Enhancing patient safety during the pandemic

First, I want to acknowledge what a challenging 18 months this has been for all of you and thank you for continuing to deliver safe patient care throughout the pandemic. Your response has been incredible in its scale but also exhausting for all.

In the national team, we had to adjust our ways of working. In March 2020, we shifted from planned work wherever possible to support the covid-19 response. Our improvement teams helped develop guidance on caring for patients with tracheostomies and contributed to “safety netting” guidance for people with suspected coronavirus at home, helping ensure they seek urgent medical attention if their condition deteriorates.

We continued analysis of incidents reported to the National Reporting and Learning System (NRLS) with an additional focus on covid-19 related incidents to identify and quickly act on any new or emerging safety risks. To communicate key messages to the system, we developed the Patient Safety Bulletin and continued sharing patient safety alerts.

We launched the first National Patient Safety Strategy at the Patient Safety Congress in 2019 and I am pleased that we have made significant progress, despite the challenges of covid-19. I want to thank everyone who has supported and participated in strategy implementation.

With your help and feedback, we recently launched the Learn from patient safety events (LFPSE) service which will replace NRLS/STEIS over time. Recording safety events, whether they result in harm or not, provides vital insight into what can go wrong in healthcare and the reasons why. At a national level, this allows for new or under-recognised safety issues to be identified and acted upon on an NHS-wide scale, ensuring providers across the country take action to reduce the risk.

Over 700 patient safety specialists have been identified from more than 350 organisations. The specialists will provide a route for two-way communication between the national patient safety team and the rest of the NHS, enabling rapid sharing of learning between organisations. The specialists will work closely with patient safety partners - the first framework to support patient involvement in our work was published in June.

We have made good progress across the five national safety improvement programmes. The Medicines Safety Improvement Programme is delivering reductions in the risk of the use of opioids and methotrexate. NEWS2 has been implemented across 99.3 per cent of acute and 100 per cent of ambulance trusts to support the safer management of deteriorating patients, and we are working with care homes to increase the use of deterioration management tools. Work is underway on reducing restrictive practices and improving sexual safety in mental health settings. As part of our continued work to improve maternal and neonatal safety, we are testing the Maternal Early Warning Score (MEWS) tool and recruiting trusts to a maternity safety culture project and continuing to work with a re-designed Maternity Transformation Plan.

We have identified several key enablers that support improvement, including addressing inequalities, patient co-design, improving measurement, enhanced training in quality improvement and creating a better safety culture. We will build on this knowledge so that we can support continuous and sustainable improvement.

This year at the Patient Safety Congress, I will be speaking about what we have learned and how we can continue to improve safety and support the NHS during this period of recovery. Other team members will lead workshops and sessions on the patient safety specialists, patient safety partners, the medical examiner programme and some of our national safety improvement programmes. We look forward to seeing you there.