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This report recommends investment in hubs to produce aseptic injectable medicines in England in order to create high volumes of aseptic pharmacy products which will: save time for nursing staff enable care closer to home produce significant savings.

What will I learn? Basic personal alarms for the elderly. Alarms that send a signal for assistance. Personal alarms and telecare. Fall detectors and alarms. How much does a personal alarm cost? Lifeline alarm services. Choosing and buying a personal alarm.

My much loved daughter-in-law, Mariana Pinto, died on 16 October 2016. She was 32. Her tragic and unexpected death raised many questions for us about standard practice by psychiatric services and about patient safety. The evening before she died, Mariana was taken by ambulance to her local A&E department, escorted by four police officers, and handcuffed for her own safety. She was psychotic – delusional, paranoid, violent and very distressed. She had attacked her husband (my son) who had visible bite marks, scratches and bruises. It was a first episode and totally out of character. She had not eaten or slept for several days. In A&E she was brought food and drink but spat it out, believing it to be poisoned. She kept trying to escape from the cubicle. The police stayed, stating that she was extremely vulnerable. Eventually she agreed to take a sedative – but not before she had held it under her tongue for some time, and only after we, her family, were able to persuade her that she should take it. Once she was finally sedated, she was given various tests to rule out any physical cause, and a mental health act assessment. This was done with her and her husband together. There was no attempt to see him separately. She was deemed competent to make decisions about her care, and as she wanted to go home, was discharged, with a referral to the local Crisis Team, who we were told would receive the referral at 8 am the following morning and would arrange to visit. The psychiatric team operate within A&E but for a separate mental health trust. This same trust runs the Crisis Team. It is deemed outstanding by the Care Quality Commission (CQC). The following morning, there was no contact from the Crisis Team. My son rang them at midday to ask when they would visit. They said normally between 5 and 7 pm on Sundays and to ring back if he needed to. He rang back at 3.30 pm stating that she had deteriorated rapidly and asking for the visit to be brought forward. He was told that it could not be. At 4.00 pm Mari ran out of the open door to the roof terrace and jumped off it. She did not survive her injuries. The Coroner gave a narrative verdict, making it clear that Mariana did not know what she was doing, though her actions were deliberate. She also gave a Prevention of Future Deaths Report. Whilst the trust is obliged to reply, there is no statutory obligation to demonstrate that the actions they have promised have actually been taken. There was no attempt at any risk assessment. There was no attempt to check that my son could speak freely (he could not – it was a studio apartment). There was no attempt to call the emergency services on his behalf, and no attempt to check he had been able to do so. None of this is regarded as negligent or especially problematic. Since her death the Crisis Team do visit on Sunday mornings. We also found out that the number we were given to call was for service users already allocated a key worker, rather than a more general number – but as my son spoke to senior staff on each call, this should not have made a difference. After her death we raised the following questions: Surely given the bite marks and bruising, her husband should have been allowed to give his information to the psychiatric team separately? No, it turns out that while this would have been good practice, it was not negligent. Surely, given that her family knew and loved her, we should have been asked post sedation if she seemed like herself (she did not). No, it turns out that this is not seen as necessary. It’s not even regarded as good practice. Surely, given that she was paranoid and had told the police that she did not trust her husband, her husband should have been given private space to discuss the discharge and rehearse what to do if things went wrong once the sedative wore off? And surely we should have been told that the Crisis Team is not instead of calling 999 in an emergency. And efforts made to help us to decide if the situation was an emergency. No, it turns out that while this would have been good practice, it was not negligent. The mental health trust has now introduced a written discharge template for care and contingency planning. We have been told that the circumstances of Mariana’s death were unusual and could not have been foretold. That may be. But there are still lessons to be learnt. To improve patient safety in mental health crisis and to learn from deaths, we need to change standard practice. It should become standard to: See family and friends separately if someone is paranoid, to understand the family’s concerns, learn more about the patient and work together to consider how best the patient can be kept safe and helped. Provide written care and contingency plans to patients and their family Use one number for a Crisis Team helpline, with clear policies to offer help and support to service users and to their carers, and proper protocols in place to assess risk and intervene if someone is at immediate risk of harm. Make it very clear to patients that a referral to a Crisis Team is not a substitute for calling 999 in an emergency (where there is an immediate risk of harm to the patient or others) and to distinguish between a crisis and an emergency. Other professionals have a role in this too: On discharge, the A&E staff (who were very kind and very concerned) could invite the family to come back if the situation deteriorates, making it clear that it was an emergency, was a legitimate use of 999 and of A&E, and that the Crisis Teams are not for emergencies. The police could do the same, if they are trusted by the family (in many cases they are not).

How you can contribute: The project leads are looking for suggestions from colleagues who may have worked with domiciliary carers and tested ideas around deterioration. Any advice on measures and impact and data sources is also encouraged.

Outstanding models of district nursing explores the elements that need to be in place to support an outstanding District Nursing service. It includes the views and experiences of a wide range of stakeholders including patients, carers, commissioners and GPs. It recommends that the Government and NHS: Urgently increase investment in the District Nursing service to give it the capacity and capability to meet the challenges of the 21st century Maintain the post-qualifying District Nurse Specialist Practice Qualification (DNSPQ), which develops DNs’ professional growth and enhances their clinical skills Develop a strategy to expand commissioners’, providers’ and the public’s understanding and knowledge of the District Nurse role, enabling them to recognise the added value they bring to the local health economy and particularly to the wider Health and Social Care system Develop a standardised data collection system and data set, collecting meaningful data that recognises value for money, promoting a strong economic case for investment in the District Nursing service Develop a standardised approach to the assessment of quality, to measure District Nurse effectiveness in England, providing reliable data, enabling innovation and cost-effective practice to be recognised and disseminated Explore the co-location of District Nursing teams within Primary Care Networks to provide personalised care, continuity of care and enhanced working relationships across primary and community care teams.

The website includes links to: Information on the #FakeMeds campaign Register of authorised online sellers of medicine How to use self-test kits safely Yellow Card to report any suspected fake medicines or side effects Information about the CE Mark

The video provides recommendations, strategies, and tools for realising five guiding principles for advancing the safety of home care.

This resource by the Cancer Council advises these safety guidelines to reduce exposure to chemotherapy drugs at home, both for you and your family and friends during the recovery period at home. Safety precautions can vary depending on the drugs you receive, so ask your treatment team about your individual situation.