Issue 28: 1 October 2015
Quality and Safety eBulletin
Welcome to the Quality and Safety eBulletin
This eBulletin brings you the latest news from key national agencies and initiatives across
the UK, under themed headings.
We welcome your feedback on the eBulletin. Please contact us at
qualityandsafety@rcn.org.uk.
Claire Constable, Sarah Raybone and Ross Scrivener
RCN Nursing Department
Quality and Safety part-themed eBulletin: Older People's Day
This part-themed Quality and Safety eBulletin focuses on Older
People's Day.
Older People's Day
Older People’s Day is on 1 October every year to coincide with the UN International Day of Older
Persons. The day aims to be a celebration of the achievements and contributions that older people
make to society and the economy. Follow news and events on Twitter at @OlderPeoplesDay.
Frailty toolkit
Older people living with frailty make up between 9 per cent and 25 per cent of the population. This
toolkit from NHS England aims to provide GPs and practice nurses with a suite of tools to support
the case finding, assessment and case management of frail older patients. NHS England, in
collaboration with Public Health England and Age UK, is also launching a new guide to healthy
ageing. View the toolkit.
Frailsafe
The Frailsafe project has identified the most common and highest impact issues which can result in
harm to patients in the first few days of acute care. Frailsafe aims to improve measured quality of
care for frail older patients admitted to NHS hospitals with medical emergencies by July 2016. Visit
the website to find out more about the safety checklist, other collaboratives and case studies.
Visit: Frailsafe.
Time to take the helm?
The National Health Service has been under immense scrutiny in its provision of care to the older
frailer population. This blog suggests that the time has come for nurses to step in and employ their
diverse skills and take over leading at the helm of clinical service delivery to ensure that patients'
needs are fully met from all perspectives. View the blog.
Older people's resource
This resource focuses on nursing older people who are living with frailty and intensity of need. It
includes examples of work that the RCN has been carrying out on older people's care; examples of
good practice in caring for older people and links to the work of key organisations that support and
promote good care. Visit the older people's resource.
RCN highlights
Supporting the delivery of immunisation (PDF 619KB). An effective immunisation service depends
on staff being suitably skilled and qualified. This publication builds on national guidance for
immunisation training and recommends the standardisation of immunisation training for all nursing
staff. A separate Immunisation knowledge and skills competence assessment tool is available to
support staff and help managers assess competence and knowledge.
Immunisation knowledge and skills competence assessment tool (PDF 591KB). This competence
framework has been developed to support the training and assessment of registered and nonregistered health care workers who have a role in immunisations. A separate guidance document
on Supporting the delivery of immunisation education is also available.
Getting started on Twitter. A guide for those who are new to Twitter on how to use this social
media site effectively, with information on registering for an account, using hashtags, mentions
and direct messages as well as top tips for getting noticed.
Caring for people with liver disease. Caring for people with liver disease: a competence framework
for nursing describes the professional standards expected of practitioners when caring for people
with liver disease – both adults and young people. This framework will help the nursing team to
identify individuals at risk of liver disease, promote healthy livers and lifestyle as well as care for
individuals with existing liver disease. Norgine Pharmaceuticals Ltd have provided financial support
for this publication.
See also: RCN launches framework to improve care for liver disease patients.
The RCN has published the following briefing paper:
Delivering the Five Year Forward View - Understanding the critical role of nursing across a
selection of UK and international case studies. Using a selection of UK-based and international case
studies, this briefing explores and celebrates innovative, patient-centred nursing across three of
the seven care models in the Five Year Forward View (FYFV). The purpose of this work is to
highlight the central role which nurses are already playing in delivering the spirit of FYFV across
different health systems, and to make the case that policy-makers in the UK should be engaging
with nurses to ensure that FYFV is as effective for patient care as it possibly can be.
RCN responds to Health Minister’s comments on pay and morale. The RCN has responded to
comments made by Health Minister Alistair Burt MP that ‘there is no evidence that the pay freeze
affected staff morale’ in the NHS. The comments were made in response to a parliamentary
question on NHS pay by Louise Haigh MP.
Minimum wage increase imminent. Some RCN members will be affected by upcoming changes to
the National Minimum Wage. As of 1 October the National Minimum Wage (NMW) is set to rise by
20p to £6.70 an hour for those aged 21 or over. Younger people, for whom the NMW is currently
between £2.73 and £5.13 an hour, will see their pay increase between 8p and 17p. RCN
Employment Relations Adviser Clare Jacobs said that while the increase in the NMW is good news,
particularly for health care assistants in the independent sector, the RCN is committed to securing
better pay, terms and conditions for all members.
Time to Care – RCN Wales launches the RCN’s Welsh Government manifesto for the 2016 election.
RCN members in Wales believe that protecting safe nursing staffing levels must be the first priority
for the next Welsh Government. The Royal College of Nursing represents over 24,500 members
within the nursing family in Wales. The Manifesto sets out the key policies which are of greatest
importance to the Royal College of Nursing in Wales at this time
NICE Consultation Gateway
The NICE consultation gateway pages provide information about the work that NICE does, current
NICE consultations and new topics for guideline and guidance development, and how you can get
involved. We will highlight these pages in every bulletin.
You can find out the latest on NICE consultations and new topics in development at Current
consultations and topics in development.
RCN events
The RCN organises an annual programme of events and conferences, including RCN Congress, to
support all health care professionals with their personal and professional development. See:

RCN national events
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England regions and branches
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Northern Ireland
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Scotland
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Wales.
Events
Afternoon tea drop-in: Older people's day. 1 October, 14.30 to 15.30 at the Library and Heritage
Centre (London). Our new series of free afternoon tea drop-ins kicks off with Older People's Day.
Join us at the Library and Heritage Centre, London, to learn more by discovering key resources
and useful information on caring for older people. RCN Professional Lead for the Care of Older
People and Dementia, Dawne Garrett, will be on hand to chat with you and answer questions. All
whilst enjoying a free cup of tea and a biscuit (or two). No need to book, just drop by and say
hello.
RCN & MNDA: Resilience - Skills for when the going gets tough(er). 13 October 2015, 20
Cavendish Square (London), This joint public lecture from the RCN and MND Association will
recognise the demands of nursing and caring in cases which bring extraordinary pressure to the
individuals involved as well as exploring coping strategies which might be employed.
Frances Kelly, Motor Neurone Disease Co-ordinator, will use her vast experience and explore the
challenges and stress points of nursing and supporting people with MND - many of these points
will be recognisable in other terminal illnesses.
Dame Barbara Munroe will follow this with insights into how professionals might best prepare for
and recover from such stresses. Barbara has delivered training programmes across the world and
is a well-known speaker and lecturer and written extensively about psychological and social
aspects of palliative care. Book online atwww.rcn.org.uk/mndpl or call: 029 2054 6460
Who wants to lead? Exploring perceptions of a crisis in nursing leadership. The Winifred Raphael
Lecture 2015. 20 October 2015, RCN HQ, 20 Cavendish Square, London W1G 0RN. The event
begins at 6.30pm. Over the last decade, healthcare reforms have led to nurses working in a
context of high pressure, rapid change and uncertainty. Recent high profile reports have
recognised the importance of effective leadership, and highlighted the problems that can occur in
services when this is not in place. Middle managers (who include ward sisters and matrons) are on
the frontline of change and innovation, and key to the quality, safety and efficiency of patient
care. Despite this, many NHS Trusts are finding it hard to recruit to this grade – and to those
higher up the scale. This talk by Professor Bridie Kent PhD, BSc (Hons), RN, Professor in
Leadership, Plymouth University, will explore the perceptions of a crisis in nursing leadership, and
discuss the role that research can have in strengthening the position of nursing and patient
care. The lecture will be chaired by Dame Carol Black, Principal of Newnham College Cambridge
and Chair of the Nuffield Trust.
Let’s talk about end of life care. RCN and NCPC End of Life Care workshop 2015. 28 October 2015,
RCN Cardiff Gate, Cardiff CF23 8XG. The Royal College of Nursing (RCN) and the National Council
for Palliative Care (NCPC) are working together on a series of interactive workshops on caring for
people at the end of their lives. These workshops will be of interest to all non-specialist nurses in
both the acute setting and the community and general practice, including care homes. particularly
those working with people who have a life limiting illness and may want to talk about their worries
and concerns. Other dates/locations available: 15 December 2015, RCN HQ London.
RCN Defence Nursing Forum and Ethics Committee. Doing the right thing on a difficult day. 5
November 2015, RCN HQ, 20 Cavendish Square, London, W1 0RNReconciling your professional
responsibilities with ethical considerations in the field of defence nursing can be challenging. This
workshop will explore how to get the balance right and explain what support is available for those
facing difficult decisions. Topics include: whistleblowing and the duty of candour, ethical
considerations for defence nurses and deprivation of liberty standards, planning for future
operations and launch of the DNF oral histories project.
What’s new in women’s health? An update Women’s health conference and exhibition. 6 November
2015, RCN HQ, 20 Cavendish Square, London, W1 0RN. This one day conference, hosted by the
RCN women’s health forum, is essential for all nurses and health care professionals working in the
field of women’s health. As women’s health is a broad field, the day has been designed to appeal
and cover many conditions that will be useful to nurses working in the community right through to
the gynaecology ward and gynaecology oncology setting.
RCN Continence Care forum conference and exhibition. 25 November 2015. This conference
provides the opportunity to meet other health care professionals who are passionate about
promoting healthy bladder and bowel management.
Quality improvement
Audit, reviews, legislation, inspections, regulation
Care Quality Commission. GP practice exits special measures following improvements for patients.
The Priory Avenue surgery in Caversham, Reading is the first GP practice in England to come out
of special measures following improvements in the quality of its services.
NHS England. NHS maternity review. The NHS maternity review is currently underway to make
recommendations for the improvement of services for women and their families. It is open to
women, fathers, partners, their families and advocates, professionals, commissioners and people
from representative organisations. The closing date for comments is 31 October 2015.
NHS England. New hospital collaboration drive. NHS England Chief Executive Simon Stevens has
announced radical new options for the future of local hospitals across the NHS.
NHS Improving Quality. Improving access to perinatal mental health services in England- a review.
This new publication by NHS IQ presents the results of a three month scoping exercise to identify
current guidance and practice relating to Perinatal Mental Health services.
Regulation and Quality Improvement Authority. Review of Services for People with an Acquired
Brain Injury. RQIA has published the report of its independent Review of Brain Injury Services in
Northern Ireland. Each year, in Northern Ireland over 2,000 people sustain a brain injury, while
many more live with the long-term effects. The review team, which included experts in the field
from across the UK, assessed acquired brain injury services against brain injury service standards
and quality indicators.
Guidance, innovation, tools
BMC Medicine. Trustworthy guidelines – excellent; customised care tools- even better. The role
and utility of guidelines has seen some debate – and some activity to move towards more
trustworthy guidelines and ways to better use that knowledge in routine care. This paper reflects
some of this but focuses on that the “case to be made for creating tools that translate existing
evidence into tools to help patients and clinicians work together to decide next steps”.
Canadian Medical Association Journal. Reducing pain during vaccine injections: clinical practice
guideline. The pain experienced when being vaccinated may seem trivial, but for some it can be
the hurdle that cannot be overcome and the cause of refusal or non-compliance.
Public Health England. Diabetic eye screening: use and transfer of patient information. New
guidance explains the general practice to diabetic retinopathy screening (GP2DRS) system and
why we need information about people with diabetes who are eligible for screening.
NHS England. Latest wave of funding to recognise and reward innovation. More than £90,000 is up
for grabs for fresh ideas to help address England’s biggest healthcare challenges in the second
wave of this year’s NHS Innovation Challenge Prizes. The Innovation Challenge is a key part of the
drive to embed innovation across the NHS, which includes the NHS Innovation Accelerator and test
bed programmes and the new models of care vanguard sites. Applications for the second wave of
this year’s prize fund are now open.
Royal College of Paediatrics and Child Health. Epilepsy passport. This innovative tool developed by
Royal College of Paediatrics and Child Health sets out to improve communication between
professionals and keep children and young people out of hospital. With lack of communication
being one of the major factors leading to poor epilepsy care and management, child health experts
have today launched a pioneering ‘Epilepsy Passport’ which aims to improve the sharing of
information between young patients and their healthcare professionals.
Practice examples and case studies
Frailsafe. The Frailsafe project is supported by a Health Foundation ‘Closing the Gap in Patient
Safety’ award. Frailsafe aims to improve measured quality of care for frail older patients admitted
to NHS hospitals with medical emergencies by July 2016. The checklist is designed to be a ‘check
and challenge’ list triggering an interaction between the senior doctor and another member of staff
(eg nurse or junior doctor) on acute medical assessment units (AMUs). View the case studies.
Housing LIN. Sensitive hospice design: A holistic end of life caring environment. This Housing LIN
Case Study no 110 provides an overview of the award winning design characteristics that formed
the brief to convert The Mary Stevens Hospice in Stourbridge into a contemporary building that
can provide a holistic setting for people living with cancer and other life-limiting illnesses, staff and
the wider community.
Reports, commentary, statistics
Action on smoking and health. Smoking and dementia. This fact sheet examines the association
between smoking and dementia. It reviews the evidence of a causal link including the association
between secondhand smoke exposure and risk of dementia. The fact sheet reviews the extent of
the problem, the association between smoking, dementia and other modifiable risk factors, and
key health messages arising from this research.
Alzheimer’s Research UK. One in three people born in 2015 will develop dementia, new analysis
shows. Alzheimer’s Research UK has renewed its call for urgent action on dementia as new
analysis estimates that one in three people born this year will develop the condition during their
lifetime. The findings, revealed on World Alzheimer’s Day (21 September), foreshadow a looming
national health crisis as the UK population ages, and underlines the need for global efforts to
develop new treatments to succeed.
Asthma UK. Down with DNAs. DNAs cost the NHS £162 million every year and asthma has one of
the highest rates of missed appointments. We hope that by giving practical advice on how to
reduce DNAs more people with asthma will have a review and that the review itself will be more
effective. The tips from Asthma UK have been compiled from real-life success stories where
practices have made changes and seen a difference in efficiency and asthma outcomes.
Center for Disease Dynamics, Economics & Policy. State of the world’s antibiotics 2015. This report
from the [US] Center for Disease Dynamics, Economics, and Policy is accompanied by interactive
maps that show resistance trends by country.
Carers Trust. A charge on caring? Analysis of the use and impact of charges by councils providing
support to unpaid carers. This report finds that a growing number of councils are considering
charging carers for the support they receive, putting them in financial difficulties and at risk of ill
health. The research is based on Freedom of Information requests which were sent to 147 local
authorities in England to find out how many are currently charging carers for support, the impact
those charges are having on carers and the number of councils that will be debating the
introduction of charges in the next twelve months.
Centre for Health Economics, University of York (CHE). Waiting time prioritisation: evidence from
England. A number of OECD countries have introduced waiting time prioritisation policies which
give explicit priority to severely ill patients with high marginal disutility of waiting. There is
however little empirical evidence on how patients are actually prioritised. This paper exploits a
unique opportunity to investigate this issue using a large national dataset with accurate measures
of severity on over 200,000 patients.
Department of Health (DH). The UK government's response to the report: cross-border health
arrangements between England and Wales. This document outlines the UK government response
to a report on cross-border health arrangements between England and Wales. It makes clear that
the Department of Health and the Welsh Government agree with the report’s main message: that
the English and Welsh national health services should work together for the benefit of patients who
need to access services on both sides of the border.
DH. Enabling closer working between the emergency services. This consultation seeks views on
proposals to increase joint working between emergency services, in order to improve effectiveness
and deliver savings for the public. The closing date for responses to this consultation is 20 October
2015.
DH. Consultation on the roles and functions of the National Data Guardian for Health and Care.
This consultation seeks views on the responsibilities of the statutory National Data Guardian for
health and social care. The responses will form a major part of the development for more detailed
proposals to establish the National Data Guardian for health and social care on a statutory footing.
The National Data Guardian for health and social care will help to ensure that personal confidential
data is held and used to support better outcomes from health and care services, at the same time
providing confidence that there are thorough safeguards in place to protect personal confidential
data. The consultation closes on 17 December 2015.
DH. NHS public health functions arrangement: National Pandemic Flu Service - telephony
management services. This document sets out the arrangements under which the Secretary of
State for Health delegates to NHS England responsibility for providing a telephony routing service
for the National Pandemic Flu Service, which will direct calls from the public to the call centre
providers. The arrangements don’t relate to the provision of the call centres themselves.
DH. Clinics authorised to carry abortions. The Department of Health is responsible for approving all
non-NHS clinics and hospitals for the termination of pregnancy (abortion). This document contains
a list of approved independent sector places that can carry out abortions.
Fabian Society, Bright Blue and CentreForum. The generation game: spending priorities for an
ageing society. This report has been jointly published by the Fabian Society, Bright Blue and
CentreForum. It calls for radical new measures to tackle the challenges of an ageing population.
Health and Social Care Information Centre. NHS Immunisation Statistics, England - 2014-15. The
information in this bulletin about immunisation statistics in England comes from Public Health
England (PHE).
Health Foundation. Need to nurture: outcomes-based commissioning in the NHS. This publication
examines what outcomes-based commissioning means, the evidence to support it, progress to
date on introducing the approach in England, and the optimum role of national policy in response
to it. This work is the product of interviews and discussions with many commissioners, providers,
policy makers, experts and academics; as well as a rapid literature review.
Health Foundation. Inspiring stories of improvement. This month the Health Foundation highlights
some of the stories from projects they’ve supported over the last decade. Covering mental health,
maternity, primary care and older people's services, they provide ideas for improvement and
innovation that can be used in the health service.
House of Commons Education Select Committee. Inquiry: mental health and wellbeing of looked
after children. Building on the Health Committee’s recent report on childrens' and adolescents'
mental health and CAMHS, the Education Committee has announced an inquiry into the mental
health and wellbeing of looked after children. The deadline for receipt of written submissions is 29
October 2015.
International Longevity Centre UK. Rethinking cancer: the big 'C': quantifying the social and
economic impact. This report quantifies the cost of cancer to the UK economy, its families and its
communities. It outlines the changes required to increase survivorship and better support those
living with and beyond cancer, their employers, families, friends and relatives.
International Longevity Centre (ILC). Creating a sustainable 21st century healthcare system. This
report highlights how a ‘perfect storm’ of demographic and wider economic and social trends are
converging to push up the cost of healthcare across the globe. It showcases examples of
innovation from across the world which could save lives and money if introduced more widely. It
suggests that a concerted focus on innovation and prevention - developing more empowered
health consumers, whilst also maximising the potential of big data - would help to deliver
significant savings in the long-term.
King’ Fund. Foundation trust and NHS trust mergers. Mergers of trusts in the NHS are often
instigated by national bodies so that NHS trusts can gain foundation trust status or failing
providers can be rescued from financial difficulties. This report looks at 20 mergers between 2010
and mid-2015 and finds that significant sums of money are being spent on such mergers (£2
billion on just 12 mergers over this period), often based on faulty reasoning and a lack of evidence
that mergers offer lasting solutions.
National Audit Office. Managing conflicts of interest in NHS clinical commissioning groups. This
report outlines the findings from an investigation into managing conflicts of interest in CCGs and
how these risks are managed. It also examined the accountability, control and assurance
arrangements for managing conflicts of interest; as well as how these arrangements were working
in the 211 CCGs active in 2014-15, based on analysis of information on CCGs’ websites,
undertaken prior to April 2015.
National Audit Office. Investigation into the Cancer Drugs Fund. This report finds that the Cancer
Drugs Fund has improved access to cancer drugs not routinely available on the NHS, but all parties
agree it is not sustainable in its current form.
National Palliative and End of Life Care Partnership. Ambitions for Palliative and End of Life Care: A
national framework for local action 2015-2020. This UK national framework urges health
organisations and local authorities to act together to improve end of life care for people of all ages.
NHS Clinical Commissioners. Transforming healthcare in England’s core cities. This report shows
how CCGs in England’s core cities are taking up the challenge set out in the Five Year Forward
View and transforming the way in which healthcare is delivered to the benefit of their local
population. The key themes of the report are: developing new partnerships, ensuring equity of
care across diverse populations, improving wellbeing, and finding better ways to provide
healthcare services.
National Audit Office. Investigating the impact of out-of-hours GP services on A&E attendance
rates: multilevel regression analysis. This series of papers summarises the methodological
approaches taken, in carrying out innovative or novel analysis. Such analysis is conducted under
our statutory authority to examine and report to Parliament on the economy, efficiency and
effectiveness with which government departments and other bodies have used their resources.
NHS Providers. Community health services. A way of life. Community health services “will become
a way of life and a way of sustaining better, healthier, independent living for longer”. They will
provide people and communities with support and control over how that happens and reflects the
lives that people are living.
Public Health England (PHE). Local action on health inequalities: practice resources. This suite of
documents explain factors contributing to inequality in public health and set out methods for local
bodies to reduce them. Building on the work of the Marmot Review, the UCL Institute of Health
Equity has produced four papers which include evidence, and examples of practical action that can
be taken at a local level to reduce health inequalities. They are designed for people working in
local services, particularly directors of public health and public health teams; people working in
local authorities; services that may influence health and wellbeing, such as planning; and health
and wellbeing boards.
Public Health England. Routes to diagnosis 2006-2013, preliminary results. This report shows that
the proportion of cancers diagnosed as a result of emergency presentation at hospital has
decreased. At the same time, the proportion of cancers diagnosed through urgent GP referral with
a suspicion of cancer (known as the two week wait) has increased.
Public Health England. Health matters: smoking and quitting in England. This is the first in a series
of resources which aims to bring together a range of resources in an easily accessible package that
aim to address public health priorities. This document provides information on the prevalence of
smoking and evidence for what has been proven to work to promote cessation at local and national
level.
Public Health England. Changes in health in England, with analysis by English regions and areas of
deprivation, 1990 to 2013: a systematic analysis for the Global Burden of Disease Study 2013.
This paper estimates of the main causes of death and disability, attributable risk factors and the
effect of deprivation, modelled for England and its regions. It finds that sickness and chronic
disability are causing a much greater proportion of the burden of disease as people are living
longer with several illnesses. The accompanying online tool allows users to see how the disease
burden falls over time by English region and deprivation and the relative impact of different
diseases and risk factors.
Public Health England. The NHS Atlas of Variation in Healthcare. Reducing unwarranted variation to
increase value and improve quality. This Atlas is the latest in the series of the NHS Atlases of
Variation in Healthcare, the first since the creation of two new organisations under the Health and
Social Care Act: NHS England and Public Health England (PHE).
Public Health England. Government invests £350 million to create world-class public health labs in
Harlow. The investment will see part of Public Health England move from its existing ageing
facilities at Porton Down into the new labs at Harlow, to continue their vital work in tackling some
of the biggest issues in public health.
Public Health England. NHS commissioning 2015-2016. This agreement sets out outcomes to be
achieved and funding provided for NHS England to commission public health services.
Public Health England. Vaccination of individuals with uncertain or incomplete immunisation status.
One-page summary for health professionals and immunisation practitioners giving vaccinations.
Public Health England. Childhood flu programme training slide set for healthcare professionals. A
training resource for health care practitioners.
Reform. Delivering the new Government’s health agenda. This conference brochure for Reform's
conference held on 9 September 2015 includes articles from those working within health care and
the articles discuss the New Models of Care agenda as well as delivering high-quality seven day
services for patients.
World Health Organization (WHO). Physical activity strategy for the WHO European Region 2016–
2025. WHO estimates indicate that, in Europe, more than one third of adults and two thirds of
adolescents are insufficiently active. Worldwide, physical inactivity causes 6 - 10 per cent of cases
of coronary heart disease, diabetes and breast and colon cancer and 9 per cent of premature
mortality. The aim of this strategy is to inspire governments and stakeholders to work towards
increasing levels of physical activity.
World Health Organization (WHO). The European health report 2015. This publication presents
highlights from the 2015 European health report. It shows continuing improvements in health
throughout the Region and decreases in some of the inequalities in health between countries,
notably in life expectancy and infant mortality; nevertheless, these differences still amount to 11
years of life and 20 healthy babies per 1000 live births between the best- and worst-performing
countries.
Patient safety
Agency for Healthcare Research and Quality. Patient Safety Primers – High reliability. High
reliability organisations are those that operate in complex, high-hazard domains for extended
periods without serious accidents or catastrophic failures. High reliability is an ongoing process of
cultivating organisational mindfulness; standardisation is necessary but not sufficient for achieving
resilient and reliable health care systems.
BBC Health News. NHS uncovers 1,000 FGM cases in England. There were more than 1,000 newly
recorded cases of female genital mutilation (FGM) in England between April and June, NHS data
reveals. For the first time the official figures were expanded to include information from general
practices and mental health trusts.
British Medical Journal (BMJ). A new issue of Quality and Safety has been published. Articles in this
issue of BMJ Quality and Safety include: the wisdom of patients and families, venous
thromboembolism prophylaxis, health care standards and Infection prevention and control in
nursing homes.
Guardian Health. Views from the NHS frontline. ‘The NHS I knew when I started out as a medical
student has been chipped away and patient safety is under threat’.
Health Quality and Canadian Patient Safety Institute. Never events for Hospital Care in Canada:
safer care for patients. A group of Canadian health care organizations have compiled this list of
eleven patient safety incidents (considered ‘never event’s) that should never happen in Canadian
hospitals. Led by Health Quality Ontario and supported by the Canadian Patient Safety Institute,
the report’s authors apply the definition that: Never events are patient safety incidents that result
in serious patient harm or death, and that can be prevented by using organizational checks and
balances.
Institute for Healthcare Improvement. 6 Ways to Make Primary Care Safer. “While patient safety
risks in the hospital setting are well known, it can be easy to overlook the risks of harm in primary
care. In the following post, IHI Patient Safety Director Jennifer Lenoci-Edwards describes the
moment she realized that safety means different things in different settings. She also outlines
recommendations for improving primary care patient safety.” [American].
Institute for Healthcare Improvement. Reliability. “As health care organizations strive to join the
ranks of other high-reliability organizations, many health settings continue to struggle with the
basic challenge of developing reliable systems. Reliable systems can reduce defects and rework
and facilitate safer care of our patients, thereby improving patient outcomes.” A new topic page for
resources for improving reliability. [American].
Medicines and Healthcare Products Regulatory Agency (MHRA). Medicines, medical devices and
blood regulation and safety notice. A list of field safety notices received by the MHRA.
MHRA. Medicines: company led recalls. Recalls of medicines issued by manufacturers.
NHS England. Patient safety incident reporting continues to improve. NHS England has published a
data report on patient safety incidents reported between 1 October 2014 and 31 March 2015. The
reporting of incidents to a national central system helps protect patients from avoidable harm by
increasing opportunities to learn from mistakes and where things go wrong. Incident reporting is
also important at a local level as it supports clinicians to learn about why patient safety incidents
happen within their own service and organisation, and what they can do to keep their patients safe
from avoidable harm.
thebmj. Evidence about electronic cigarettes: a foundation built on rock or sand? Public Health
England recently endorsed the use of e-cigarettes as an aid to quitting smoking. In this analysis,
Martin McKee and Simon Capewell question the evidence on safety and efficacy underpinning the
recommendations.
Evidence based practice
British medical Journal (BMJ). Perioperative diabetes care: development and validation of quality
indicators throughout the entire hospital care pathway. This study aims to develop a set of quality
indicators for optimal perioperative diabetes care throughout the hospital care pathway and to gain
insight into the feasibility of the indicator set in daily clinical practice by assessing the clinimetric
properties of the indicators in a practice test.
National Institute for Health and Care Excellence (NICE). Home care: delivering personal care and
practical support to older people living in their own homes (NG21). This guideline covers the
planning and delivery of person-centred care for older people living in their own homes (known as
home care or domiciliary care).
Personalised care to support those who need help to live at home.
NICE medical technology guidance. Virtual Touch Quantification to diagnose and monitor liver
fibrosis in chronic hepatitis B and C. This guidance supports the NHS using the device, Virtual
Touch Quantification (VTq), in people with chronic hepatitis B or C who need liver fibrosis
assessment. Using this device could mean these patients can avoid having a biopsy – where a
small piece of the liver is removed for examination.
NICE recommends device for diagnosing liver damage which could help thousands avoid biopsy.
NICE quality standard. Cardiovascular risk assessment and lipid modification. This quality standard
covers identifying and assessing cardiovascular risk, and lipid modification for preventing
cardiovascular disease, in adults (aged 18 years and over).
NICE. Edoxaban for preventing stroke and systemic embolism in people with non-valvular atrial
fibrillation (TA355). NICE has published recommendations for Edoxaban as an option for
preventing stroke and systemic embolism in people with non-valvular atrial fibrillation who have
one or more risk factors.
NICE. NICE to sponsor new NHS Vanguards. As a member of the NHS Five Year Forward View
Board, NICE is sponsoring four ‘vanguards’ – groups of NHS and local government organisations
which have been designated to pilot the new models of care described in the NHS Five Year
Forward View.
Vanguards: piloting new models of care for the NHS.
National Institute for Health and Care Excellence (NICE). Project to make development of new
treatments more efficient. NICE is partner of a new public-private project which aims to identify
activities that can make the development and regulation of medicines more efficient.
NICE. Online learning tool for bladder cancer. NICE has launched a new online learning tool to
support the implementation of the guideline on bladder cancer. The tool uses interactive activities
and case studies to support clinicians in diagnosing, staging and treating non-muscle-invasive and
muscle-invasive bladder cancer.
Patient focus
Alzheimer Scotland. Aberdeen’s first Dementia resource centre. Alzheimer Scotland’s Dementia
Resource Centre for Aberdeen will be officially opened on Monday 21 September (World
Alzheimer’s Day) at 2pm. The centre is at 13-19 King Street in Aberdeen and will serve as a dropin for anyone seeking information and advice about dementia, as well providing home support,
support for carers and carer education.
Audit Commission. NHS maximum waiting times and patient choice policies. This briefing has been
produced by researchers at the House of Commons Library and sets out policy on maximum
waiting time standards and patient choice. It applies to England only.
Foundation of Nursing Studies. International Practice Development Journal - guest editorial - The
currentness of person-centred practice. This is an overview of how person-centredness fits in with
larger societal changes from Gaby Jacobs of Fontys University of Applied Sciences, The
Netherlands. “The most important challenge within care and cure now is how to provide highquality care with fewer resources and less manpower. This special issue of the International
Practice Development Journal puts forward an important perspective from which to do this:
person-centered practice.”
Health and Social Care Information Centre. Patient-Led Assessments of the Care Environment PLACE England 2015. These are the results from the 2015 Patient-Led Assessments of the Care
Environment (PLACE) programme. These self-assessments are undertaken by teams of NHS and
private/independent health care providers, and include at least 50 per cent members of the public
(known as patient assessors). They focus on the environment in which care is provided, as well as
supporting non-clinical services such as cleanliness, food, hydration, and the extent to which the
provision of care with privacy and dignity is supported. In 2015, for the first time the assessments
considered aspects of the environment in relation to the provision of care to those with dementia.
Health Innovation Network. Social value of investing in dementia support. The Health Innovation
Network has published a report showing that the positive social value of peer support groups for
people with dementia, their carers and volunteers can be far greater than the investment.
House of Commons Library. NHS maximum waiting times and patient choice policies. This briefing
sets out policy on maximum waiting time standards and patient choice in the English NHS.
Implementation Science. Improving the quality of life in nursing home patients: protocol for an
effectiveness-implementation cluster randomized clinical hybrid trial.Nursing home patients have
complex mental and physical health problems, disabilities and social needs, combined with
widespread prescription of psychotropic drugs. Preservation of their quality of life is an important
goal. This can only be achieved within nursing homes that offer competent clinical conditions of
treatment and care.
Monitor. Outpatient appointment referrals survey. This survey indicates that too few NHS patients
say that they are being offered a choice about where they receive care, indicating that more work
needs to be done to promote patient choice across the NHS. 40 per cent of respondents to NHS
England and Monitor’s annual survey into patient choice said they were offered a choice of hospital
or clinic for their first outpatient appointment by their GPs. The survey indicated that, where
patients are offered a choice, they are much more likely to be able to go to the hospital or clinic
they want.
National Institute for Health Research. Integration and continuity of primary care: polyclinics and
alternatives - a patient-centred analysis of how organisation constrains care coordination. Integration has emerged as a major theme. Co-ordination and continuity of care are
important aspects of care and a clear target of integration and this study suggests integrated care
organisations are “more likely to favour the development of care co-ordination and, therefore,
continuities of care than a system of care networks”.
National Institute for Health Research. ReseArch with Patient and Public invOlvement: a RealisT
evaluation - the RAPPORT study. Patient and public involvement (PPI) is a prerequisite for many
funding bodies and NHS research ethics approval. PPI in research is defined as research carried
out with or by the public rather than to, about or for them. While the benefits of PPI have been
widely discussed, there is a lack of evidence on the impact and outcomes of PPI in research. The
aim of this study is to determine the types of PPI in funded research, describe key processes,
analyse the contextual and temporal dynamics of PPI and explore the experience of PPI in research
for all those involved.
National Institute for Health Research. An evidence base to optimise methods for involving patient
and public contributors in clinical trials: a mixed-methods study. In comparison with other study
designs, randomised trials are regarded as particularly likely to benefit from patient and public
involvement (PPI). Using mixed-methods research this study investigated PPI from the
perspectives of researchers and PPI contributors.
National Institute for Health Research. Integration and continuity of primary care: polyclinics and
alternatives - a patient-centred analysis of how organisation constrains care coordination. Integration has emerged as a major theme. Co-ordination and continuity of care are
important aspects of care and a clear target of integration and this study suggests integrated care
organisations are “more likely to favour the development of care co-ordination and, therefore,
continuities of care than a system of care networks”.
National Voices. How should we think about value in health and care? This paper asks readers to
think about the elements of value in social care and examines difference approaches to thinking
about value. The paper considers how new frameworks and measures of value can be created to
assess financial, social and person-reported outcomes. It sets out how we might establish a
broader way of understanding value and value for money in health and care.
NHS England. Survey on patient choice of outpatient appointment. NHS England and Monitor have
published the results of an annual online survey about patients’ experience of their legal right
around choice of outpatient appointment.
NHS England. Personalised medicine. Sir Bruce Keogh has outlined an emerging strategy for
Personalised Medicine in the NHS.
NHS Improving Quality (NHS IQ). Revolutionising person centred care for people with complex
care needs. NHS IQ's Long Term Conditions Year of Care Commissioning Programme early
implementer site.
Parliamentary and Health Service Ombudsman. Complaints about acute trusts 2014-2015. This
report has revealed that, similar to last year, the top three reasons for hospital complaints
investigated by the Parliamentary and Health Service Ombudsman in the last financial year (201415) were poor communication, errors in diagnosis and poor treatment. Non-medical aspects of
patient care are cited as a factor in almost half of all complaints investigated by the Parliamentary
and Health Service Ombudsman.
Public Health England. National Conversation on Health Inequalities: Video photo stories. Public
Health England has published “video photo stories” illustrating people’s experiences of health
inequalities.
Public Health Wales. Access matters – making health care environments accessible to people with
sensory loss. The NHS Centre for Equality and Human Rights will be hosting an event on
Wednesday 14 October 2015 in the All Nations Conference Centre in Cardiff, starting at 9.30am.
The aims of the event are to share examples of inclusive design and to offer practical solutions to
support Health Boards and NHS Trusts in making the environment accessible to people with
sensory loss.
Royal College of Physicians (RCP). Putting the pieces together: removing the barriers to excellent
patient care. This report outlines many of the structural and systematic challenges faced by
patients whilst presenting a vision of how to reform and improve the systems and structures that
underpin the NHS. It notes that in some areas of patient care, physicians have found that services
are planned and commissioned in such a fragmented way that care is often disrupted and in some
cases not available at all. It also describes examples of commissioners, service planners and
clinicians building strong, collaborative relationships to improve patient care.
Further guidance.
eHealth
BMC Health Services Research. Making sense of a new technology in clinical practice: a qualitative
study of patient and physician perspectives. “The number of new technologies for risk assessment
available in health care is increasing. These technologies are intended to contribute to both
improved care practices and improved patient outcomes. To do so however, there is a need to
study how new technologies are understood and interpreted by users in clinical practice.”
Department of Health. Consultation on the roles and functions of the National Data Guardian for
Health and Care. This consultation seeks views on the responsibilities of the statutory National
Data Guardian for health and social care. The responses will form a major part of the development
for more detailed proposals to establish the National Data Guardian for health and social care on a
statutory footing. The National Data Guardian for health and social care will help to ensure that
personal confidential data is held and used to support better outcomes from health and care
services, at the same time providing confidence that there are thorough safeguards in place to
protect personal confidential data. The consultation closes on 17 December 2015.
Department of Health. Diabetic eye screening: use of personal information. This guidance
document is the fair processing notice for diabetic eye screening and explains the use and transfer
of patient information.
Digitalhealth.net. Clinical commissioning groups must work closely with all local health providers to
develop and deliver local digital roadmaps, NHS Providers and trust IT experts have argued. NHS
England announced earlier this month that CCGs will take the lead on developing digital roadmaps,
outlining how each local health economy will achieve the target of a paperless NHS by 2020.
GPOne, NHS Wales. Over two hundred GP practices in Wales are using a text reminder
service. The 'My Health Text' service makes it easier for GP practices to send text messages to
patients, providing messages and reminders about upcoming appointments, seasonal vaccinations
or surgery closures. My Health Text for GP Practices.
Guardian Health. Better data is vital to solve A&E problems. Digitisation of healthcare is moving
apace but when our hospitals capture information about emergency care, they rely on a dataset
developed in the early 1980s.
Guardian Health. 5 Inventions that will revolutionise health care. Most people know they are sick
or their health is at risk because of symptoms – pain, temperature, swelling, rash etc. These are
the alarm bells that drive people to doctors. However, new epidemics like obesity and type 2
diabetes can start causing damage a long time before symptoms appear, and no alarms go off.
House of Commons Library. Accessing and sharing health records and patient confidentiality. This
briefing sets out current arrangements for accessing patient records and sharing confidential
patient information.
Journal of Medical Internet Research (JMIR). Mobile phone app aimed at improving iron intake and
bioavailability in premenopausal women: a qualitative evaluation. Low iron intake can lead to iron
deficiency, which can result in impaired health and iron-deficiency anaemia. A mobile phone app,
combining successful dietary strategies to increase bioavailable iron with strategies for behaviour
change, such as goal setting, monitoring, feedback, and resources for knowledge acquisition, was
developed with the aim to increase bioavailable iron intake in premenopausal women.
Medicines and Healthcare products Regulatory Agency. Download the Yellow Card mobile app to
report suspected adverse drug reactions. The MHRA is encouraging clinicians to use the Yellow
Card app to report suspected reactions and receive up to date information. The mobile app was
launched in July and has resulted in 27 suspected adverse drug reaction reports being submitted.
NHS Improvement Quality (NHS IQ). Tailored health and care evidence straight to your
fingertips. NHS IQ's Knowledge and Intelligence team developed a unique and innovative solution
to bring the latest evidence in health and social care to you quickly and with minimal effort.
NHS England. Improving palliative care data collection and end of life care co-ordination in
England. Public Health England's National End of Life Care Intelligence Network (PHE NEoLCIN) has
published a statement updating on progress towards a new national data collection from specialist
palliative care services.
RCN. Getting started on Twitter. A guide for those who are new to Twitter on how to use this social
media site effectively, with information on registering for an account, using hashtags, mentions
and direct messages as well as top tips for getting noticed.
Royal Pharmaceutical Society. Summary Care Record guidance updated. NHS England has
commissioned the implementation of SCR into community pharmacy. The Royal Pharmaceutical
Society has revised its guidance on using the SCR, which provides all pharmacists with support on
when, and how to use it.
Staff focus
BBC Health News. Safe nurse staffing levels made a priority in 2016 manifesto. Safe staffing levels
have been made a priority in the Royal College of Nursing's health manifesto for 2016. The
campaign urges Welsh politicians to support its initiatives ahead of next year's assembly elections.
Care Quality Commission (CQC). A National Guardian for the NHS: your say. CQC has launched a
public consultation seeking views on the new role of a National Guardian, who will be responsible
for leading local ambassadors across the country so that staff feel safe to raise concerns and
confident that they will be heard. The new role will be hosted within CQC, working closely with
other bodies including, Monitor, the NHS Trust Development Authority and NHS England.
Department of Health. FGM enhanced dataset: guidance on NHS staff responsibilities. This
guidance outlines what NHS staff are expected to do as part of the new requirements set out in
the FGM enhanced dataset.
Guardian. Addenbrooke’s hospital in special measures after 'serious staff shortages'. One of the
UK's biggest NHS trusts has been placed in special measures after inspectors found it was
"inadequate". Cambridge University Hospitals Trust needs to make improvements at
Addenbrooke's and Rosie Birth Centre, NHS regulator Monitor said. Inspectors expressed concerns
about staffing levels, delays in outpatient treatment and governance failings. But they said
workers were prepared to go the extra mile for patients, rating the quality of care as
"outstanding”.
BBC Health News. Addenbrooke's and Rosie hospitals' patients 'put at risk'.
Guardian Health. Nurses’ career defining moments. From the man with dementia who diagnosed
another patient to the terminally-ill woman full of joy, nurses recount experiences they will always
remember.
House of Commons Library. NHS whistleblowing procedure in England. This briefing sets out the
current rights and procedures for NHS staff in England to raise concerns about safety, malpractice
or wrongdoing at work. It also refers to guidance on where wider disclosure of concerns may be
appropriate, including raising concerns with the Care Quality Commission.
NHS England. New framework has been developed to support non-medical endoscopists has been
published. Health Education England (HEE) has worked closely with key stakeholders including the
British Society of Gastroenterology, Royal College of Nursing and Council of Deans to develop the
‘Non-Medical Endoscopists (NMEs) competence assessment portfolio’ which will support learning
and development.
Nursing and Midwifery Council. Who will confirm a nurse or midwife? The NMC’s Council will soon
making the final decision about taking revalidation forward. The first nurses and midwives likely to
revalidate will be those with an April 2016 renewal date. An important step will be finding an
appropriate person to confirm that you have met all the revalidation requirements. The NMC’s tool
will help you to find out who your confirmer could be.
Public Health England. Childhood flu programme training slide set for healthcare professionals. This
slide pack has been developed for trainers and leaders of the childhood flu programme. The
material is comprehensive and you can adapt the pack to suit your particular training needs.
RAND Europe. A review of the dementia research landscape and workforce capacity in the United
Kingdom. This report was commissioned by the Alzheimer's Society and it seeks to inform funding
and capacity-building efforts in dementia research. The study conducted a bibliometric analysis of
the UK dementia research landscape examining the diverse fields of activity and topics within
dementia, as well as the UK's impact, as well as an analysis of the dementia workforce pipeline
and capacity.
Smith Institute. From pay squeeze to a staffing crisis: a study of recruitment and retention in the
NHS and local government. This study and survey is intended to inform the on-going debate about
the impact of the pay squeeze on the recruitment and retention of staff in the NHS and local
government. It offers a review and commentary on what is happening, based around the views
and opinions of HR professionals.
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