The short anonymised stories illustrate the profound impact that failures in public services can have on the lives of individuals and their families. Most of the summaries we are publishing are cases we have upheld or partly upheld. These are the cases which provide clear and valuable lessons for public services by showing what needs changing so that similar mistakes can be avoided in future. They include complaints about failures to spot serious illnesses and mistakes by government departments that caused financial hardship. Examples include SaTH and SSOTP, and several examples from mental health
Open access. Since its publication in 2008, SQUIRE (Standards for Quality Improvement Reporting Excellence) has contributed to the completeness and transparency of reporting of quality improvement work, providing guidance to authors and reviewers of reports on healthcare improvement work. In the interim, enormous growth has occurred in understanding factors that influence the success, and failure, of healthcare improvement efforts. Progress has been particularly strong in three areas: the understanding of the theoretical basis for improvement work; the impact of contextual factors on outcomes; and the development of methodologies for studying improvement work. Consequently, there is now a need to revise the original publication guidelines.
Emergency and urgent MH liaison targets. You can request a copy of this article by replying to this email. Please be clear which article you are requesting.
Our review of the way NHS trusts review and investigate deaths has found that opportunities to learn from patient deaths are being missed – and too many families are not being included or listened to when an investigation takes place.
Vulnerable older people should be offered befriending programmes or exercise classes to prevent loneliness.
In a new quality standard NICE urges councils, housing organisations and the voluntary sector to work together to identify vulnerable older people.
Those most at risk should be directed to dancing or swimming clubs; arts groups or singing programmes or helping with reading in schools; as well as volunteering and befriending programmes
This quality standard covers all young people (aged up to 25) using children’s health and social care services who are due to make the transition to adults’ services. It includes young people:
with mental health problems
with disabilities
with long-term, life-limiting or complex needs
in secure settings
under the care of local authorities.
The Care Quality Commission has told West London Mental Health NHS Trust that it must make significant improvements in the care of patients at Broadmoor Hospital in Berkshire.
CQC has issued a Warning Notice requiring the trust to improve care at the high security psychiatric hospital.
Inspectors visited Broadmoor in November 2016 to check the trust’s progress in meeting requirements that had been identified on a previous inspection. On the latest inspection, CQC found that the trust still did not have enough suitably qualified staff deployed to meet the needs of patients.
Most recently, we were asked if we would like to take part in a pilot inspection to test the CQC’s plans to work more closely together through the lens of their new ‘well-led’ framework. This was a fantastic opportunity to work collaboratively with them to shape the way in which they monitor, inspect and regulate services. It was also a chance to receive some valuable feedback on the strength and effectiveness of our governance processes and leadership.
We were one of just four trusts nationally – and the only mental health and community trust – to take part in the pilot. After the visit, I am delighted to say that the CQC commended our commitment to person-centredness and co-production, our nursing associate roles, and our governance processes in relation to serious incidents and complaints.
Healthcare-associated infections, particularly ones caused by antibiotic-resistant bacteria, are associated with high morbidity, mortality and economic costs. In the USA, on average, 2 out of 10 patients admitted to a hospital contract a healthcare-associated infection and their mortality is estimated to exceed breast and prostate cancers, combined.1 Antibiotic-resistant pathogens are responsible for more than two million infections and 23 000 deaths each year in the USA, at a direct cost of $20 billion and additional productivity losses of $35 billion.2 In the European Union, an estimated 37 000 deaths are attributable to antibiotic-resistant infections, costing €1.5 billion annually in direct and indirect costs.3 To read the full article, log in using your NHS OpenAthens details.
England’s Chief Inspector of Hospitals has rated the community mental health services for people with a learning disability provided by Northumbria Healthcare NHS Foundation Trust as Outstanding following an inspection in April this year.
This report describes the quality improvement journey of three mental health organisations (two in England and one in Singapore). It provides key insights and lessons for others considering embarking on a similar journey.
Read our new briefing to help you understand more about how involving staff with quality improvement initiatives, can have a significant impact on your staff engagement levels.
Compassion has historically been defined as an underpinning principle of work conducted by health professionals, especially nurses.1 Numerous definitions of compassionate care exist, incorporating a range of elements. Most include a cognitive element: understanding what is important to the other by exploring their perspective; a volitional element: choosing to act to try and alleviate the other’s disquiet; an affective element: actively imagining what the other is going through; an altruistic element: reacting to the other’s needs selflessly; and a moral element: to not show compassion may compound any pain or distress already being experienced by the other.....To read the full article, log in using your NHS OpenAthens details.
Open access. Measuring quality of care and comparing this against agreed-upon standards of practice or peer performance (ie, audit) and delivery of the results to healthcare professionals and/or administrators (ie, feedback) is a common quality improvement strategy.5 Whether referred to as ‘audit and feedback’, ‘report cards’, ‘benchmarking’, ‘practice profiles’ or other synonyms, the underlying rationale for audit and feedback is sound. The large literature evaluating this approach indicates that (1) clinicians are relatively poor at self-assessment,6 meaning that they tend to pursue continuing professional development or quality improvement in areas of interest (where performance is often already high) rather than areas of greatest need; (2) comparing current performance to a target can drive increased performance in motivated individuals,7–9 meaning that when desired behaviours can be measured and presented in a formative fashion,10 health professionals may respond positively to them; and (3) high-performing health systems tend to feature audit and feedback as an evidence-based, scalable and relatively inexpensive strategy to encourage uptake of best practices.11
NELFT's HQ at CEME houses over 70 agile workspaces, six training rooms, seven meeting rooms and the boardroom. Our executive directors and leadership teams have also embraced agile working. They no longer have their own offices and utilise the open plan workplaces, meeting pods and shared facilities. The building was first used by NELFT staff in November 2016 and officially opened by Roy Lilley and the Mayors of our four London boroughs in February 2017.
M. Khurge, M. Waykole, M. Thorat, and M. Sapru. International Journal on Recent and Innovation Trends in Computing and Communication, 3 (4):
2189--2193(April 2015)
D. Marghescu, and M. Rajanen. Proceedings of IASTED International Conference on Databases and Applications (DBA 2005), page 181-186. IASTED/ACTA Press, (2005)