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Content Article
NHS England recently issued a national patient safety alert to all trusts providing maternity services after faults were discovered in IT software that could pose “potential serious risks to patient safety”. In this short blog, Clive Flashman, Patient Safety Learning’s Chief Digital Officer, calls for a closer look at the reasons into this and what we can learn from it.- Posted
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News Article
Letby inquiry: Former nurse director among ‘core participants’
Patient Safety Learning posted a news article in News
The former nursing director at the hospital where Lucy Letby murdered seven babies will be among the 'core participants' of the Thirlwall Inquiry. The inquiry, chaired by Lady Justice Thirlwall, will investigate how Letby was able to commit the murders and attempt six others while she worked as a neonatal nurse at Countess of Chester Hospital NHS Foundation Trust in 2015 and 2016. This week, Alison Kelly, who was director of nursing and quality at the trust during the time of Letby's crimes, was announced as 1 of 10 core participants in the inquiry. Also named were former Countess of Chester chief executive Tony Chambers, former medical director Ian Harvey and former human resources director Sue Hodkinson. Ms Kelly and Mr Harvey were among the senior staff at the trust who were accused of failing to act when clinicians first raised concerns about Letby. How managers responded to such concerns is one of the areas due to be investigated by the Thirlwall Inquiry. A number of organisations are also on the list as core participants, including the Nursing and Midwifery Council (NMC), NHS England, the Royal College of Paediatrics and Child Health, the Department of Health and Social Care and Countess of Chester itself. Read full story Source: Nursing Times, 3 January 2024 -
News Article
Managers fear ‘unfair’ professional regulation
Patient Safety Learning posted a news article in News
More NHS managers support regulation of their roles than oppose it, despite many fearing its implementation will be unfair or disproportionate, a survey suggests. The trade union Managers in Partnership surveyed NHS managers working at Agenda for Change band 8a and above throughout the UK late last year, collecting 291 responses. Asked whether they “in principle… support professional regulation of NHS managers”, 49% said they supported or strongly supported it. Just 19% said they opposed or strongly opposed, while the remainder were neutral. However, respondents – 22% of whom said they were already covered by a professional regulator, and likely to be nurses, doctors or finance or legal professionals – appeared sceptical about the benefits. Asked whether they thought professional regulation of NHS managers would make processes for raising concerns/whistleblowing better or worse, only 26% said it would be better. 20% said these would get worse, and the remainder said it would be “about the same”. Read full story (paywalled) Source: HSJ, 9 January 2023 -
News Article
NHSE to catalogue ‘harm and near misses’ where BMA rejects derogations
Patient Safety Learning posted a news article in News
The NHS will start recording harm caused to patients during strike action where exemptions have been rejected by the British Medical Association (BMA). BMA council chair Phillip Banfield yesterday accused NHS England of the “weaponisation” of the strike “derogation” process, saying trusts had this week submitted more of the requests, which would permit some striking doctors to return to work, and were not providing information needed to determine if they were justified. NHS England wrote back to Professor Banfield, insisting it was only trying to prioritise safety, but also saying it would revise its own approach to derogation requests. This will include: asking trusts whose requests were rejected by the BMA “to compile a picture” of the impact on services; reinforcing requirements to report patient safety incidents during strikes and after mitigation requests, so “we can evidence harm and near misses which might have been avoided”. The letter says: “We have consistently asked local medical and other clinical leaders to consider applying to the BMA for patient safety mitigations where they have significant concerns for patient safety that cannot be mitigated through other options available to them, and where they can make a strong evidential case that the return of a limited number of junior doctors would address these risks. “We have done this, in part, because we have received a number of reports over previous periods of action that some teams have been put off seeking patient safety mitigations because of their prior experience of having applications rejected, or not receiving a response in time. We are sure you would agree that this is an unsatisfactory position, and that where patient safety concerns exist, these should always be escalated appropriately.” Read full story (paywalled) Source: HSJ, 4 January 2024 -
Content ArticleThe World Health Organization (WHO) has shared a list of key milestones in their Global Patient Safety Journey during 2023.
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News Article
NHSE trying to ‘undermine’ doctors strike, claims BMA
Patient Safety Learning posted a news article in News
NHS England has been accused of bowing to political pressure and trying to “undermine” the junior doctors strike. British Medical Association council chair Philip Banfield tonight wrote to NHSE chief executive Amanda Pritchard accusing her organisation of the “weaponisation” of the process used to agree minimum services level during the strike. Junior doctors walked out yesterday to begin a six day strike, the latest in their 10 month campaign and the longest in NHS history. Professor Banfield’s letter claims that NHSE is not respecting the terms of the voluntary agreement to provide “derogations”. These, says the letter, “allow for junior doctors to return to work in the event of safety concerns arising from ‘unexpected and extreme circumstances’ unrelated to industrial action”. The BMA accuses trusts of not providing the information the union needs to determine if the requests for derogations are justified. It said that the lack of information provided by trusts had led to it turning down 20 requests for derogations. The letter states: “We are increasingly drawing the conclusion that NHS England’s change in attitude towards the process is not due to concerns around patient safety but due to political pressure to maintain a higher level of service, undermine our strike action and push the BMA into refusing an increasing number of requests; requests, we believe, would not have been put to us during previous rounds of strike action. “The change in approach also appears to be politicisation and weaponisation of a safety critical process to justify the Minimum Service Level regulations.” Read full story (paywalled) Source: HSJ, 3 January 2024 -
Content ArticleThe BMA has sent a letter to Amanda Pritchard, Chief Executive of NHS England, highlighting the increasing concerns from their members about the protection of healthcare workers and patients from Covid-19, particularly in light of the rise in cases, hospitalisations and deaths that occurred in September and October.
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Content ArticleEfforts to increase physician engagement in quality and safety are most often approached from an organisational or administrative perspective. Given hospital-based physicians’ strong professional identification, physician-led strategies may offer a novel strategic approach to enhancing physician engagement. It remains unclear what role medical leadership can play in leading programmes to enhance physician engagement. In this study, Rotteau et al. explore physicians’ experience of participating in a Medical Safety Huddle initiative and how participation influences engagement with organisational quality and safety efforts. They found that The Medical Safety Huddle initiative supports physician engagement in quality and safety through intrinsic motivation. However, the huddles’ implementation must align with the organisation’s multipronged patient safety agenda to support multidisciplinary collaborative quality and safety efforts and leaders must ensure mechanisms to consistently address reported safety concerns for sustained physician engagement.
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Content ArticleIn a video and article published in Trends in Urology and Men's Health, Peter Duffy shares his experience of what it is to be a whistle-blower in the NHS, in the context of historical scandals of UK healthcare and whistleblowing, examining the roles of the NHS itself, the regulators and the law in the ensuing events.
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News Article
Half trust’s staff told CQC they had ‘no confidence’ in its leaders
Patient Safety Learning posted a news article in News
More than half of a trust’s staff told the Care Quality Commission (CQC) they did not have confidence in its executive leadership, with just 16% saying they did, the regulator has reported. The CQC surveyed staff as part of its inspection of East Kent Hospitals University Foundation Trust. Eighty-four per cent either said they disagreed with the statement “I have confidence in the executive team”, or neither agreed nor disagreed. That leaves just 16% who said they did have confidence. Some said they felt “traumatised”, “devalued” or “damaged” by a recent restructuring programme at the trust, which has been grappling major care quality and performance problems for several years. The CQC also revealed in a report today that it issued a warning notice to the trust after inspections at its two main sites in July. They ordered immediate improvements in its emergency departments, medical care and children and young people’s services. Read full story (paywalled) Source: HSJ, 20 December 2023 -
Content Article
TED talk: Tribal leadership (Ted Logan, March 2009)
Patient-Safety-Learning posted an article in Leadership
David Logan talks about the five kinds of tribes that humans naturally form—in schools, workplaces, even the driver's license office. He argues that by understanding our shared tribal tendencies, we can help lead each other to become better individuals. -
Content ArticleThis rapid evidence review and economic analysis makes the business case for investing in the wellbeing of NHS staff. It was written by a team from the University of East Anglia, RAND Europe and the International Public Policy Observatory (IPPO) and includes a narrative review of data on the current state of the mental health and wellbeing of NHS staff. Data shows that nearly half of staff reported feeling unwell as a result of work-related stress in the most recent survey, that sickness absence has increased and that there are high vacancy and turnover rates in some trusts. Research also shows that patient care can be affected by poor healthcare staff wellbeing.
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News ArticleThe national clinical director for older people has announced he is leaving NHS England and said a major government funding settlement will be needed to maintain progress and take community services to the ‘next stage’. Adrian Hayter joined NHSE in 2019 as NCD for older people and integrated person centred care. Dr Hayter, who is also a longstanding GP partner in Berkshire, said community services were now much more prominent at NHSE — and in its asks of the service – than they were four years ago. He said: “When I first came in, there wasn’t very much in planning guidance about what was happening in the community at all. Now that is different and we are expecting a range of initiatives in 2024. “But the future is that all of these things are not individual programmes - they’re all part of a particular approach to how we manage and support people for as long as possible in their own homes. “Urgent community response [where services are required to respond within two-hours to urgent needs, referred from a range of services] and virtual wards are a continuum of care. “And the growth of virtual wards have helped extend what happens in the community all the way through to the acute level care.” National long-term funding for several of the new services – badged in the 2019 long-term plan as “Aging Well” – is also now due to end, with integrated care boards instead asked to commission them locally. Dr Hayter warned that, as well as moving those services closer together, there needed to be a future government spending review settlement aimed at growing community services, to meet the needs of the rapidly ageing population. Read full story (paywalled) Source: HSJ, 18 December 2023
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Content Article
Who’s who at NHS England (updated 23 November 2023)
Patient Safety Learning posted an article in NHS England
This overview provides detail on the structure of NHS England’s executive group. -
Content ArticleThis toolkit from the Institute from Healthcare Improvement (IHI) equips patient safety and finance leaders with tools and a collaborative approach to make a compelling business case for organizational investments to advance patient and workforce safety initiatives.
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EventuntilThe health and care workforce continues to face profound challenges, with severe staff shortages and increasing financial pressures across health and care. While the NHS Long Term Workforce Plan aims to support the NHS’s future needs, it does not cover the social care workforce, resulting in a knock-on effect across the entire health and care system, particularly for those who rely on social care services. To resolve the challenges facing health and care, the sector needs to embrace positive disruption and its potential to change the nature of work and to improve recruitment, retention and the health and wellbeing of the workforce. This event from the King's Fund will explore the changing nature of work and how this can support the health and care system to adapt to future challenges. It will look at the different expectations between those already in the workforce and those joining it, and the challenges and opportunities this presents – whether it’s redesigning job roles, reforming education and training and providing different routes into health and care careers, developing a system that embraces flexible working, creating spaces for digital collaboration, or supporting moves to shift care out of hospital and into the community. Attendees will consider how those working in health and care can be supported to make the most of these opportunities against the backdrop of deep-seated cultural issues in the health and care system. Conference sessions will explore how to support the health and care workforce to succeed in their roles, and how organisations can be more responsive to the needs of people who work in them, whether through redesigning job roles to enable staff to deliver the best possible care, reforming regulation to support managers to succeed, or creating development opportunities to enable staff to work in a way that supports their health and wellbeing. Please join us to learn and share your leadership and workforce challenges. You will also have the opportunity to collaborate with experts and leaders from across the health and care system through keynote speeches, panel debates and interactive workshops. Register
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Content ArticleJames Titcombe, Melanie Leis, and Peter Howitt delineate the major themes of a roundtable to address challenges in improving patient safety, emphasising the need for data sharing nuances, cultural shifts, optimising limited resources, prioritising workforce plans, and staff well-being.
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News Article
Black Country doctors back vote of no confidence in management
Patient Safety Learning posted a news article in News
Doctors at a Black Country mental health trust have backed a vote of no confidence in their management team. Sources say that the Black Country Healthcare NHS Trust is not acting in the best interests of patients and they believe it wants to cut beds. They also have no confidence in the way that the trust has removed its chief medical officer, Mark Weaver. The NHS Trust said it was aware of concerns and had agreed to work on them going forward. The doctors wrote to the trust board following a meeting of the Medical Advisory Committee claiming that over the past two years the relationship with the board had become fractured. In the letter they claimed the voice of doctors was not being taken seriously by the board and that clinical priorities were secondary to financial performance. They also said they were seriously disturbed with the way in which Mr Weaver had been asked to step down and that the deputy chief medical officer Dr Sharada Abilash had not been asked to take over while due process occurred. Read full story Source: BBC News, 9 December 2023 -
Content ArticleLucy Letby was allowed to continue working with new-born babies despite her colleagues raising concerns about her for months. Her conviction highlighted how NHS executives put the reputation of the Countess of Chester NHS Trust ahead of patient safety. But what happened in Cheshire was far from a one-off. File on 4 hears from doctors with unblemished medical careers who were sacked after raising patient safety concerns. The programme follows one medic through an Employment Tribunal as he attempts to save his career, and hears the emotional, brutal toll the process takes on him. For the first time, a top doctor who won record damages talks about the extraordinary steps her managers took to undermine her. Their tactics included relocating her to an empty office with a broken chair and telling colleagues that she agreed with their assessment she was incompetent. And a former NHS executive tells the programme that trusts are more interested in “flying LGBT flags” than tackling concerns about patient safety. With widespread calls for NHS managers to be regulated, File on 4 asks who should take on the role, given the willingness of the NHS to redeploy managers found to have ignored patient safety concerns, or even punished those who dared to raise them.
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Content Article
This book sets out what the terms governance and leadership mean, and how thinking about them has developed over time. Using real-world examples, the authors analyse research evidence on the influence of governance and leadership on quality and safety in healthcare at different levels in the health system: macro level (what national health systems do), meso level (what organisations do) and micro level (what teams and individuals do). The authors describe behaviours that may help boards focus on improving quality and show how different leadership approaches may contribute to delivering major system change. -
Content ArticleThe second annual Safety For All conference was held at the Royal College of Physicians in London on Tuesday 5th December 2023. Over 100 members of the healthcare community attended this event, including occupational health professionals, patient safety experts, frontline staff, patients and academics. The conference was hosted by the Safer Healthcare and Biosafety Network and Patient Safety Learning as part of the Safety For All campaign, supported by B. Braun, BD, Boston Scientific and Stryker. Attendees had the opportunity to hear from two keynote speakers: Lynn Woolsey, UK Deputy Chief Nurse at the Royal College of Nursing and Dr Henrietta Hughes, Patient Safety Commissioner for England. The conference was chaired and facilitated by Dr Rob Galloway, A&E Consultant at Brighton and Sussex Hospital NHS Trust, with a welcome introduction from Dr Ian Bullock, CEO of the Royal College of Physicians. There were a number of panel sessions and presentations throughout the day which are summarised in the attachment below, including on sustainability, antimicrobial resistance and antibiotic underdosing, violence at work, clinical communications, human factors, implementing the Patient Safety Incident Response Framework (PSIRF), and women's health and the menopause.
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Content ArticleLeadership walkarounds (LWs) have been promoted in practice as means to drive operational, cultural and safety outcomes. This systematic review in BMJ Open Quality aimed to evaluate the impact of LWs on these outcomes in the US healthcare industry. The authors found only positive association of LWs with operational and perception of cultural outcomes.
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News ArticleFormer Prime Minister Boris Johnson is scheduled to provide evidence at the Covid Inquiry on the 6 and 7 of December. Long Covid is one of the most catastrophic consequences of the pandemic and it deserves a prominent place in the discussions during this critical phase of the inquiry. The Long Covid Groups will be delivering a letter to No.10 Downing Street today, urging attention to the unique challenges faced by those with Long Covid. Read the letter and sign the petition
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News Article
NHS trust under investigation accused of hypocritical email to staff
Patient Safety Learning posted a news article in News
The boss of a hospital trust being investigated by police for alleged negligence over 40 patient deaths has been accused of sending a hypocritical email urging staff to have the courage to raise concerns despite the dismissal of whistleblowing doctors. The investigation, Operation Bramber, was sparked by two consultants who lost their jobs after raising concerns about deaths and patient harm in the general surgery and neurosurgery departments of the Royal Sussex County hospital in Brighton. In an email to staff on Friday, the chief executive, George Findlay, said the trust was committed to learning from its mistakes. He said: “When things do go wrong, we must be open, learn and improve together. That openness is how we give people courage to raise concerns and make a positive difference to patient care.” James Akinwunmi, a consultant neurosurgeon who was unfairly dismissed by the trust in 2014 after he raised the alarm about patient safety, said Findlay’s email was “laughable”. He told the Guardian: “Whistleblowers, including myself, have done exactly what he is encouraging in the email and they were sacked for it, so you can draw your own conclusions. I suspect what they are doing is damage limitation. Instead, they should be dealing with surgeons who have been a problem for years.” Another more recent whistleblower, who did not want to be named, expressed incredulity at Findlay’s claim that he wanted to encourage staff to raise concerns. They said: “The email is hypocritical. How can staff have the ‘courage to raise concerns’ after what has happened to those who have? Those brave enough to blow the whistle about patient safety have been sanctioned, lost their job and had their lives destroyed.” Read full story Source: The Guardian, 3 December 2023 -
News Article
Minister: There’s systemic racism in the NHS
Patient Safety Learning posted a news article in News
A health and social care minister privately said there was ‘systemic’ racism within the NHS and called for an investigation into it. Helen Whately told Matt Hancock of her belief in a private message which was today shown to the covid public inquiry. An inquiry hearing with Mr Hancock – who said he agreed with the point – was shown an exchange between Ms Whately, then care minister, and Mr Hancock in June 2020. The Guardian had reported the previous day that an internal report had found systemic racism at NHS Blood and Transplant. Ms Whately, who is now minister of state covering social care and urgent and emergency services, said: “I think the Bame next steps proposed are important but don’t go far enough. There’s systemic racism in some parts of the NHS, as seen in NHSBT.” She added: “Now could be a good moment to kick off a proper piece of work to investigate and tackle it.” Read full story (paywalled) Source: HSJ, 1 December 2023
