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NHS England: The Month – June 2025
Mark Hughes posted an article in NHS England
‘The Month’ is a new publication from NHS England which provides a strategic update for health and care leaders. This edition includes details of the 100 day plan for Sir Jim Mackey’s first few months as NHS England Chief Executive, information about the new Urgent and emergency care plan 2025/26 and highlights of other recent healthcare publications and developments.- Posted
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Women would no longer be prosecuted for terminating a pregnancy in England and Wales under a proposed shake-up of abortion laws. MPs are set to get a free vote next week - meaning they will not be told how to vote by their party - on a change to the law. It comes amid concern more women are being investigated by police on suspicion of illegally ending a pregnancy. Abortion is illegal in England and Wales, most often prosecuted under a piece of Victorian legislation, the Offences Against the Person Act of 1861. But it is allowed up to 24 weeks and in certain other circumstances under the terms of the 1967 Abortion Act. This requires two doctors to sign it off and even before 24 weeks can require a woman to testify that her mental or physical health is at risk. An amendment to the Crime and Policing Bill, tabled by Labour MP Tonia Antoniazzi, aims to decriminalise abortion at any stage by a woman acting in relation to her own pregnancy, ending the threat of investigation or imprisonment. The framework by which abortion is accessed would remain the same. But abortions would only need to be signed off by two doctors - as the law currently demands - if the procedure takes place in a hospital or other healthcare setting. Time limits would also still apply in healthcare settings. "The police cannot be trusted with abortion law – nor can the CPS or the wider criminal justice system," Antoniazzi said. "My amendment to the crime and policing bill will give us the urgent change we need to protect women." Read full story Source: BBC News, 20 June 2025- Posted
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From Autumn 2023, NHS organisations in England began to change the way they investigated cases of avoidable patient harm and near misses, introducing the Patient Safety Incident Response Framework (PSIRF). As part of PSIRF, organisations are required to create and publish a Patient Safety Incident Response Plan. This blog summarises the findings of a new report, Patient Safety Incident Response Plans: An analysis and reflection by Patient Safety Learning. Drawing from a sample of 13 Patient Safety Incident Response Plans, the report considers what they can tell us about the implementation of PSIRF. PSIRF When something goes wrong with a patient’s care or treatment that causes them harm, or has the potential to cause harm, healthcare staff are required to formally report these incidents. Subsequently, investigations take place into these events, which can act as an important source of insights and learning. These investigations provide an opportunity to identify what went wrong and the actions needed to prevent a similar incident from taking place in the future. In England, the NHS has recently introduced a new approach to these investigations called PSIRF. This represents a significant shift in the way the NHS responds to patient safety incidents and is intended to be a major step towards establishing a systems approach to patient safety in the NHS. A systems approach is one that focuses on understanding how different parts of the healthcare system interact, rather than placing blame solely on individuals when things go wrong. Patient Safety Incident Response Plans As part of PSIRF, NHS organisations in England are required to create and publish a Patient Safety Incident Response Plan. These plans should specify the methods an organisation intends to use to maximise learning and improvement, and how these will be applied to different patient safety incidents. They provide an opportunity for organisations to demonstrate to patients, staff and the wider public how they are seeking to improve patient safety through incident investigations. In our new report, we have analysed a sample of 13 Patient Safety Incident Response Plans (a sample size of 6% out of the 206 organisations included in our Patient Safety Incident Response Plan [PSIRP] Finder). Our intention has been to reflect on what these tell us about the implementation of PSIRF, identify issues that could help organisations update their plans in the future and take action to reduce avoidable harm. Report findings From the sample of Patient Safety Incident Response Plans we analysed, our new report has identified a number of key themes: Variations in approach Although NHS Trusts use a common template to create their Patient Safety Incident Response Plans, their approach to completing these has varied significantly in places. An example of this is the criteria organisations use when deciding to conduct a formal Patient Safety Incident Investigation (PSII). There are some patient safety incidents, such as those classed as a ‘Never Event’, where a PSII must be carried out. However, for incidents where there is no national requirement to do so, Trusts decide whether to carry out a PSII based on their own criteria. In our analysis, we found that in some cases Trusts provided a detailed explanation of factors that they would consider in deciding on whether to undertake a PSII; however, in other plans only a brief explanation was provided. In a few cases, there was no statement on when a PSII would be required. Differences in detail While Trusts in the sample we examined all sought to meet the requirements NHS England set them for their Patient Safety Incident Response Plans, the level of detail they have provided differs considerably. An example of this can be seen when organisations detail how they have identified local patient safety priorities. Patient Safety Incident Response Plans contain both national and local priorities. While NHS Trusts are required to adopt a standardised approach to national priorities, local priorities vary from organisation to organisation. In our analysis, we found that in some cases Trusts had provided a significant amount of detail of the sources they used to identify local priorities and also included the methodology they used in prioritising these sources. Other organisations, however, provided significantly less detail—in some cases just a brief list of priorities and data sources. Critical information gaps We also identified a range of issues that Patient Safety Incident Response Plans in our sample either covered very briefly or not at all. This included: Compassionate engagement and the involvement of those affected by patient safety incidents. Detail on this was largely absent in plans, despite this being identified as one of the four key aims of PSIRF. Evidence of the existence of robust mechanisms to ensure that safety recommendations are actioned and monitored effectively. References to sharing learning and insights from patient safety investigations more widely for system-wide improvement. Recommendations Based on the findings in our report, we have identified five recommendations for NHS England and the Department of Health and Social Care. These are intended to improve the approach to creating and implementing Patient Safety Incident Response Plans. Develop a national standardised framework for evaluating individual Patient Safety Incident Response Plans. Create a central NHS repository of Patient Safety Incident Response Plans and Policies. Consider the benefits of introducing independent external reviews of Patient Safety Incident Response Plans. Update Patient Safety Incident Response Plan guidance for NHS and Foundation Trusts so this explicitly refers to sharing insights and learning from the implementation of plans. Commission a full evaluation of Patient Safety Incident Response Plans. We also highlight some key issues that we believe NHS Trusts should consider when it comes to reviewing their Patient Safety Incident Response Plans: Transparency: Trusts should seek to ensure plans are accessible and clearly communicate how approaches are developed, how they impact patients, staff and the public, and how they address patient safety incidents. Investigation quality: To help improve the depth and rigor of investigations, there should be a greater emphasis and understanding of the contributory factors to incidents in these plans. Quality improvement: Trusts should identify issues that lead to tangible actions to enhance patient safety. Knowledge sharing: How plans can help to facilitate widespread dissemination within organisations and encourage sharing across the health system in England. Standardisation of prioritisation: Explore whether a standardised approach—such as outcome-based, contributory factor-based, or a combination of both—could provide a system-wide perspective for reporting and analysis. Commenting on the report, Patient Safety Learning's Chief Executive Helen Hughes said: “Too often in the NHS we see examples of patient safety investigations not resulting in learning and improvement. This is a theme that emerges time and time again in cases of avoidable patient harm and major patient safety inquiries. The introduction of PSIRF presents a significant opportunity to improve the approach to patient safety incident investigation in England. However, if this is to live up to its ambitions, it must have a clear focus on turning insights and learning into action and improvement. The content of early Patient Safety Incident Response Plans suggests that greater work is needed in this area. Plans should have details on how safety recommendations will be monitored and evaluated, as well as including provisions for sharing good practice as widely as possible. PSIRF is intended to be flexible, with NHS guidance on the creation of Patient Safety Incident Response Plans reflecting this. However, from our analysis we have found that the lack of uniformity in these plans has the potential to complicate cross-organisational comparisons and learning. This in turn could hinder the identification of best practices as Trusts’ approaches diverge. If we are to understand and evaluate the impact of PSIRF, we believe a standardised framework for evaluating individual Patient Safety Incident Response Plans is essential.” Share your experiences and views with us Are you involved in your NHS Trust’s plans to review its Patient Safety Incident Response Plan in the near future? What issues are you considering as part of this process? What do you think is needed to deliver this? We would welcome your reflections on the issues raised in the report and are keen to hear further insights from those involved in shaping and delivering Patient Safety Incident Response Plans. You can comment below (sign up to the hub first, for free) or email the team directly at [email protected] to share your experiences.- Posted
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This guidance offers high-level information to assist those adopting ambient scribing products that feature Generative Artificial Intelligence (AI), for use across health and care settings in England. These products are sometimes referred to as ambient scribes or AI scribes and include advanced ambient voice technologies (AVTs) used for clinical or patient documentation and workflow support. The guidance is intended for settings aiming to implement a specific product or function of an existing product.- Posted
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News Article
Hospitals in England offered unlimited bonuses for taking patients off waiting lists
Mark Hughes posted a news article in News
Hospitals in England are being offered unlimited bonus payments to remove people they decide do not need treatment from their waiting lists amid warnings that thousands of patients most in need are still facing unacceptable delays. The waiting list for hospital treatment fell for the sixth month in a row in February, according to data published on Thursday. In an attempt to cut waiting lists and free up consultants to see those most in need, NHS trusts have this week been ordered to “validate” their entire waiting list. This will involve reviewing every patient and removing anyone who could be treated elsewhere or does not need an appointment with a specialist. Those whose symptoms have eased or who have already used private healthcare to undergo surgery, for example, will also be removed. Hospitals will receive an “incentive payment” for each patient they remove, and a payment cap of 5% of a trust’s waiting list is being scrapped, according to documents seen by the Guardian. It means there is no limit to the payments NHS trusts could receive for taking patients off their lists. Read full story Source: The Guardian, 10 April 2025- Posted
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Target date for NHSE abolition revealed
Mark Hughes posted a news article in News
National leaders are targeting October 2026 for the abolition of NHS England and consolidation of its functions into the Department of Health and Social Care, according to Health Service Journal. The timeframe is not yet confirmed, and will depend on ministers securing space in the King’s Speech and parliamentary time to progress a health bill. There is also an acceptance that completing the process in 18 months will be challenging. Read full story (paywalled) Source: Health Service Journal, 11 April 2025 -
News Article
Two of England’s leading doctors are to oversee a significant review into postgraduate training for newly qualified medics. National Medical Director Professor Sir Stephen Powis and Chief Medical Officer Professor Sir Chris Whitty will lead the review as part of work to address concerns raised by resident doctors (previously known as junior doctors). The review will be based on feedback from current resident doctors and students, locally employed doctors and medical educators, with a series of engagement events around the country starting from this month. The review will cover placement options, the flexibility of training, difficulties with rotas, control and autonomy in training, and the balance between developing specialist knowledge and gaining a broad range of skills. The national listening events in February and March will be followed by a call for evidence in the spring to ensure the widest possible range of views, experiences and ideas are captured. A report on the review’s findings is due to be published in the summer. Read full story Source: NHS England, 19 February 2025 -
Content Article
In this annual report for 2023/24, Healthwatch England outlines how the public’s stories have changed care for the better, and the work they are doing to make sure that the health and social care system puts patients at its very heart. Healthwatch England is a statutory committee of the Care Quality Commission (CQC). Its main functions are to: provide leadership, guidance, support to local Healthwatch organisations; escalate concerns about health and social care services to CQC; and advise Government, NHS England and local authorities about the quality of services.- Posted
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On Wednesday 15 October 2024, the Department of Health and Social Care announced an independent review of patient safety across the health and care landscape in England. This blog sets out Patient Safety Learning’s response to this announcement. Today the Government has published the terms of reference for a review of patient safety across the health and care landscape. This review will: “… assess whether the current range and combination of organisations delivers effective leadership, listening, learning (including investigations and their recommendations) and regulation to the health and care systems in relation to patient and user safety (and to what extent they focus on the other domains of quality).”[1] This follows on from the publication of Dr Penny Dash’s latest report highlighting significant failings at the Care Quality Commission (CQC), the independent regulator of care providers.[2] The main focus of the review will be on the following organisations: CQC – including the Maternity and Newborn Safety Investigations programme National Guardian’s Office Healthwatch England and the Local Healthwatch network Health Services Safety Investigation Body (HSSIB) Patient Safety Commissioner for England NHS Resolution (patient safety-related learning functions only, not clinical negligence functions). The review will focus on how these bodies work together, with the findings feeding into the government's 10-year plan for the NHS, expected to be published in the spring next year. Patient Safety Learning welcomes this announcement and sets out some initial reflections on this below. A fragmented landscape The landscape of organisations with patient safety roles and responsibilities is fragmented and lacks coordination. This makes it often ill-suited to tackling complex systemic challenges to patient safety. This is an issue we highlighted in our report last year, The elephant in the room: Patient safety and Integrated Care Systems.[3] Therefore, we welcome any steps to promote cross-organisational working and coordination between regulators, ultimately with the aim of reducing avoidable harm. Figure 1: Patient safety environment in England The need to review roles and remits of patient safety organisations in England is not a new issue. The CQC itself referred to this as early as 2018, in their report Opening the door to change: NHS safety culture and the need for transformation.[4] This was also highlighted in 2020 by the Independent Medicines and Medical Devices Safety (IMMDS) Review. Chaired by Baroness Julia Cumberlege, this looked at the harmful side effects of medicines and medical devices and how to respond to them more quickly and effectively in the future. It stated that: “We have found that the healthcare system – in which I include the NHS, private providers, the regulators and professional bodies, pharmaceutical and device manufacturers, and policymakers – is disjointed, siloed, unresponsive and defensive. It does not adequately recognise that patients are its raison d’etre. It has failed to listen to their concerns and when, belatedly, it has decided to act it has too often moved glacially.”[5] Again this was raised last year by the Parliamentary and Health Service Ombudsman. In their report, Broken trust: making patient safety more than just a promise, they stated that: “… political leaders have created a confusing landscape of organisations, often in knee-jerk rection to patient safety crisis points. HSIB, the Patient Safety Commissioner, PHSO, NHS England, NHS Resolution and more than a dozen different health and care regulators all play important roles in patient safety. But there are significant overlaps in functions, which create uncertainty about who is responsible for what. This means patient safety voice and leadership are fractured. This is not due to a lack of dedication and professionalism from those tasked with championing patient safety. The problem is structural.”[6] Patient perspective An overly complex system of regulation and oversight that cannot tackle underlying patient safety problems ultimately has a very real human cost. The persistence of avoidable harm, and every avoidable death and disability that accompanies this, is an unnecessary tragedy for patients, families and healthcare professionals. At Patient Safety Learning, we believe that patients should be engaged for safety at the point of care, if things go wrong, in improving services, advocating for changes and in holding the system to account. We identify this as one of our six foundations of safer care in our report, A Blueprint for Action.[7] This is also one of the seven strategic objectives in the WHO Global Patient Safety Action Plan, which states that: “Patients, families and other informal caregivers bring insights from their experiences of care that cannot be substituted or replicated by clinicians, managers or researchers. This is especially so for those who have suffered harm.”[8] We would therefore stress the importance that this new review must feature a clear commitment to including and involving patients as part of the process. This should not be a top-down exercise without patient and public input. Safety culture We believe that we need a transformation in the health and care system’s approach to patient safety. Fundamental to this is patient safety not being seen as another priority, which in practice will be weighed (and inevitably traded-off) against other priorities, but as a core purpose of health and care. This will require a cultural shift in health and care in the UK. There remains a significant gap between what organisation leaders say about creating a patient safety culture in the NHS and what is done in practice. We see plentiful evidence of this in inquiries into unsafe care, whistleblower testimonies and staff survey results. This was an issue we examined in greater detail earlier this year in our report, We are not getting safer: Patient Safety and the NHS staff survey results.[9] In this context, we believe it would be beneficial if the review also considers the role of national leadership organisations in actively contributing and creating a just and fair culture in health and care. Safety Management System There is a growing debate in patient safety about the possible benefits that healthcare may gain from moving towards a Safety Management System (SMS) approach. SMSs are an organised approach to managing safety which are widely used in different industries. An SMS approach is used to: help enable proactive assessments of risks specify how risks should be managed set clear lines of accountability and responsibility in addressing risks. In considering the application of SMSs to UK healthcare, HSSIB in October 2023 published a report, Safety management system: an introduction for healthcare.[10] This identified the requirements for effective SMSs, how these are used in other safety critical industries and considers the potential of application of this approach in healthcare. A country-wide SMS would have the potential to provide a more structured and joined up approach to patient safety strategies, involving all the national bodies. Patient Safety Learning believes that integral to this is a standards-based framework to ensure safe, quality patient care is consistently delivered.[11] A patient safety standards framework helps organisations understand ‘what good looks like’ for patient safety, understand where more action is needed for improvement, with clearly defined safety aims and goals. Such a framework will enable organisations and regulators to demonstrate a risk-based approach to patient safety and evidence achievement, can provide assurance that patient safety sits at the organisation’s core, improves performance through increased effectiveness, and enables patients and families, staff, funders and communities to identify and differentiate good safety providers. This is an issue we believe requires serious consideration and we look forward to contributing as part of our submission to this review. References Department of Health and Social Car. Review of patient safety across the health and care landscape: terms of reference, 15 October 2024. Department of Health and Social Care. Independent report: Review into the operational effectiveness of the Care Quality Commission, 15 October 2024. Patent Safety Learning. The elephant in the room: Patient safety and integrated care systems, 11 July 2023. CQC. Opening the door to change: NHS safety culture and the need for transformation, December 2018. The IMMDS Review. First Do No Harm: The report of the Independent Medicines and Medical Devices Safety Review, 8 July 2020. PHSO. Broken trust: making patient safety more than just a promise, 29 June 2023. Patient Safety Learning. The Patient-Safe Future: A Blueprint For Action, 2019. WHO. Global Patient Safety Action Plan 2021-2030, 3 August 2021. Patient Safety Learning. We are not getting safer: Patient safety and the NHS staff survey results, 26 March 2024. Health Services Safety Investigations Body. Safety management systems: an introduction for healthcare, 18 October 2024. Patient Safety Learning. Standards: What Good Looks Like, Last accessed 15 October 2024.- Posted
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This is the terms of reference for an independent review of patient safety across the health and care landscape in England. The review will map the broad range of organisations that impact on quality and focus on six key organisations overseen by the Department of Health and Social Care, which have a significant impact on patient safety. The primary task of this review is to assess whether the current range and combination of organisations delivers effective leadership, listening, learning (including investigations and their recommendations) and regulation to the health and care systems in relation to patient and user safety (and to what extent they focus on the other domains of quality). Based on this assessment, the review will make recommendations on whether greater value could be achieved through a different approach or delivery model. The review will also set out the wider landscape of quality, looking at health and social care. The mapping work will provide context for the review of the specific organisations named below. This work will also be used to more widely inform the 10-year health plan. The main focus of the review will be on the following organisations: Care Quality Commission (CQC) - including the Maternity and Newborn Safety Investigations programme National Guardian’s Office (NGO) – NGO is hosted by CQC and its work on staff experience should inform improvements in patient safety Healthwatch England (HWE) and the Local Healthwatch (LHW) network – HWE is also hosted by CQC. Its work, alongside LHW, on patient experience should inform improvements in safety Health Services Safety Investigation Body Patient Safety Commissioner for England NHS Resolution (patient safety-related learning functions only, not clinical negligence functions)- Posted
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At Patient Safety Learning we often get asked by patients and families who have received poor healthcare what they need to do to make a complaint. Although we cannot get directly involved in individual cases, we have put together a simple guides on the steps you can take if you need to make a complaint about NHS care in England. We also have the following guides: How do I make a complaint about my NHS care Northern Ireland: a simple guide for patients and families How do I make a complaint about my NHS care in Scotland: a simple guide for patients and families How do I make a complaint about my NHS care in Wales: a simple guide for patients and families How do I make a complaint about my private care: a simple guide for patients and families How do I make a complaint: Sources of help and advice If you are a healthcare professional looking at these pages, the NHS Complaint Standards, model complaint handling procedure and good complaint handling guides set out how organisations providing NHS services should approach complaint handling. They apply to all NHS organisations in England and independent healthcare providers who deliver NHS-funded care. You have the right to make a complaint about any aspect of NHS care, treatment or service. Every organisation that provides an NHS service in England must have their own complaints procedure. You can usually find information about how to complain in waiting rooms, at reception, on the organisation’s website or by asking a member of staff. Here are the steps to take if you would like to make a complaint. More information on each step is given below. Step 1: Informal complaint Many issues can be resolved quickly by speaking directly to the staff at the place where you received care or accessed a service. You are under no obligation to make a complaint informally before you make a formal complaint. However, if you believe something has gone wrong with the healthcare provided to you or a loved one, it is almost always best to discuss your concerns with the medical staff as soon as possible, especially if your main concern is to have something urgently put right. Talk to the staff concerned or a manager and explain why you are unhappy. If you prefer, you can contact the Patient Advice and Liaison Service (PALS) at the organisation and ask them to investigate the matter. Contact your local hospital trust for contact details of their PALS. If your complaint is about a family health service (such as a GP, dentist, optician or pharmacist) you can contact the practice complaints manager. They may be able to settle your complaint straight away. If you are not satisfied with their response, however, you can submit a formal complaint through local resolution procedures—see Step 2. Step 2: Local resolution procedures If you would like your complaint to be dealt with more formally, you should use the NHS complaints procedure. The first stage is local resolution, where the NHS is required to investigate and respond to your complaint. You should make your complaint as soon as possible so that your memory of events is fresh. Your complaint must be made: no later than 12 months after the event(s), or no later than 12 months from when you first became aware of the issues. NHS organisations may consider complaints outside these time limits—for example, if you have a long-term illness or condition. A complaint can be made verbally, in writing or electronically. You can complain: Directly to the provider (such as a the hospital or GP surgery). To your local integrated care board (ICB) for complaints about primary care services (GPs, dentists, opticians or pharmacists) and secondary care (such as hospital care, mental health services, out-of-hours services, NHS 111 and community services like district nursing). Each ICB has its own complaints procedure, which is often displayed on its website. Find your local integrated care board. AvMA (Action against Medical Accidents) has a number of self-help guides that provide clear and straightforward explanations of the procedure and guide you through making a complaint, including a helpful template letter. Under the NHS complaints procedure, you can get: An explanation for what happened. An apology or other statement of regret. Steps to review procedures to avoid similar incidents happening in future. In general, the NHS complaints procedure will not: Offer financial compensation. Address issues of staff discipline, for instance by sacking someone or having them struck off a professional register. If you are not satisfied with the final response to your complaint, you have the right to request an independent review of your complaint by the Parliamentary and Health Service Ombudsman—see Step 3. Step 3: Parliamentary and Health Service Ombudsman If you have tried local resolution and are not happy with the result, or if the investigation has taken over six months, you can ask for an independent review by the Parliamentary and Health Service Ombudsman (the Ombudsman). You must go through the NHS Complaint (local resolution) stage first—the Ombudsman will not consider your complaint until you do. Although you have a right to request an independent review of your complaint, the Ombudsman is unlikely to agree to a review if it thinks that more should be done to resolve the complaint at local resolution stage. You should try to request a review within 12 months of the incident occurring or when you first became aware that something had gone wrong. If this is not possible, you can ask the Ombudsman to consider your request, particularly if you have a good reason for the delay such as trying to obtain other advice. You can use the Ombudsman’s own forms to submit your complaint if you wish. AvMA also provides further guidance on making a complaint to the Ombudsman. Once the Ombudsman has confirmed its decision, this is the end of the NHS complaints procedure. If you still strongly disagree with the Ombudsman’s decision the only way to challenge it is via judicial review. Step 4: Judicial review Although the NHS complaints procedure finishes with a final decision by the Ombudsman, you may be able to challenge the Ombudsman’s decision by seeking a judicial review. You will need to take legal advice to see if you are eligible. Judicial review is a legal process in which the courts assess whether a public body—in this case the Ombudsman—has reached or failed to reach a decision fairly. The grounds for this can include: There has been an unfair or biased process. This could be that the public body has failed to review evidence presented by one side or hasn’t given a fair hearing on the basis of the written information. The decision is irrational. The most important point about judicial review is that it must be sought very quickly after the decision has been made. You should seek legal advice as quickly as possible if you are considering this route. An application for judicial review should be made as soon as possible and no later than three months after the public body’s decision has been made. The Law Society provides a list of lawyers who specialise in medical matters.- Posted
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This report by the National Audit of Dementia (NAD) presents the results of the fifth round of audit data. For the first time, the audit has been undertaken prospectively, which will enable hospitals to take earlier action to improve patient care and experience. However, this has demonstrated that many hospitals still have no ready mechanism to identify people with dementia once admitted. One notable improvement is delirium screening (dementia is the biggest risk factor for developing delirium). Screening for delirium has improved from 58% in round 4 to 87% in the current audit. In addition, a high number of pain assessments are also being undertaken within 24 hours of admission (85%). Although encouraging, the report highlights that 61% of these assessments were based only on a question about pain—an approach that can be unreliable in patients with dementia. While this report acknowledges that our health services have experienced an extraordinarily difficult and challenging time, it does shine a light on a need for more training. It states that is encouraging that many staff have received Tier 1 dementia training (median 86%), but suggests that a much higher proportion of ward-based patient facing staff should have received Tier 2 dementia training (median 45%). It found that only 58% of hospitals are able to report the proportion of staff who have received training. As such, the report recommends that any member of staff involved in the direct care of people with dementia should have Tier 2 training, and this training should be recorded to provide assurance to the public and regulators. -
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This report by the Royal College of Midwives (RCM) highlights the impact of midwifery staffing shortages on women. It looks at historical failures to invest appropriately in maternity services and talks about a mounting maternity crisis, drawing attention to Care Quality Commission inspections of maternity services that are identifying concerns around safety directly linked to staffing shortages. According to the report’s findings, if the number of NHS midwives in England had risen at the same pace as the overall health service workforce since the last general election, there would be no midwife shortage; there would be 3,100 more midwives in the NHS, rather than having a shortfall of 2,500 full-time midwives. The RCM published the results of a survey last month which showed that midwives give 100,000 hours of free labour to the NHS per week to ensure safe care for women. It also showed that staffing levels were repeatedly cited as cause for concern around the safety of care, and that midwives and maternity support workers are exhausted and burnt out. -
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9.1 million people will be living with major illness by 2040, 2.5 million more than in 2019, according to this new report published by the Health Foundation. The analysis is part of a four-year project led by the Health Foundation’s Real Centre in partnership with the University of Liverpool, focusing on levels of ill health in the adult population in England up to 2040. It lays out the scale and impact of the growth in the number of people living with major illness as the population ages. The analysis finds that 19 of the 20 health conditions studied are projected to increase in prevalence, including a rise of more than 30% in the number of people living with conditions such as cancer, diabetes and kidney disease. Overall, the number of people living with major disease is set to increase from almost 1 in 6 of the adult population in 2019, to nearly 1 in 5 by 2040, with significant implications for the NHS, other public services and the public finances. The challenges of improving care for an ageing population and enabling people to live independent lives for longer are not unique to England, with countries across the globe facing similar pressures on their health services. However, with the NHS already under unprecedented strain, the findings point to big changes in how care should be delivered in future. Much of the projected growth in illness relates to conditions such as anxiety and depression, chronic pain and diabetes, which are predominantly managed outside hospitals in primary care and the community. This reinforces the need for investment in general practice and community-based services, focusing on prevention and early intervention to reduce the impact of illness and improve the quality of people’s lives. The analysis finds that 80% of the projected increase in major illness (2 million people) will be among people aged 70 and over, with the remaining 20% (500,000 people) among the working-age population (20-69 years old). It also projects that improvements in some of the main causes of poor health, such as fewer people smoking and lower cholesterol rates, will be offset by the impact of obesity as many people who have been obese for long periods of their lives reach old age. The report warns that there is no silver bullet to reduce the growth in people living with major illness and that supporting people to live well with illness will increasingly be an essential function of health care and other services in the future. Its findings underline the need for a long-term plan to reform, modernise and invest in the NHS alongside a bold, new approach that invests in the nation’s health and wellbeing.- Posted
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This policy explains how the Structured Judgement Review (SJR) process is implemented within Maidstone and Tunbridge Wells NHS Trust. The policy advises staff on how to undertake a mortality case record review, which documentation to use, in which circumstances an SJR is required and how the new process relates to previous systems and processes. The policy also explains how the process links to revised mortality reporting, escalation of concerns and dissemination of learning. It covers all inpatients and Emergency Department patients who die whilst in the Trust’s care, and patients who die within 30 days of discharge.- Posted
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In this report, Patient Safety Learning considers the roles and responsibilities of Integrated Care Systems (ICSs) in relation to patient safety, and how this fits in with the wider patient safety landscape in England. This article contains a summary of the report, which can be read in full here or from downloading the attachment below. Action is needed to ensure that ICSs are not ‘patient safety free zones’, says Patient Safety Learning. A year on from ICSs being placed on a statutory footing, a new report, The elephant in the room: Patient Safety and Integrated Care Systems, argues that there needs to be a greater focus on the role that they play in patient safety. The report sets out what we mean by avoidable harm in healthcare, outlining the scale of this problem and the need for a transformation in approach to improving patient safety. It also looks at the landscape of different coordinating groups and organisations in England that have roles and responsibilities to improve patient safety and reduce avoidable harm. What is revealed is a complex and fragmented environment, lacking strong measures for cross-organisational thinking and coordination to address complex systemic threats to patient safety. Considering the creation and initial development of ICSs, the report highlights how there has been little mention of their role in, or impact on, patient safety. It illustrates that although patient safety has not been set as explicit priority for ICSs, the delivery of safe care runs implicitly through each of their main aims. It goes on to consider the potential role that ICSs can potentially play in helping to embed and improve patient safety. Recommendations Considering the steps that could be taken to address the current gap that exists between patient safety and ICSs, and the wider fragmentation of the patient safety landscape in which they operate within, the report makes the following recommendations: The Department of Health and Social Care and NHS England should consider introducing a fifth aim for ICSs making explicit their role in helping to improve patient safety and reduce avoidable harm. NHS England should update the NHS Patient Safety Strategy to account for ICSs being placed on a statutory footing in July 2022 and set out their roles and responsibilities in relation to this. The Department of Health and Social Care and NHS England should consider revising the remit of the National Patient Safety Committee to take on a greater role in coordinating and joining-up the existing patient safety landscape in England. The National Patient Safety Committee should regularly publish agendas, papers and the minutes of its meetings to help inform all bodies that may be impacted by this, such as ICSs and individual healthcare providers, and also patients and the wider public. Patient Safety Learning comment: Patient Safety Learning Chief Executive Helen Hughes said: “ICSs present a significant opportunity to drive improvements in patient safety in local health systems across the NHS. However, we think patient safety remains the ‘elephant in the room’ in the development of ICS roles and responsibilities. Currently there is not clear guidance or support to ensure that ICSs treat patient safety as a core purpose of healthcare. We believe they need to have specific aims for reducing avoidable harm and improving patient safety. There also needs to be clarity on where the patient safety role of ICSs fits into the wider healthcare system. The landscape of organisations with patient safety roles and responsibilities in England is fragmented and lacks coordination, often ill-suited to tackling complex systemic challenges to patient safety. We believe that the Department of Health and Social Care and NHS England need to consider how to better join-up this system, to promote cross-organisational working, coordination and ultimately reduce avoidable harm.”- Posted
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This report summarises the key insights from the Birmingham ICS Delivery Forum event, held in Birmingham in April 2023. It places the discussions that took place into the broader context of health and care transformation, both at a local and national level, and uses wider sources and research to expand upon the key points. Key messages about the potential role of Integrated Care Systems (ICSs) Subvert the health and care system: ICSs present a unique opportunity to refocus and rebalance resources into health prevention, early intervention and reducing levels of health inequality. Strive for transformation: ICSs are grappling with unprecedented operational pressures and service demand that can, at times, distract from the ultimate goal of transforming health and care provision. These are not binary choices, as progress in one will advance the other. Be patient with public health and prevention: Initiatives to support public health will take time to bed in and prove their value and ICS strategy should account for this fact. Leadership has a role to play in ensuring that organisations are empowered to take localised action on prevention and health inequalities. Taking preventative action should not be considered a distraction from immediate challenges, but rather, the solution to manging demand in the long-term. Embed awareness of health inequality at all levels, and throughout every programme: Initiatives addressing health inequality cannot be addressed with siloed efforts, it must be a concept that underpins every level of leadership of an ICSs and be fundamental to the system culture. Partnership is essential to unlocking health inequalities and addressing unmet need: As ICSs mature, partnership-based programmes and initiatives are forming an increasing part of ICS strategy to tackle health inequalities and improve population health. Use information governance as an enabler of data sharing: ICSs can harness data governance to viability improve longevity of partnerships and provider collaboratives. Clarify points of entry across the system: Providers of various sizes, in both public and private sectors are experiencing difficulties in accessing the relevant functions of ICSs. Accordingly, ICSs need to provide greater clarity regarding points of entry into the system. Diversify leadership across every level: Diversity of perspectives and professional representation at ICB and ICP level will be crucial to the successful delivery of collaborative, integrated care.- Posted
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This is the transcript of an oral statement to the House of Commons by Steve Barclay MP, Secretary of State for Health and Social Care, on improving safety in mental health in-patient services across England. In this statement the Secretary of State: Provided an update on the independent inquiry into mental health in-patient care across NHS trusts in Essex between 2000 and 2020. He announced that in response to concerns raised by the inquiry’s Chair, Dr Geraldine Strathdee, about the extremely low engagement from staff at Essex Partnership University NHS Foundation Trust, the Government had made the decision to give the inquiry statutory powers. He also noted that Dr Strathdee would be standing down from the inquiry and a new Chair would be appointed in due course. Advised that the findings and recommendations of a rapid review of how data is used in in-patient mental health settings in England has now been published, noting that the Government will consider this report and respond in due course. Stated that the Department of Health and Social Care would be working alongside the new Health Services Safety Investigations Body to undertake a series of investigations focused on mental health inpatient settings on the following themes: how providers learn from deaths in their care and use that learning to improve services, including post-discharge services; how young people are cared for in mental health in-patient services and how that care can be improved; how out-of-area placements are handled; and how to develop a safe staffing model for all mental health in-patient services. The statement was followed by questions and comments from members of the House of Commons.- Posted
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NHS services have been under increasing pressure in recent years, particularly since the start of the Covid-19 pandemic. We have previously reported on the NHS’s efforts to tackle the backlogs in elective care and its progress with improving mental health services in England. This report gives an overview of NHS services that may be used when people need rapid access to urgent, emergency or other non-routine health services, and whether such services are meeting the performance standards the NHS has told patients they have a right to expect. It covers: general practice community pharmacy 111 calls ambulance services (including 999 calls) urgent treatment centres accident and emergency (A&E) departments. Key findings Population changes are contributing to increasing demand for healthcare. Demand for unplanned or urgent care is increasing. The number of general and acute hospital beds has increased slightly following a downward trend before the Covid-19 pandemic, but occupancy rates have also risen and patients are now staying longer in hospital compared with previous years. The number of NHS staff has increased, including those working in unplanned or urgent care. he number of staff vacancies across the NHS rose from the start of 2021 but has recently fallen. Spending on the NHS continues to increase. The total budget for NHSE in 2022-23 was £152.6 billion, some £28.4 billion more than in 2016-17 at 2022-23 prices. Patients’ access to services for unplanned or urgent care has worsened. There is considerable variation in service performance and access, both between regions and between different providers. Covid-19 had, and continues to have, an adverse impact on the NHS’s capacity to meet healthcare needs. The NHS has not met key operational standards for unplanned or urgent care since before the pandemic. Performance against operational standards, and more widely, has deteriorated further since the onset of the pandemic. Overall performance of the unplanned and urgent care system has been worsened by delays transferring patients from one service to another. The NHS has not been able to secure the full benefits of increased spending and staff numbers and productivity has fallen since the onset of the Covid-19 pandemic. NHSE has a plan to reduce waiting times and improve patients’ experiences.- Posted
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In this blog Aiden Fowler, the National Director of Patient Safety in England and a Deputy Chief Medical Officer at the Department of Health and Social Care, reflects on progress made in implementing the NHS Patient Safety Strategy, four years on from its publication. He outlines some of the main programmes of work associated with this and considers their impact on avoidable harm in the NHS.- Posted
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This standard has been produced by NHS England to promote consistent delivery and quality of specialist orthodontic care provision to patients in England. It aims to ensure that resources invested by the NHS in specialist care are used in the most effective way, provide the best possible quality and quantity of care for patients and meet need rather than serve demand. The standard includes the following information: What is orthodontics? Complexity assessment Illustrative patient journey Assessing need Understanding current provision Model of care Clinical standard National key performance indicators Quality and outcome measures -
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Despite their widespread use, the impact of commissioners’ policies for body mass index (BMI) for access to elective surgery is not clear. Policy use varies by locality, and there are concerns that these policies may worsen health inequalities. This study in BMC Medicine aimed to assess the impact of policies for BMI on access to hip replacement surgery in England. The authors used National Joint Registry data for 480,364 patients who had primary hip replacement surgery in England between January 2009 and December 2019. They found that rates of surgery fell after localities introduced policies restricting access to surgery based on BMI, whereas rates rose in localities with no policy. Localities with BMI policies have higher proportions of independently funded surgery and more affluent patients receiving surgery, indicating increasing health inequalities, and policies enforcing extra waiting time before surgery were associated with worsening mean pre-operative symptom scores and rising obesity. The authors recommend that BMI policies involving extra waiting time or mandatory BMI thresholds are no longer used to reduce access to hip replacement surgery.- Posted
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Digital health inequality, observed as differential utilisation of digital tools between population groups, has not previously been quantified in the NHS. But recent developments in universal digital health interventions, including a national smartphone app and online primary care services, allow measurement of digital inequality across a nation. This study in BMJ Health & Care Informatics aimed to measure population factors associated with digital utilisation across 6356 primary care providers serving the population of England. The authors concluded that the study results are concerning for technologically driven widening of healthcare inequalities. They highlight the need for targeted incentives to digital in order to prevent digital disparity from becoming health outcomes disparity.- Posted
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This report published by the National Vascular Registry (NVR) contains information on emergency (non-elective) and elective procedures for the following patient groups: patients with peripheral arterial disease (PAD) who undergo either (a) lower limb angioplasty/stent, (b) lower limb bypass surgery, or (c) lower limb amputation patients who have a repair procedure for abdominal aortic aneurysm (AAA) patients who undergo carotid endarterectomy or carotid stenting.- Posted
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Patient Safety Partners (PSPs) are being recruited by NHS organisations across England as part of NHS England’s Framework for involving patients in patient safety. PSPs can be patients, relatives, carers or other members of the public who want to support and contribute to a healthcare organisation’s governance and management processes for patient safety. In this blog, Chris Wardley, PSP at a large NHS hospital trust, introduces the Patient Safety Partners Network (PSPN). Chris describes his own experience of starting as a PSP, talks about the large scope of the role and highlights the unique opportunity to influence how an organisation approaches patient safety. He also invites PSPs to join the new network, talking about how it is already helping PSPs in England share learning as they shape their new roles. The Patient Safety Partner role introduced by NHS England is new and aims to take the involvement of patients, families and carers in how healthcare organisations are run to a different level. NHS England states that having a PSP “requires power sharing, a commitment to openness and transparency between staff and patients, as well as good leadership; it must not be tokenistic.”[1] The invitation to apply for the PSP role at our large hospital trust said, “this is a new and evolving role designed to shape the future of patient safety in our Trust and across the UK.” When we applied for the role, neither my fellow PSP nor I appreciated the implications of these bold and grand words. PSPs bring with them a wide range of backgrounds and experience, but most importantly, they are there to offer a patient’s perspective. In our careers, both of us held roles leading innovation for change. My fellow PSP trained as a nurse in the same Trust and was a senior nurse in others before moving into nursing education. I am a chartered engineer and former senior manager in the construction industry. Both of us had also spent several years promoting the patient, family and carer voice in a county-wide role. When we started as PSPs earlier this year, neither of us expected to have any influence for a while. But after a few months, we started to make welcomed prompts and suggestions. Now after six months, this is progressing rather faster, and we are excited that we have a small but important part to play in improving patient safety in our Trust. Why do Patient Safety Partners need a network? Some PSPs are supported by local networks—which might be informal arrangements between local trusts or organised by Integrated Care Boards—but very many aren’t. Organisations are recruiting to these new roles in many ways, seeking a wide range of experiences and expecting very different levels of engagement and influence from the PSPs they engage. The PSPs who are part of the Patient Safety Management Network (PSMN) suggested that an informal, peer support and learning community specifically for PSPs would be valuable. We were therefore delighted that Patient Safety Learning agreed to convene a discussion forum and following this, support a dedicated network. The Patient Safety Partners Network (PSPN) is only a few months old but already has over 70 members. It has held three virtual meetings, focusing on topics of interest to PSPs: communication and variation in PSP roles between trusts. Since we started as PSPs, we have both found the network a great resource for sharing and learning from others both in the same role and outside it. Having the opportunity to connect with PSPs working in different settings gives us the opportunity to hear new perspectives and support each other. At the meetings, we talk about how our role is playing out in real life, what our expectations and issues are, and how we are each getting involved in improving patient safety. It’s a unique opportunity to learn from each other and understand how other organisations are dealing with patient safety issues and big governance changes such as the roll out of the Patient Safety Incident Response Framework (PSIRF). [2] The conversations we’ve had have been very helpful. We’re beginning to understand the variation in roles in terms of how PSPs are engaged, their level of involvement in organisational processes and governance, and what they are being asked to do practically. The network is currently running a survey for PSPs to help establish how they are operating across England. As they become established, PSPs are taking a range of approaches—some are beginning by engaging with patients and front-line staff, while others are finding a place on senior level committees. At our Trust, my fellow PSP and I have focused on using our different experiences and strengths. Wherever you are focusing your time, being a member of the PSPN can help you gain the information and confidence to connect with the people in the engine room of your Trust, where you can have a real influence on making improvements for patients. Commitment The PSPN meets online each month on a Tuesday—we alternate meetings between daytime and early evening to fit the availability of different members. Several of our members take turns to chair the meetings and all PSPs are welcome. Our meetings last an hour, and the discussion is always based around topics raised by members. We would love to hear your views and experience at the meetings, but there is no pressure to contribute if you prefer to just watch and listen. You can also use the chat function in Teams to ask questions and suggest topics during the meeting. Someone takes notes at each meeting so that those who are unable to attend can catch up, but these are only shared on the private PSPN area of the hub, and all comments are non-attributable. The PSP network meetings are safe spaces amongst colleagues. Membership The network is open to Patient Safety Partners working with NHS organisations in England. It is hosted on the Patient Safety Learning hub and you can join by signing up to the hub today. When putting in your details, please tick ‘Patient Safety Partners Network’ in the ‘Join a private group’ section. If you are already a member of the hub, please email [email protected] to apply to join the PSPN. Other patient safety networks supported by the hub Find out more about the growing number of informal peer support networks hosted and supported by Patient Safety Learning. The networks provide a forum for people involved in patient safety to meet up, share ideas and initiatives and learn from others. Related reading Patient Safety Partners - A workshop at Kingston Hospital Reflections on PSIRF, patient engagement and why we investigate: a recent discussion at the Patient Safety Management Network Top picks: PSIRF insights and opinions Top picks: PSIRF tools, templates and examples References 1 Framework for involving patients in patient safety. NHS England and NHS Improvement, 29 June 2021 2 Patient Safety Incident Response Framework. NHS England, 16 August 2022 3 NHS Patient Safety Strategy: Safer culture, safer systems, safer patients. NHS England and NHS Improvement, 2 July 2019- Posted
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