Like healthcare systems all over the world there are times when things go tragically wrong. We all understand that healthcare is a people business, and that with the very best intentions people will make mistakes. Improving safety is about reducing risk and minimising mistakes. The NHS has embarked on a journey to become one of the safest healthcare systems in the world.
What’s been achieved in England in the last three years?
- A complete overhaul of CQC standards, and comprehensive ratings inspections of all trusts, as well as primary care providers. The CQC has completed its first round of acute hospital inspections which has seen 31 hospitals go into ‘special measures’ turnaround and 20 come out – including 7 moving to a ‘good’ rating.
- The introduction of the duty of candour and new protections for those who raise concern and blow the whistle mean that the NHS is now more transparent:
- Introduction of an Independent National Officer (INO) for whistleblowing based in the Care Quality Commission (CQC) to lead and support a network of individuals within NHS trusts appointed as ‘local freedom to speak up guardians’.
- Consultation on new legislation to prohibit discrimination against applicants believed by the prospective employer to have been whistleblowers, published in March 2017.
- Whistleblowing statutory framework extended to include student nurses and student midwives, meaning those people are now afforded protection under the Public Interest Disclosure Act; our intention is to extend the definition further to include other healthcare students in 2018.
- NHS Prescribed Persons for the NHS extended to include NHS Protect, Public Health England, Healthwatch England and Health Education England and Local Education and Training Boards.
- Patient Safety Collaboratives, each established and led locally by an Academic Health Science Network, are now delivering a locally-owned improvement programme in order to create safer systems of care, to learn from errors (including medication errors) and reduce avoidable harm. Sign Up To Safety is a 3 year, voluntary national campaign launched in June 2014 as part of a set of initiatives to reduce avoidable harm, save lives and improve patient safety across the NHS in England.
- NHS Litigation Authority – from April 1st ‘NHS Resolution’ – has introduced a national Safety and Learning Service to work with NHS organisations, with the use of Scorecards, to help them understand their claims data to better assess where local interventions would have the greatest impact in reducing high volume or high cost claims. NHS Resolution has also supported the national campaign and in 2015/16 provided over £18m of Sign Up To Safety incentive payments to support local safety improvement plans across the country.
- Rigorous inspection, with CQC’s completion in January 2017 of comprehensive ratings of all trusts, primary care and adult social care providers, providing a baseline assessment of the quality and safety of these services. These comprehensive inspections have helped trusts to understand the specific areas where improvements are needed and to take targeted action, and have provided increased transparency on performance for people who use services.
Key improvements for 2017/18 and 2018/19
- Preventing healthcare acquired infections. The NHS, led by NHS Improvement, will build on its success in reducing the incidence of MRSA bloodstream infections and C. difficile infections to make the same progress on Gram-negative infections such as E. coli, Klebsiella and Pseudomonas bloodstream infections. By 2020/21 the level of such healthcare associated infections will fall by 50%. This will be achieved with a system-wide approach by relevant providers and commissioners:
- Extending mandatory data collections to more cases and publishing and learning from locally comparable data on key infections published by Public Health England.
- Following guidance and tools developed by NHS Improvement to support local teams to prevent Gram-negative bloodstream infections.
- Giving E. coli infections the same level of priority as MRSA and Clostridium difficile through, for example, displaying numbers of infections on ward information boards.
- Maternity safety. 44 Local Maternity Systems will be in place from April 2017, leading and delivering transformation of maternity services by implementing Better Births for their STP, including:
- Providing more personalised, safer maternity services with women having access to unbiased evidence-based information. Women will be better able to make choices about their care and have more continuity of care during the ante natal, birth and postnatal periods. Seven ‘early adopter’ areas delivering new models of maternity care for 125,000 births a year and over 15% of the population by the end of 2018, including offering improved continuity of care to over 20,000 women.
- Working to achieve the national maternity ambition to reduce the 2010 rate of stillbirths, neonatal deaths, maternal deaths and brain injuries in babies that occur during or soon after birth by 20 per cent by 2020, demonstrating progress towards the national ambition to reduce rates by 50 per cent by 2030.
- Learning from deaths. We want the NHS to become the world’s largest learning organisation, with a culture that uses all sources of insight, including from complaints (64), to improve services and quality of care, particularly for the most vulnerable. As part of the implementation of the CQC report Learning, Candour and Accountability, trusts will be expected to have proper arrangements for learning from deaths of patients in their care. From April 2017 trusts will be asked to publish data on all deaths judged as likely to have been caused by problems in care – along with actions taken to learn and prevent such deaths in future. This information will be provided quarterly and summarised in each organisation’s annual Quality Accounts. Alongside such learning, the NHS will also:
- Improve support to and communication with bereaved families and carers.
- Improve the standards and understanding of data on harm and mortality.
- Ensure that services for people with learning disabilities and mental health problems are a core part of this learning.
- Improving inspections. The CQC will develop a more targeted, responsive and collaborative approach to regulation, including specifically considering how to regulate new care models and complex providers. CQC will work with NHS Improvement to deliver the Use of Resources rating of NHS acute trusts.
- Improving investigations. From April 2017 the new Healthcare Safety Investigation Branch will be operational, undertaking up to 30 investigations where learning from patient safety can be maximised, and advising the NHS on how to improve its own investigations. Revised guidance on investigating serious incidents will also be published by NHS Improvement. Together these changes should ensure safety incidents are investigated appropriately, to ensure patient concerns are allayed and learning is spread quickly across the NHS.
- Reducing medication error. We will also develop plans to reduce the level of medication error across the NHS, ensuring that patients can always be confident that the medicine they are prescribed is the right one for them.
- Patient Safety Incident Management system (PSIMS). NHS Improvement will develop and deliver a new Patient Safety Incident Management System. This will be designed for all healthcare settings and will make it easy and rewarding to record patient safety incidents, provide feedback, and enhance learning from what has gone wrong.
- Global leadership for patient safety. The NHS approach to patient safety is widely recognised as world-leading. We continue to work with national and international partners to ensure we can best benefit the safety of patients in England, for example through contributing to and leading WHO patient safety initiatives and the pan-European Patient Safety Expert Group.