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A good night’s sleep is essential for healing, yet, for many patients, it can feel almost impossible to be able to sleep or get rest during an inpatient stay. The Noise at night sleep pack project at Nottingham University Hospitals was a finalist at the Picker Experience Network 2025 Awards. In this blog, project lead Kelly Morley tells us why this initiative and a renewed focus on reducing noise at night was so important. Despite the dedication of staff and the comfort measures provided on our wards, night‑time noise remains one of the most common concerns raised through patient feedback and it was quickly identified as one of the top three patient experience priorities within our trust. At Nottingham University Hospitals (NUH), we know that sleep isn’t a luxury it’s a vital part of the fundamentals of patient care. Why night-time noise matters Hospitals are naturally busy environments. Even after lights dim, clinical activity continues as staff carry out observations, respond to emergencies, check medications and support patients who are awake or unwell. For patients, though, these unavoidable sounds can lead to: Interrupted sleep or the inability to fall asleep. Increased anxiety and stress. Decreased mental awareness. Higher pain sensitivity. Slower recovery times. Lower patient satisfaction. Complaints. Decreased uptake in rehabilitation exercises. Deconditioning. Longer patient stays. Many patients tell us that a noise is one of the most challenging aspects of their stay. Sleep is not just a comfort—it’s a critical part of recovery. Even as far back as in 1859, Florence Nightingale published her book 'Notes on Nursing', which contains lots of good advice about sleep in patients and these are still actions we would do well to take into consideration in modern nursing. “Unnecessary noise, then is the most cruel absence of care that can be inflicted on either the sick or well” (Florence Nightingale) What our patients were saying Through patient surveys, ward feedback and conversations with patients and staff, we regularly heard that noise from equipment, conversations, staff, bins, alarms and other patients would significantly affect their sleep. When asked the question: Do you have any suggestions as to how we can improve the quality of sleep for in-patients or any comments you would like to make? Patients responded: “Would be willing to try anything.” “I think the sleep pack should be mandatory and given to inpatients.” “Ask staff to speak quietly and answer the buzzers quicker—it sounded like they were moving furniture last night.” When we asked staff what they thought prevented patients from sleeping they reported: “Noise from other patients.” “Lighting.” “Observations/medications/investigations/turns.” "Noise from staff.” This feedback drove our improvement work. Sleep packs: small items, big impact To help patients rest better, many wards at NUH now offer sleep packs. These typically include: A sleeping well in hospital leaflet—this was designed by clinical staff with an interest in sleep and why it matters. The leaflet pulls together all literature that has been written in the Trust to date in regard to sleep and amalgamates this into one simple evidence-based leaflet. Earplugs—to soften unavoidable environmental noise. These are in singular packs and can be replaced as and when needed. Eye masks—to reduce disruption from lighting on the wards, particularly when nurses tend to other patients. Slipper socks—these ensure patients are not looking around for slippers in the night, opening lockers, looking under beds and, best of all, they are a simple measure that can also reduce slips, trips and falls. Sleep packs may seem like a small intervention, but patients consistently tell us they make a real difference—especially for those who struggle to settle in unfamiliar surroundings. The items are always used with the aid of clinical judgement, and it is reiterated that these items are not always suitable for everyone. Our aim is to ensure these packs are readily available and consistently offered, particularly to patients most likely to benefit. Post implementation, the feedback was very different: “Thank you for supplying the sleep pack. They have definitely made a difference.” “The mask was comfy and helped.” “Sleep packs, very beneficial. Sleep interrupted a lot as observations being taken regularly, but this is to be expected and not a criticism.” How our staff are supporting quieter nights Staff play a crucial role in creating a calmer night‑time environment. Across NUH a quieter hospitals group was formed to work on the problems that were identified during this project, including: Reducing unnecessary noise on wards: Lowering voices during night rounds. Limiting equipment noise where safe to do so. Closing doors softly. Using soft close bins/ doors. Having top tips poster for staff—reiterating the sleep leaflet guidance and making staff more aware. Planning care to avoid multiple disturbances during the night: Grouping non‑urgent tasks together (cluster care). Using soft‑close bins and quieter equipment where possible. Responding to patient needs: Offering sleep packs. Adjusting lighting levels where safe to do so. Addressing concerns quickly. This work is guided by patient experience feedback and in collaboration with ward teams who see first‑hand how important sleep is for recovery. Below is the feedback from the ward manager of one of our pilot wards, and they continue to see the benefits of these packs. “The ward can be noisy at night, and I think we had all just accepted that disturbed sleep is to be expected when you are in hospital, but this trial has changed that outlook. The sleep packs are really simple but very effective, they contain an eye mask, slipper socks, ear plugs and a leaflet with hints and tips of how to get a good night’s rest. Staff have been offering them to patients in the evening, feedback has been great with a few patients claiming ‘it’s the best night’s sleep they have had in years'. We will carry on with them after the study finishes.” (Amy, ward manager on sample ward for pilot – PDSA 2) How the community can help Support from families and visitors also plays a part in creating a restful environment. Simple actions can make a difference: Being mindful of noise during visiting times and remembering people are often sicker than they look and often need more rest. Avoiding phone calls late at night. Encouraging relatives to use call bells instead of raised voices. Bringing in comfort items that help patients relax. Sharing feedback so we can continue improving. Together, we can support better sleep in our hospitals for everyone. So what’s next? Improving sleep in hospital isn’t solved by one intervention alone—it’s a combination of thoughtful design, staff awareness, helpful tools like sleep packs, and ongoing feedback from patients and families. Our commitment at NUH is to continue: Listening to patient experiences. Reacting to feedback. Supporting clinical teams. Introducing practical solutions. Creating calming, quiet environments. Because a quieter night isn’t just about comfort—it’s about better care and better patient outcomes. Noise at night sleep pack presentation: Poster in wards:

On 3 July 2025, the UK Government published its 10 Year Health Plan for England. In the following months there has been much commentary on the practical implications of this and how it will impact patient safety, and healthcare more broadly.  This article brings together reflections from organisations and individuals on the Plan’s vision for the future of the NHS. The 10 Year Health Plan for England identifies four major challenges shaping the future of healthcare in England: An ageing population living with multiple health conditions. Changes in illness, with more than a quarter of the population having a long-term health condition. Higher public expectations of how the NHS should provide services. Increases in cost, with health spending in England meeting the Organisation for Economic Co-operation and Development (OECD) average but achieving worse outcomes. To take on these challenges, and act on the opportunities available, the 10 Year Health Plan reimagines the NHS through three radical shifts: 1. Hospital to community- envisioned by the initiation of “a historic expansion of provision in people’s neighbourhoods. By bringing more integrated services into local communities, patients will have more power to tailor care to their individual needs and more convenient access.” 2. Analogue to digital - transforming the NHS “from being a bricks and mortar service to a digitally led one, where patients can access care online and offline 24 hours a day, 365 days a year. By embracing the digital revolution, we will give patients the ability to control their appointments, choose their providers and access the help they need to manage their health and their care.” 3. Sickness to prevention - with a goal to “halve the gap in healthy life expectancy between the richest and poorest regions, while increasing it for everyone, and to raise the healthiest generation of children ever. This will boost our health, but also ensure the future sustainability of the NHS.” Commentaries on the Plan and its implications for the future of health and care Below are several different perspectives on the 10 Year Health Plan for England that we have added to the hub: Patient Safety Learning In our response to the Plan we highlighted that although it disappointingly does not recognise patient safety as one of its core themes, it does set out a welcome ambition to tackle some of the key underlying causes of avoidable harm. We sought to elaborate on this, setting out why patient safety needs to be at the core of the delivery of this new Plan. Much of the focus of our response concerns two of its three radical shifts: “Hospital to community” and “Analogue to digital”. Our response notes: In seeking to create a Neighbourhood Health Service, service redesign and plans should ensure that patient and staff safety is core to how care is delivered, unnecessary hospital admission is prevented and early discharge is supported. If the NHS is to become a fully digitally enabled service, patient safety will need to be at the heart of the introduction, implementation and operationalisation of new technologies and innovations, particularly AI-enabled care. A strong emphasis is placed on patient choice in the Plan, but relatively little is said about the role of patient and public involvement in shaping healthcare services—beyond engagement through new digital portals. Coupled with the proposed centralisation of patient experience functions within the Department of Health and Social Care there are valid concerns this could weaken the strength and independence of the patient voice. The absence of considering and responding to problems with NHS culture is a significant oversight in the 10 Year Health Plan. If the healthcare system is to truly be transformed over the next decade, then we cannot simply proceed by ignoring these issues or assuming they will resolve themselves. The Plan does not address the absence of systematic approaches to sharing learning about avoidable harm, the inadequacy of joined up approaches and user-centred design in solution development. Read more here. From analogue to digital: Tackling inequality and digital exclusion in the future NHS In this blog, Katie Heard from the Good Things Foundation considers the digital implications of the 10 Year Health Plan. She reflects on the benefits and risks for those who are digitally excluded, what more can be done and how existing resources can help support further progress. Read more here. Compassionate leadership and the 10 Year Health Plan: address moral injury In this blog Naja Felter and Alistair Thomson, noting the recognition of moral injury in the 10 Year Health Plan, make the case for compassionate leadership. They highlight there is ample evidence for the impact of this style of leadership in health and social care, including higher quality care, greater patient satisfaction, lower levels of workforce stress and burnout, and improved financial organisational performance. Read more here. Dazed and confused? Policy ideas behind the 10-Year Health Plan In this article, Phoebe Dunn, Nicholas Mays and Hugh Alderwick ask whether the 10-Year Health Plan is a coherent blueprint for ‘reimagining’ the NHS, or a collection of ideas pulling in different directions? They identify five policy ideas that seem to guide key proposals in the Plan, draw on evidence about their potential impact, and stand back to see what it all adds up to for the NHS. Read more here. Patient Power: energising the 10-Year Health Plan through patient partnership This is a video of a Patients Association online event that considered what needs to be done to ensure patient partnership is in the foundations of the 10 Year Health Plan. The session explored what meaningful patient agency looks like in practice, drawing on real-life insights from the Patients Association helpline and focus groups. Watch the recording. How will waiting times in community health services affect the shift towards neighbourhood health? Community services are under growing strain, with more than 1.1 million people waiting for care, and the steepest rise among children and young people. In this Quality Watch article, Jessica Morris notes that focus to date has largely been on efforts to improve waits for hospital care, but as neighbourhood health services are rolled out, addressing pressures on community services will be essential if the ‘hospital to community’ shift is to become a reality. Read more here. Podcast: Alan Milburn on the 10-year health plan In this podcast, The Health Foundation speaks to Alan Milburn about the future of the NHS and his thoughts on the government’s 10-Year Health Plan. Alan was Secretary of State for Health from 1999 to 2003, during the Blair governments, with his tenure seeing the development of the NHS Plan (2000) and record levels of investment. As Lead Non-Executive Director at the Department of Health and Social Care, Alan also had a hand in writing and developing the new plan. Read more here. What does the NHS 10 Year Plan mean for dementia? In this article, Alzheimer’s Research UK reflects on what the Plan means for people affected by dementia. It considers how it will potentially impact dementia diagnosis, new treatments, improving brain health and prevention. Read more here. Share your views with us What is your opinion on the 10 Year Health Plan? In the coming months we would like to feature more perspectives on how ideas and proposals flowing from this Plan are impacting how the NHS approaches patient safety. We would welcome your views and experiences of this. You can comment below (sign up to the hub first for free) or email the team directly at [email protected] to share your views.

In this interview, David Osborn, chartered occupational safety and health practitioner and member of the Covid-19 Airborne Transmission Alliance (CATA), speaks to Lotty Tizzard, Digital Content Manager at Patient Safety Learning, about how CATA was established during the pandemic to advocate for adequate respiratory protection for NHS employees.  David explains how CATA advocated for the government and heath service to recognise that Covid-19 is passed on by aerosol transmission (through microscopic particles in the air). He also outlines why surgical masks do not adequately protect people against catching airborne viruses and describes how inadequate respiratory protective equipment (RPE) contributed to thousands of NHS staff catching Covid-19 at work. As a result, many healthcare workers died and a large number still live with the ongoing symptoms of Long Covid. David describes CATA's involvement as a Core Participant in the Covid-19 Inquiry and outlines what he hopes will be done to ensure the UK is better prepared for future pandemics. Patient Safety Learning is also a member of CATA. Clarification David wishes to clarify a point raised in the interview: "When talking about the “IPC Cell” I said that they 'didn’t produce minutes'. In fact, notes or minutes were taken at all IPC Cell meetings. The point I was making is that they were not published ('produced' in the sense of being released into the public domain), when the minutes of most other groups such as SAGE and NERVTAG were published. The few IPC Cell minutes that have trickled into the public domain have mostly been as a result of Freedom of Information requests by a colleague and a few that I have managed to obtain myself. In some cases, public authorities have taken around 18 months to disclose documents, and it has required the intervention of the Information Commissioner's Office. I anticipate that more minutes will be disclosed for public scrutiny as time goes on." You can read more about CATA and the Covid-19 Inquiry in David's blogs and presentations on the hub: Respiratory protective equipment: An unequal solution for healthcare workers? A blog by David Osborn Healthcare workers with Long Covid: Group litigation – a blog from David Osborn Covid-19 : A risk assessment too far? A blog by David Osborn CATA and the UK Covid-19 Public Inquiry: Presentation from David Osborn Join the conversation Were you working in health and social care during the pandemic? We'd like to hear about your experience of health and safety at work. Were you provided with adequate PPE to carry out your job safely? Did you catch Covid-19 while at work? You can join the conversation by commenting below (you'll need to sign up first) or get in touch with us directly by emailing [email protected]

At a recent Patient Safety Education Network meeting, Karen Male, ward leader at the University Hospital Southampton, gave a presentation on how she reduced falls on her ward. We asked Karen to share her journey and insights in a blog for the hub. The Patient Safety Education Network is a informal voluntary peer network for those in patient safety education and training roles. It provides a monthly drop-in session with guests to talk through issues of importance to those in patient safety education and training roles and now has over 470 members. You can find out about the network here. The challenge I joined the ward 14 months ago at a time when there was a high number of falls. In one year there was 72 falls, including four high-harm falls, and we would regularly have three falls a day. Falls prevention and staff confidence was low in the management and assessment of falls, and policies and procedures were not being followed. The ward layout was challenging—a corridor with three-bedded bays, long and narrow. Many of the patients were older and there had been a lot of Covid infections. My goal was simple: to reduce the falls in our ward. What I did I organised an entire ward awayday focusing on falls education, prevention, management of falls, and policies and procedures—everyone attended at the same time. This allowed the staff to discuss the way they worked ('work as done'). Back at the ward a Baywatch bay and a PHUDD scoring system was set up with the aim to reduce falls, particularly unwitnessed falls, by identifying if someone is high, medium or low risk of falling. The ward is a long corridor so one to two Baywatch bays are required. The PHUDD scoring system was used to identify those patients most at risk and to identify where they can go on the ward for the safest outcomes and if additional support is needed. It’s completed at least once daily for patients. On the PHUDD scoring system, 1 point was given to each question where the answer is yes. A point was added for any fall in the hospital. This was then used to decide which patient needed to be in the Baywatch bay. This score is on the handover and reviewed daily and at catch ups. Outcomes We have significantly reduced our falls—there has been 61.7% reduction in falls. There has been two long periods with no falls (one for a 48-day period and one for a 50-day period). Since the education day, we have had 1 or 2 falls a month rather than 5-11 falls every month. In the last 4 month we have had 6 falls instead of the potential 44. Staff are now educated on policies and procedure around the prevention of falls and the management of falls. Staff are proactive in the prevention of falls. Everyone knows that the Baywatch bay is the priority. And then everyone has their ends of the bay but we all cover each other. We have signs to say that’s it’s a Baywatch bay—for staff but also for relatives to say we can’t leave this bay. PHUDD score gives us evidence. You might have enough staff but we might have five patients with a particularly high score. So we have more staff around the bays to even it out where it’s needed. Night staff feel empowered to move patients who were most at risk to higher observation beds as they are the staff group most affected by falls on the ward. Bay nursing introduced handovers conducted outside of the bays, which enhanced the communication as opposed to being in an area away from the patients. We have completed a falls After Action Review and were praised for our significant improvement in post falls management and documentation. Senior management across our Trust have asked to learn more about the falls reduction plan. Barriers faced I met barriers. Staff were not acting in the way I wanted so I met resistance. But I was very honest with them. Told them what the consequences were. Got the most resistant on board first and then everyone else was easier. At the beginning the staff were demotivated and didn’t feel part of a team. We need to keep our teams valued and motivated. It’s an ongoing commitment to staff. We are always looking at how we can improve and asking staff what their ideas are. I think the biggest thing I did was look at what was my one main priority. And that’s what we focused on—falls. Now we are moving to pressure ulcers. If you pick one big thing to work on it’s easier. Give it a big focus and then, once sorted, move on to the next thing rather than trying to do everything at once. Next steps Training and education is essential—this has continued regularly from the ward leadership team. I’d like to do some simple quantification—more cost effective, efficient. PHUDD score gives us evidence. You might have enough staff but we might have five patients with a particularly high score. So we have more staff around the bays to even it out where it’s needed. We are now doing another nurse-led trial setting daily goals for patient mobility. We are very clear what the goals are, to increase mobilisation, and these goals are on the handover sheets for everyone to see. Further reading on the hub Yellow kits - an innovation to reduce the risk of falls in Accident and Emergency departments "The greatest part of this adventure has been the sharing of information." The Patient Safety Education Network one year on Implementing the aSSKINg pressure ulcer care bundle – a blog by Susan Martin Have you implemented a new initiative in your organisation? Have you improved patient safety where you work? We would love to hear from you and share on the hub your journey. If you are a member, you can share directly on the hub or please contact [email protected] to discuss further.

This webinar for UK healthcare professionals will be delivered by DISN UK Group committee members. It will focus on using diabetes technology–insulin pumps, CGM, POCT–in the hospital. We will discuss and outline the newest JBDS technology guideline and provide the attendees with most up to date information regarding using diabetes technology when a person with diabetes is admitted to hospital. Educational outcomes – 3 points: Recognise different types of diabetes technology Use of diabetes technology in the different scenarios in inpatient setting Effective support for people with diabetes and use of diabetes technology when admitted to hospital Register for the webinar

This conference focuses on developing systems and processes for locally driven ward and unit accreditation for quality. These approaches can be used as a tool to encouraging ownership of continuous quality improvement at ward, unit or service level, reduce variation and increase staff pride and team working within their practise. Through practical case studies of organisations that have successfully introduced locally driven ward and unit accreditation systems the conference will provide practical guide to implementing systems, and improving staff engagement in driving forwards improvement for the benefit of patients, service users and communities. For further information and to book your place visit https://www.healthcareconferencesuk.co.uk/virtual-online-courses/ward-accreditation-for-quality-conference or email [email protected]. hub members receive a 20% discount. Email [email protected] for discount code. Follow this conference on Twitter @HCUK_Clare #wardaccreditation