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Content ArticleIn this blog, Patient Safety Learning make the case that staff safety is intrinsically linked to patient safety. It sets out how the six foundations for safer care from the report, A Blueprint for Action, can be used to consider how making improvements to staff safety complements patient safety.[1] It looks in more detail at four key aspects of staff safety and how these areas are intertwined with improving patient safety: Physical safety – considering how the Covid-19 pandemic has highlighted the importance of this in ensuring patient and staff safety is not jeopardised. Safe staffing levels – outlining the importance of this to protect the welfare of staff and avoid creating conditions in which patient safety incidents are more likely to occur. Psychological safety – setting out the importance of having organisational cultures that enable staff to feel secure in speaking up about incidents of unsafe care, ensuring that opportunities for learning and innovation are not shut down by a blame culture. Support to staff after patient safety incidents – highlighting the key role that providing emotional support to health and social care staff who are involved in patient safety incidents can play in fostering an environment of openness and learning. It concludes by setting out the activities Patient Safety Learning will undertake over the course of September to raise awareness of, and promote action for, staff safety. References: 1. Patient Safety Learning, The Patient-Safe Future: A Blueprint for Action, 2019.
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News Article
NHS People Plan 2020/21 response by The Health Foundation
Clive Flashman posted a news article in News
NHS People Plan provides a stop-gap but leaves glaring omissions 'Two years after it was first promised, the NHS is still waiting for a long-term workforce plan. Some of the measures announced in today’s People Plan are positive. As the plan acknowledges, it is important to learn from the impressive changes made by NHS staff during the pandemic. And improving support for people from black and minority ethnic communities – who make up one fifth of the NHS workforce – is rightly a top priority. 'But there are glaring omissions. The NHS went into the pandemic with a workforce gap of around 100,000 staff, yet the plan does not say how this will be addressed in the medium term. This is particularly concerning at a time when our recruitment of nurses from abroad has dropped dramatically. These details are missing because the NHS is still waiting on government to set out what funding will be available to expand the NHS workforce – without which the NHS cannot recruit and retain the doctors, nurses and other staff it needs. 'While this plan at least provides a stop-gap to help get the NHS through the winter, there is no equivalent plan for social care – a sector suffering from decades of political neglect and the devastating impact of COVID-19 on care users and staff. A comprehensive workforce plan for both the NHS and social care is needed now more than ever'. -
News Article
Launch of NHS People Plan (2020-21)
Clive Flashman posted a news article in News
"We are the NHS: People Plan 2020/21 – action for us all, along with Our People Promise, sets out what our NHS people can expect from their leaders and from each other. It builds on the creativity and drive shown by our NHS people in their response, to date, to the COVID-19 pandemic and the interim NHS People Plan. It focuses on how we must all continue to look after each other and foster a culture of inclusion and belonging, as well as take action to grow our workforce, train our people, and work together differently to deliver patient care. This plan sets out practical actions for employers and systems, as well as the actions that NHS England and NHS Improvement and Health Education England will take, over the remainder of 2020/21. It includes specific commitments around: Looking after our people – with quality health and wellbeing support for everyone Belonging in the NHS – with a particular focus on tackling the discrimination that some staff face New ways of working and delivering care – making effective use of the full range of our people’s skills and experience Growing for the future – how we recruit and keep our people, and welcome back colleagues who want to return The arrival of COVID-19 acted as a springboard, bringing about an incredible scale and pace of transformation, and highlighting the enormous contribution of all our NHS people. The NHS must build on this momentum and continue to transform – keeping people at the heart of all we do." -
Content Article
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News Article
Coronavirus: Nurses' leaders urge 'care for those who caring'
Patient Safety Learning posted a news article in News
Nurses' leaders want all healthcare employers - including the NHS - to "care for those who have been caring" during the coronavirus crisis. The Royal College of Nursing (RCN) is calling for better risk assessments; working patterns and mental health care for those on the front line. It warns many may be suffering from exhaustion, anxiety and other psychological problems. The Department of Health and Social Care said support was a "top priority". The RCN has released an eight-point plan of commitments it wants to see enforced to mark the 100 days since the World Health Organization (WHO) declared a pandemic. Amongst its suggestions are a better COVID-19 testing regime for healthcare workers and more attention paid to the risks posed to ethnic minority nurses. It says employers and ministers "must tackle the underlying causes which have contributed to worse outcomes for Bame staff". Read full story Source: BBC News, 19 June 2020 -
News Article
ICUs advised how to improve staffing ratios as covid pressure eases
Patient Safety Learning posted a news article in News
Intensive care units (ICU) will be advised how to improve their staffing-to-patient ratios shortly as the number of patients admitted to hospital with COVID-19 falls across the country. In expectation that the pandemic would put intense pressures on ICUs, staff ratios were relaxed. NHS England told trusts to base their staffing models on one critical care nurse for every six ICU patients, supported by two non-specialist nurses, and one senior ICU clinician for every 30 patients, supported by two middle-grade doctors. Before the pandemic, guidance from the Faculty of Intensive Care Medicine recommended a ratio of one non-specialist nurse per patient. For senior clinicians the ratio was 1:10 New guidance, expected as early as next week, will encourage trusts to reduce the number of patients per ICU specialist nurses and senior clinicians on a localised basis as part of “transitional arrangements” aimed at moving staffing models back towards normal standards of care, HSJ has been told. The new guidance, drawn up by NHS England, the Faculty of Intensive Care Medicine and the British Association of Critical Care Nurses, will give trusts recommended staffing ratios based on the occupancy rates of their ICUs. It will tell trusts the existing ratios should be applied if their ICUs are running at four times their normal capacity. For ICUs running at double capacity, this ratio would be reduced to 1:2 for ICU nurses, and 1:15 for senior clinicians. Read full story Source: HSJ, 8 May 2020 -
Content ArticleThis guidance includes; What are RRTs and CCO services? What is COVID-19? Why is COVID-19 important to the RRT and CCO service? Overarching principles Safety of the RRT responders Identification of suspected / confirmed cases Use of NIV, CPAP and high flow nasal oxygen Method of activation of the RRT Coordinating a response to a patient with suspected / confirmed COVID-19 Use of non-ICU staff as members of the responding team Training of staff.
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News Article
Intensive care staffing ratios dramatically diluted
Patient Safety Learning posted a news article in News
The staff-to-patient ratios for intensive care are being dramatically reduced as the NHS seeks to rapidly expand its capacity to treat severely ill covid-19 patients, HSJ has learned. Acute trusts in London have been told to base their staffing models for ICU on having one critical care nurse for every six patients, supported by two non-specialist nurses and two healthcare assistants. Trusts have also been told by NHS England and NHS Improvement’s regional directorate to plan for one critical care consultant per 30 patients, supported by two middle grade doctors. The normal guidance is the consultant-to-patient ratio “should not exceed a range between 1:8-1:15”. Nicki Credland, chair of the British Association of Critical Care Nurses, confirmed the plans had been agreed today nationally. She told HSJ: “There will absolutely be a lot of concern about this in the profession, but it’s the only option we’ve got available. We simply don’t have the capacity to increase our staffing levels quickly enough." “It will dilute the standard of care but that’s absolutely better than not having enough critical care staff. There’s also a massive issue around the ability of critical care nurses not only to care for their patients but also monitor what the non-specialists in their teams are doing.” Read full story (paywalled) Source: HSJ, 24 March 2020 -
News Article
Hospital’s critical care unit overwhelmed by coronavirus patients
Patient Safety Learning posted a news article in News
A major London hospital has declared a “critical incident” due to a surge in patients with coronavirus, with one senior director in the capital calling the development “petrifying”. In a message to staff, Northwick Park Hospital in Harrow said it has no critical care capacity left and has contacted neighbouring hospitals about transferring patients who need critical care to other sites. The message, sent last night and seen by HSJ, said: “I am writing to let you know that we have this evening declared a ‘critical incident’ in relation to our critical care capacity at Northwick Park Hospital. This is due to an increasing number of patients with Covid-19. “This means that we currently do not have enough space for patients requiring critical care. “As part of our system resilience plans, we have contacted our partners in the North West London sector this evening to assist with the safe transfer of patients off of the Northwick Park site” Read full story (paywalled) Source: HSJ, 20 March 2020 -
Content Article
Department of Health and Social Care: Coronavirus (COVID-19) action plan
Claire Cox posted an article in Guidance
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News Article
NHS prepares to cancel elective ops in readiness for covid-19 surge
Patient Safety Learning posted a news article in News
System leaders are telling hospitals to prepare for a potential suspension of all non-emergency elective procedures which could last for months, as they get ready for a surge in coronavirus patients. Senior sources told HSJ NHS England had asked trusts to risk stratify elective patients in readiness for having to suspend non-emergency work to free up capacity. HSJ understands trusts have been told to firm up their plans for how they would incrementally reduce and potentially suspend non-emergency operations, while also protecting “life saving” procedures such as cancer treatment. An announcement is expected soon, with patients affected given at least 48 hours notice. It has not been decided how long it might last for, as the duration of any surge in cases and acute demand is unknown. But HSJ has been told it could stretch out for several months, with three or four months discussed, which would potentially mean tens of or even hundreds of thousands of cancelled operations. Read full story (paywalled) Source: HSJ, 12 March 2020 -
News Article
Doctors told not to fear reprisal during coronavirus outbreak
Patient Safety Learning posted a news article in News
NHS national leaders are set to reassure doctors they should not fear regulatory reprisals, within reason, if they end up working outside their areas of expertise during the coronavirus outbreak. HSJ understands the UK’s four chief medical officers and the General Medical Council are drafting a letter to be sent to all UK doctors, which will contain the reassurances, as the system braces for a sharp rise in covid-19 cases. The letter will also urge doctors to be flexible and not to resist new ways of working, with senior figures expecting many clinicians working in other specialities or locations during the outbreak. The letter will say doctors, while still expected to follow good medical practice, should not fear reprimand from their employers or national bodies such as the GMC, NHS England or other regulators. Read full story (paywalled) Source: HSJ, 11 March 2020 -
News Article
Trainee nurses to join coronavirus fight
Patient Safety Learning posted a news article in News
Third year undergraduate trainee nurses will be invited into clinical practice to support the coronavirus effort, while routine care quality inspections are “going to need to be suspended”, the Chief Executive of NHS England has said. Speaking at the Chief Nursing Officer’s summit event in Birmingham this morning, Sir Simon Stevens told delegates NHSE was working with the Nursing and Midwifery Council to “see how many of the 18,000 [relevant] undergraduates are available”. It is understood they would be paid, and follows government moves to pass emergency legislation to relax rules around working in healthcare. Asked about Care Quality Commission inspections during the outbreak, Sir Simon said: “There will be a small number of cases where it would be sensible to continue for safety related reasons… but the bulk of their routine inspection programmes is clearly going to need to be suspended and many of the staff who are working as inspectors need to come back and help with clinical practice.” Read full story (paywalled) Source: HSJ, 11 March 2020 -
Content Article
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Content ArticleMEs are a key element of the death certification reforms, which, once in place, will deliver a more comprehensive system of assurances for all non-coronial deaths, regardless of whether the deceased is buried or cremated. MEs will be employed in the NHS system, ensuring lines of accountability are separate from NHS Acute Trusts but allowing for access to information in the sensitive and urgent timescales to register a death. This case study outlines the approach of South Tees Hospitals NHS Foundation Trust as one of the early adopter sites. To date, the following learning points have been identified and explored: End of Life Care, ceilings of care and avoidable admissions Some investigations have highlighted cases where the End of Life Care pathway could have either been established or fully implemented, where this would have been of benefit to patients and their families. Some patients may not have been cared for in the right location, and some admissions could have been avoided if the End of Life Care pathway had been suitably established and followed. Early detection and response to physiological deterioration, and effective communication Response stretched by implementation of National Early Warning Score (NEWS) but still learning around effective communication of escalation. The use of standardised communication tools is essential. Record keeping and organisation of medical records Some learning was identified in relation to the accuracy and completeness of medical records. It was evident that not all records are reflective of the clinical picture. Discussion with specialty teams is vital to support the investigation An independent review by the ME should be further supported by speciality ‘experts’, and if possible, peer review from other trusts can be sought to allow for full independent review. Seeking speciality opinion from those not directly involved with the case within STHFT has also been shown to be effective. Pathways for links to wider clinical governance processes have been strengthened.
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Content ArticleTopics include human factors, learning from deaths, neonatal and maternal patient safety, patient safety in primary care, medicines safety, safety in social care and patient engagement. 2. Master Slides (3).pdf AC_Salfordsafety_primary_care (1).pdf CW - Salford Apr 2019.pdf JH - Meds Safety Salford.pdf MT - Maternal and Neonatal Health Safety Collaborative Break out session.pdf Ursula Clarke PSP Patient Safety April 2019 final.pdf VC - Salford University Patient Safety Conference Glos_ Hosp_ Workshop_ 23 _April _2019.pdf
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Content ArticleThis paper presents a narrative review of the evidence relating to the quality and safety of locum medical practice. Its purpose is to develop our understanding of how temporary working in the medical profession might impact on quality and safety and to help formulate recommendations for practice, policy and research priorities. The authors conclude that there is very limited empirical evidence to support the many commonly held assumptions about the quality and safety of locum practice, or to provide a secure evidence base for the development of guidelines on locum working arrangements. It is clear that future research could contribute to a better understanding of the quality and safety of locum doctors working and could help to find ways to improve the use of locum doctors and the quality and safety of patient care that they provide.
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Content ArticleHow will this programme help trusts? What does the programme consist of? Further information
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Content ArticleThis report builds on those of previous years to provide analysis of longer-term trends and insights into the changing NHS staff profile. It focuses specifically on the critical NHS workforce issues that have been repeatedly identified in recent years: nursing shortages, and shortages of staff in general practice and primary care. The report also explores key pressure points: student nurses the international context and international recruitment retention. The report concludes by summarising the key workforce challenges that will need to be considered in the development of the full NHS people plan. Patient Safety Learning's repsonse to the report: This report on NHS workforce trends released by the Health Foundation today includes some really interesting findings, particularly around the changes in the skills mix between nurses and clinical support staff (including health care assistants and nursing assistants). The report states that in 2009/10 there were equal numbers of nurses and support staff, with one clinical support staff member for every FTE nurse in the NHS. In 2018/19, the number of support staff per FTE nurse had risen 10% to 1.1 FTE per nurse. Looking at the numbers, this translated to the NHS employing 6,500 more clinical support staff to doctors, nurses, and midwives, compared to 4,500 more FTE nurses. While changes to ratio of nurses to clinical support staff may reflect changing patient needs, technological advances and other factors, the report also notes concerns that these may be ‘introduced in an unplanned way in response to negative factors – such as cost pressures or recruitment difficulties – rather than positive drivers of improvement’. At Patient Safety Learning we believe to achieve a patient-safe future, patient safety must be more than a priority for an organisation. It must be core to its purpose, reflected in everything that it does. This should apply to the NHS when considering changes in workforce staffing and numbers so that the impact that these may have on patient safety is considered as an intrinsic part of the decision making process. While the report notes that in many cases decisions on skill mix changes are implemented well and evidence led, it’s not clear whether patient safety has been taken into account. Our view is that these decisions should involve a explicit, evidence-based assessment of the impact on patient safety which leads to the selection of the option that offers that safest outcome for patients.
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Content Article
Journey to the Genie – a blog from Eve Mitchell
Patient Safety Learning posted an article in Safe staffing levels
Sometimes, you have those days where you have had enough. ENOUGH. That’s really where the Genie started. I began my career in the private sector, joining the NHS as an ‘experienced hire’ some five years later through ‘Gateway to Leadership – Cohort III’. I probably should have known that a moniker based on the Roman army was telling me something. I had moved from an organisation where the worst thing that had happened was moving the water machine, to an organisation where the water machines had been removed some years before for "cost improvement" purposes. The organisation was struggling to cope on a number of levels, and there was no single answer to solve any of the issues. Sticking plasters were used to cover gaping holes, and we had significant clinical and financial issues. Please don’t misunderstand. I had a baptism of fire, with many incidents I wouldn’t want to put into print, but my wholehearted support of the healthcare workforce, of their resilience and humour, their ability to innovate, and their willingness to stand up and fight, was sown in those first few weeks as a fresh-faced newbie with a desire to change the world. I was approached to join another organisation in those heady days of ‘turnaround’ which gradually became ‘transformation’, as realisation dawned that death by a thousand cuts wasn’t actually saving any money, was impacting on care quality, and maybe (just maybe) we needed a different approach. I was often asked to work with the nursing and midwifery teams based on experiences in my first NHS trust. The issues were often the same. Finance and HR had data – not necessarily matching data – and nursing and midwifery had ‘professional judgement’. Somehow that didn’t hold as much weight, so working together with nursing from ward to board, we would produce our own data based on care levels, costs and WTE, so we could come to the table to ask some really simple questions: “Would you want to be cared for on this unit based on the care that is available?” It made a huge difference, and started to change the conversation from one of conflict and protectionism to one of collaboration. After seven years of working through the same issues in each organisation it reached that point again. Surely there must be a better way? What would happen if we could extend our single organisation work to one that could look at variation between organisations, and include outcome measures, and look at workforce planning across all settings of care? So, with an idea in our minds and a plan to do good, Creative Lighthouse Ltd was formed. Establishment Genie was born in a shed and has been both kicked and nurtured by some wonderful critical friends and safe staffing experts. The hard work, bloodied knuckles from knocking on so many doors, and the highs and lows of running a tech start-up in a sector that often doesn’t embrace technology started to pay off. The Genie achieved NICE endorsement in April 2017 and was awarded a grant by Innovate UK to develop and test the Genie across all settings of care. We have now worked with front-line staff from more than 500 teams and organisations to review, remodel and report on their workforce, supporting them to meet the challenges of safe and affordable care with a backdrop of clinical and financial shortages, and track their progress using outcome measures to show that they are improving quality of care. However, the journey doesn’t stop there. Dear reader, to paraphrase poorly, I have a dream. I have a dream that one day every health and social care organisation will put workforce at the centre of all their planning processes. A dream that all health and social care organisations will use the same approach to plan their workforce and share outcomes and data for the benefit of all, and the future of health and social care. A dream that our frontline health and social care leaders will work beyond professional and organisational boundaries to ensure that every person has the best and most appropriate care, provided in the most appropriate place, with the safety of every individual at the core of every action and intervention. Thankfully I love to travel and cannot wait to meet more innovative disruptors who share that same dream. Jump onboard – it’s going to be one heck of a ride! Read on the hub case studies showing how trusts are developing their approach to workforce planning. -
Content ArticleThe aim of the UK-wide survey was to obtain a snapshot of the structure of, and role-specific training and CPD provision for, the non medical, non-midwifery maternity workforce. The objectives were to: determine the ratio of unregistered staff to registered midwives in the maternity services determine the number of maternity services where nursing associates were employed determine the number of maternity services where registered nurses were employed in areas other than neonatal care determine the areas of work for registered nurses in maternity care gather information about the role-specific training offered to non-midwives at induction and as CPD during employment. This survey is intended to add to the conversation on some aspects of the workforce and skill mix in maternity services. As a result of the findings the following recommendations are made: the opportunity should be created for a stakeholder engagement event to disseminate findings and consider aspects requiring further exploration, which may include: future training needs analysis work to explore role-specific training for non-midwifery staff (registered or unregistered) in maternity services, to clarify what should be provided. to look at utilising these findings in the wider work being carried out within the RCN safe and effective staffing campaign (RCN 2019). Although the RCN campaign is focused on nursing, these survey results may inform work on both midwifery and nursing staffing.
