they provide integrated care closer to home. It explores the legislative and policy agenda, defines the role of the CCN, sets out the core principles of providing care, considers variations in how the needs of families are assessed across the four countries of the UK and outlines examples of current models of care and service delivery.

Dr Matt-Inada-Kim, National Clinical Lead for Sepsis and Deterioration, shares the proforma he has developed to document management and treatment for the deteriorating patient for the new CQUIN, coming soon. This proforma ensures that all the CQUIN data is captured when it comes to audit. He has shared his accompanying slide set explaining about the CQUIN.   CQUIN.pptx CQUIN.pdf

In this guest blog from NHS England, the Director of Policy for National Voices throws his support behind NHS England’s refreshed statutory guidance on the importance of involving patients and the public in commissioning.

This document provides information about NHS England’s and NHS Improvement’s funding in 2019/20. It sets out how NHS England and NHS Improvement will support The NHS Long Term Plan through distribution of funding, people and resources, to transform local health and care systems.  This document explains how patients are informed, involved and consulted in the development, improvement and delivery of health and care services.