Found: Trust1. 2.The report made a series of recommendations on increasing support for staff to raise patients

Question to the Department of Health and Social Care:

To ask the Secretary of State for Health and Social Care, how many never events occurred within NHS England in each year since 2019; and how many and what proportion of these incidents involved Physician Associates in each year.

Answered by Maria Caulfield - Parliamentary Under Secretary of State (Department for Business and Trade) (Minister for Women)

Information on Never Events is published by NHS England, and all available data on Never Events is available at the following link:

https://www.england.nhs.uk/patient-safety/never-events-data/

NHS England does not collect specific data relating to Physician Associate involvement in Never Events, and as such the information is not held.

Question to the Department of Health and Social Care:

To ask the Secretary of State for Health and Social Care, how her Department records instances of near misses for (a) surgical fires and (b) other patient safety incidences.

Answered by Maria Caulfield - Parliamentary Under Secretary of State (Department for Business and Trade) (Minister for Women)

Any unexpected or unintended incident which could have or did lead to harm to one or more patients can be recorded on the Learn from Patient Safety Events (LFPSE) service, to support local and national learning. This can include surgical fires or burns. We are informed that NHS England does not define the severity of harm related to surgical fires or burns specifically. Grading the severity of harm related to a patient safety incident that is recorded on LFPSE, should be done using NHS England’s guidance on recording patient safety events and levels of harm, which asks that near miss events be graded as no harm. The guidance is available at the following link:

https://www.england.nhs.uk/long-read/policy-guidance-on-recording-patient-safety-events-and-levels-of-harm/

If a surgical fire or burn is assessed locally and constitutes a patient safety event, it would fall under the scope of the Care Quality Commission’s (CQC) Regulations 16 or 18, and must be reported to the CQC. This means that the most serious surgical fires or burns which result in serious harm or the death of a service user, are subject to mandatory reporting. NHS trusts can comply with this requirement by recording patient safety events using the LFPSE service, and NHS England shares all such data with the CQC, who are responsible for regulating compliance with CQC regulations. CQC Regulations 16 and 18 are available respectively, at the following links:

https://www.cqc.org.uk/guidance-providers/regulations/regulation-16-notification-death-service-user

https://www.cqc.org.uk/guidance-providers/regulations-enforcement/regulation-18-notification-other-incidents

Although the recording of wider patient safety events onto LFPSE is a voluntary process, providers are encouraged to record all patient safety incidents, irrespective of the level of harm, to support local and national learning.

The LFPSE service and its predecessor, the National Reporting and Learning System, do not have specific categories for surgical fires or burns. Determining how many patient safety events related to surgical fires or burns were recorded by National Health Service providers in each of the last five years would require a search of the free text of recorded patient safety events, using key words, and a subsequent expert clinical review of all potential records to determine relevance to the question. This could only be provided at disproportionate cost.

Question to the Department of Health and Social Care:

To ask His Majesty's Government what assessment they have made of the comments by the Royal College of Nursing that the fall in each of the past three years in applications to university nursing courses is a direct threat to patient safety, and what actions they are taking to improve patient safety in England.

Answered by Lord Markham - Parliamentary Under-Secretary (Department of Health and Social Care)

The number of applicants continues to outstrip the places on offer. Nursing training places are competitive, and lead to an attractive and important career in the National Health Service.

Record numbers of nurses are now working in the NHS, and the first ever NHS Long Term Workforce Plan, backed by over £2.4 billion of funding, will add 24,000 more nurse and midwifery training places by 2031.

Over the last decade, the Government and system partners have delivered major initiatives to advance patient safety in the NHS. This includes implementing the first NHS Patient Safety Strategy, establishing the independent Health Services Safety Investigations Body to address the most serious patient safety incidents, and appointing the first Patient Safety Commissioner to champion the patient voice in relation to the safety of medicines and medical devices.

Question to the Department of Health and Social Care:

To ask the Secretary of State for Health and Social Care, what accountability mechanisms are included in the NHS England Learn from Patient Safety Events system to hold (a) commissioners and (b) providers to account on patient safety (i) records and (ii) incidences.

Answered by Maria Caulfield - Parliamentary Under Secretary of State (Department for Business and Trade) (Minister for Women)

Any unexpected or unintended incident which could have or did lead to harm to one or more patients can be recorded on the Learn from Patient Safety Events (LFPSE) service, to support local and national learning. This would include incidents caused by surgical fires or burns.

Providers are encouraged to foster a positive safety culture among their staff, and ensure an appropriate local focus on incident recognition, recording, and response.

Recording onto LFPSE is a voluntary process, except where reporting to NHS England fulfils duties for other statutory mandatory requirements, such as reporting notifiable incidents to the Care Quality Commission (CQC). NHS England shares all such data with the CQC. Notifiable incidents include events resulting in “serious harm” or the death of a service user, and therefore the most serious surgical fires or burns are subject to mandatory reporting. However, providers are encouraged to record all patient safety incidents, irrespective of the level of harm, to support local and national learning.

Published National Safety Standards for Invasive Procedures include a requirement for a risk assessment and management plan to minimise the risk of surgical fires in the perioperative environment. They require that multidisciplinary team training should involve rehearsal and analysis of typical and emergency scenarios, such as a surgical fire, and that prior to surgery, any fire risk and the management plan are discussed and confirmed.

LFPSE is not designed for performance management. However, it supports certain oversight functions within providers, including the ability to review all records submitted by staff, and to mark them as either meeting certain other requirements, such as notification to the CQC, or not. This supports good governance within the provider, encouraging scrutiny of recorded events, and the fulfilment of other statutory or national policy reporting requirements. LFPSE data is being made available to integrated care boards and regional teams to facilitate their roles in safety oversight and provider improvement support.

NHS England does not hold or collect information on the number of surgical fires which occur. Although incidents where serious harm and death are captured within LFPSE, and trusts may choose to record lower levels of harm, there is no category for surgical fires within the existing reporting system with which they could be counted and therefore any count would not be definitive.

Question to the Department of Health and Social Care:

To ask the Secretary of State for Health and Social Care, how patient safety incidents were reported before the introduction of the National Reporting and Learning System (NRLS); and what data he holds on the number of such incidents recorded in (a) each of the five years (i) before and (ii) after the introduction of the NRLS and (b) in each of the last five years.

Answered by Maria Caulfield - Parliamentary Under Secretary of State (Department for Business and Trade) (Minister for Women)

The National Reporting and Learning System (NRLS) has been in operation since 2003 and supports NHS England to fulfil statutory duties relating to the collation of and learning from patient safety incident reports.

NRLS is principally a secondary use service and collects patient safety incident records that are recorded on healthcare providers’ Local Risk Management Systems (LRMS). The primary use of patient safety incident records is by the provider organisation that collects the data on its own LRMS and uses the information to support local safety improvement efforts. NRLS was created to support the national collation of patient safety incident records from LRMS and some of the existing LRMS predate the introduction of the NRLS.

Given its age, NRLS is being replaced with the new Learn From Patient Safety Events (LFPSE) service. More information is available at the following link:

https://www.england.nhs.uk/patient-safety/learn-from-patient-safety-events-service/

NRLS, and its replacement LFPSE, support the collation of patient safety incident records from members of the public as well as from LRMS. NRLS does this through the Patient and Public eForm, which is available at the following link:

https://www.england.nhs.uk/patient-safety/report-patient-safety-incident/#public

As part of the development of the LFPSE service, work is underway to determine how best to support the future collection of patient safety incidents information from patients and the public. A report on the first stage of this work, published in October 2023, is available at the following link:

https://www.england.nhs.uk/publication/the-learn-from-patient-safety-events-lfpse-service-patient-and-family-discovery-report/

Information on how patient safety incident records are collated and used by NHS England is available at the following link:

https://www.england.nhs.uk/patient-safety/using-patient-safety-events-data-to-keep-patients-safe/

No data is held on patient safety incident recording prior to the introduction of the NRLS in 2003. Data on the number of patient safety incidents collected by NRLS is available at the following link:

https://www.england.nhs.uk/patient-safety/national-patient-safety-incident-reports/

Question to the Department of Health and Social Care:

To ask the Secretary of State for Health and Social Care, how the National Reporting and Learning System works alongside independent reports to individual (a) clinics, (b) hospitals, (c) Patient Advice and Liaison Services and (d) Clinical Commissioning Groups which are dealt with in-house.

Answered by Maria Caulfield - Parliamentary Under Secretary of State (Department for Business and Trade) (Minister for Women)

The National Reporting and Learning System (NRLS) has been in operation since 2003 and supports NHS England to fulfil statutory duties relating to the collation of and learning from patient safety incident reports.

NRLS is principally a secondary use service and collects patient safety incident records that are recorded on healthcare providers’ Local Risk Management Systems (LRMS). The primary use of patient safety incident records is by the provider organisation that collects the data on its own LRMS and uses the information to support local safety improvement efforts. NRLS was created to support the national collation of patient safety incident records from LRMS and some of the existing LRMS predate the introduction of the NRLS.

Given its age, NRLS is being replaced with the new Learn From Patient Safety Events (LFPSE) service. More information is available at the following link:

https://www.england.nhs.uk/patient-safety/learn-from-patient-safety-events-service/

NRLS, and its replacement LFPSE, support the collation of patient safety incident records from members of the public as well as from LRMS. NRLS does this through the Patient and Public eForm, which is available at the following link:

https://www.england.nhs.uk/patient-safety/report-patient-safety-incident/#public

As part of the development of the LFPSE service, work is underway to determine how best to support the future collection of patient safety incidents information from patients and the public. A report on the first stage of this work, published in October 2023, is available at the following link:

https://www.england.nhs.uk/publication/the-learn-from-patient-safety-events-lfpse-service-patient-and-family-discovery-report/

Information on how patient safety incident records are collated and used by NHS England is available at the following link:

https://www.england.nhs.uk/patient-safety/using-patient-safety-events-data-to-keep-patients-safe/

No data is held on patient safety incident recording prior to the introduction of the NRLS in 2003. Data on the number of patient safety incidents collected by NRLS is available at the following link:

https://www.england.nhs.uk/patient-safety/national-patient-safety-incident-reports/

Question to the Department of Health and Social Care:

To ask the Secretary of State for Health and Social Care, what assessment he has made of the level of public awareness of the National Reporting and Learning System; and whether he is taking steps to raise awareness of the system.

Answered by Maria Caulfield - Parliamentary Under Secretary of State (Department for Business and Trade) (Minister for Women)

The National Reporting and Learning System (NRLS) has been in operation since 2003 and supports NHS England to fulfil statutory duties relating to the collation of and learning from patient safety incident reports.

NRLS is principally a secondary use service and collects patient safety incident records that are recorded on healthcare providers’ Local Risk Management Systems (LRMS). The primary use of patient safety incident records is by the provider organisation that collects the data on its own LRMS and uses the information to support local safety improvement efforts. NRLS was created to support the national collation of patient safety incident records from LRMS and some of the existing LRMS predate the introduction of the NRLS.

Given its age, NRLS is being replaced with the new Learn From Patient Safety Events (LFPSE) service. More information is available at the following link:

https://www.england.nhs.uk/patient-safety/learn-from-patient-safety-events-service/

NRLS, and its replacement LFPSE, support the collation of patient safety incident records from members of the public as well as from LRMS. NRLS does this through the Patient and Public eForm, which is available at the following link:

https://www.england.nhs.uk/patient-safety/report-patient-safety-incident/#public

As part of the development of the LFPSE service, work is underway to determine how best to support the future collection of patient safety incidents information from patients and the public. A report on the first stage of this work, published in October 2023, is available at the following link:

https://www.england.nhs.uk/publication/the-learn-from-patient-safety-events-lfpse-service-patient-and-family-discovery-report/

Information on how patient safety incident records are collated and used by NHS England is available at the following link:

https://www.england.nhs.uk/patient-safety/using-patient-safety-events-data-to-keep-patients-safe/

No data is held on patient safety incident recording prior to the introduction of the NRLS in 2003. Data on the number of patient safety incidents collected by NRLS is available at the following link:

https://www.england.nhs.uk/patient-safety/national-patient-safety-incident-reports/

Question to the Department of Health and Social Care:

To ask the Secretary of State for Health and Social Care, what steps he is taking to ensure that the NHS responds to concerns raised by staff about potential harm to patients (a) appropriately and (b) swiftly.

Answered by Maria Caulfield - Parliamentary Under Secretary of State (Department for Business and Trade) (Minister for Women)

Last year, NHS England rolled out a strengthened Freedom to Speak Up policy, which covers the importance of listening to concerns and responding to concerns that are raised. All organisations providing services within the National Health Service are expected to adopt the updated national policy by 31 January 2024 at the latest. The National Guardian’s Office has also produced a training package aimed at all workers, including managers and senior leaders, which underlines the importance of responding to and acting on staff concerns.

There is also a network of Freedom to Speak Up Guardians, covering every trust, whose role includes ensuring the person who raises a concern is responded to and receives feedback on the actions taken.

Following the outcome of the trial of Lucy Letby, NHS England wrote to all NHS trusts to further emphasise the importance of NHS leaders listening to the concerns of patients, families and staff and following whistleblowing procedures.

Question to the Department of Health and Social Care:

To ask the Secretary of State for Health and Social Care, whether there are protocols in place for mandatory external reviews after internal concerns on patient safety are raised within the NHS.

Answered by Maria Caulfield - Parliamentary Under Secretary of State (Department for Business and Trade) (Minister for Women)

From 2015, the National Health Service has followed the Serious Incident Framework to guide its response to serious incidents in the NHS. Details of this framework are available at the following link:

https://www.england.nhs.uk/patient-safety/serious-incident-framework/

In response to evidence that this framework was not leading to sufficient patient safety improvement, the new Patient Safety Incident Response Framework (PSIRF) was developed, tested, and is now being implemented across the NHS. All NHS organisations contracted under the NHS standard contract are expected to transition to PSIRF in autumn 2023. More information is available at the following link:

https://www.england.nhs.uk/patient-safety/incident-response-framework/

PSIRF has guidance for oversight bodies, including integrated care boards and NHS England regional teams, describing when it may be appropriate for those bodies to consider commissioning an independent patient safety incident investigation. The guidance is available at the following link:

https://www.england.nhs.uk/wp-content/uploads/2022/08/B1465-4.-Oversight-roles-and-responsibilities-specification-v1-FINAL.pdf

Providers can also commission invited reviews from Royal Colleges, including in response to patient safety concerns. These provide independent and objective advice to provider boards. The reviews support but do not replace the processes of healthcare regulatory bodies, including the Care Quality Commission and the General Medical Council, or the provider’s own procedures for addressing and managing patient safety.

NHS England will refresh ‘Maintaining High Professional Standards in the Modern NHS’, in line with current best practice and learning from incidents and reviews.

Question to the Department of Health and Social Care:

To ask the Secretary of State for Health and Social Care, what guidance his Department provides hospitals on involving the police in investigations related to patient harm.

Answered by Maria Caulfield - Parliamentary Under Secretary of State (Department for Business and Trade) (Minister for Women)

NHS England’s Serious Incident Framework sets out the key principles of serious incident management and defines the roles and responsibilities of those involved in the management of serious incidents, including the police and those providing National Health Service healthcare services.

The Department’s ‘Memorandum of understanding: investigating patient safety incidents involving unexpected death or serious untoward harm’, published in 2006, also provides a source for reference where a serious incident occurs in a healthcare setting and an investigation is also required by the police, the Health and Safety Executive and/or the coroner. The NHS, the Association of Chief Police Officers (now the National Police Chiefs' Council) and the Health and Safety Executive are party to this agreement.

Found: wages from increased PT responsibility Unmonetised but expected to have little impact on wages Patients

Found: Seriousness, Outcomes, Severity, Frequency with 95% CI, Neuro -developmental Impairment in Pediatric Patients