Tag Archives: NHS

NHS Becomes First Healthcare System In The World To Publish Numbers Of Avoidable Deaths

Publication of the data seeks to protect patients by showing how many deaths might have been caused by problems in care. It will allow trusts to share lessons and learn from failings

The NHS will become the first healthcare organisation in the world to publish estimates of how many patients may have died because of problems in their care.

The publication follows a promise by the health secretary after a 2016 Care Quality Commission report found that the NHS was missing opportunities to learn from patient deaths, and that too many families were not being included or listened to when an investigation happened.

The data will be published each quarter by individual trusts. 171 of the 223 trusts in England have already released or are releasing their first estimates by the end of December.

Each trust will make its own assessment of the number of deaths due to problems in care. The data will not be comparable and will not be collated centrally. This will allow trusts to focus on learning from mistakes and sharing lessons across their organisations and their local healthcare systems.

Health Secretary Jeremy Hunt said:

Every death resulting from a failing in care is an absolute tragedy, and despite the NHS being ranked as the world’s safest healthcare system for a second time, we still have a long way to go.

Too often I have heard from families saying that after mistakes happen they feel like a wall has gone up in the NHS, but publishing this data will help give grieving families the openness and answers they deserve. It marks a significant milestone in ensuring the NHS learns from every tragic case, sharing lessons across the whole system to prevent mistakes recurring and ultimately delivering safer care for all patients in the future.

Department of Health

Department of Health

The programme is likely to cover between 1,250 and 9,000 deaths, which research suggests is the number of deaths each year that may be down to problems in care – a fraction of the 19.7 million treatments and procedures carried out by the NHS in 2016 to 2017.

These deaths range from rare but high-profile failings in care, to those which involve terminally ill patients who die earlier than expected. These deaths may make up a large number of those caused by problems in care, showing the need to continue to focus on improving all care, including end of life care.

By collecting this data and taking action in response to failings in care, NHS trusts and foundation trusts will be able to give grieving families an open and honest account of the circumstances that led to a death. This work is already happening in some parts of the NHS, for example at University College London Hospitals NHS Foundation Trust, which recently held its first memorial service for those who have died in its care.

The data will allow trusts to learn from every failing in care, and then share lessons across the NHS to better protect patients in the future. For example, the Pennine Care NHS Foundation Trust, which as part of the Greater Manchester Partnership is working across Greater Manchester on mortality reviews, so that lessons learned are shared with other providers for the good of patients across the area.

Prof Ted Baker, chief inspector of hospitals at the Care Quality Commission, said:

The NHS is the first healthcare system to commit to reporting and publishing information on the number of avoidable deaths in its hospitals and the work that is being done by individual NHS trusts to learn from those deaths.

This new level of transparency will be central to improving care and ensuring the safety of the NHS services we all rely on. We will use this information alongside the findings of our inspections to identify where providers must make improvements and to share good practice where we find hospitals that are doing it well.

We can be proud of the progress made over the past year, but the challenge now is to deliver the full vision of a safer learning culture.

Executive Medical Director of NHS Improvement Dr Kathy McLean said:

NHS trusts are undergoing a culture change in how they learn from deaths. Trusts across the country are improving how they engage and support bereaved families, how they ensure they learn from mistakes and share good practice.

We have been clear that the change required of trust boards is one of culture and leadership, rather than one of process and counting.

Government Launches Independent National Inquiry Into Convicted Surgeon Ian Paterson

An independent non-statutory inquiry will examine the circumstances and practices surrounding the malpractice of breast surgeon Ian Paterson

Department of Health

Department of Health

The inquiry will look at lessons that can be learned from the case, and how these can improve care by the independent healthcare sector across the country. It will be chaired by the Right Reverend Graham James, Bishop of Norwich.

Paterson was a consultant breast surgeon employed by the Heart of England NHS Foundation Trust (HEFT) and had practising privileges in the independent sector at Spire Parkway and Spire Little Aston.

He was found guilty in April this year of 17 counts of wounding patients with intent. He was sentenced to jail for 20 years.

The scope of the investigation has been widened to include the independent sector, including any further action needed to strengthen CQC’s inspection regime.

Philip Dunne, Health Minister, said:

Ian Paterson’s malpractice sent shockwaves across the health system due to the seriousness and extent of his crimes, and I am determined to make sure lessons are learnt from this so that it never happens again in the independent sector or the NHS.

I believe an independent, non-statutory inquiry, overseen by Bishop Graham James, is the right way forward to ensure that all aspects of this case are brought to light and lessons learned so we can better protect patients in the future.

The inquiry will also draw on issues raised in previous reviews about Ian Paterson’s conduct, particularly Sir Ian Kennedy’s review on behalf of HEFTand Verita’s investigation into the governance arrangements at two Spire Healthcare hospitals.

The Right Revd Graham James, Lord Bishop of Norwich, said:

The actions of Ian Paterson and the grievous harm he inflicted on patients are deeply concerning, and they have given rise to some serious questions which remain unanswered.

It is vital that the inquiry be informed by the concerns of former patients of Ian Paterson and their representatives. The interests of all patients, whether they seek treatment in the NHS or the private sector, should be at the heart of this inquiry and I will do my very best in the interest of those affected and the public.

The inquiry will be informed by the victims of Paterson and their families, and is likely to consider:

  • the responsibility for the quality of care in the independent sector
  • appraisal and ensuring validation of staff in the independent sector
  • the safety of multi-disciplinary working
  • information sharing, reporting of activity and raising concerns between the independent sector and the NHS
  • the role of insurers of independent sector healthcare providers (including how data it holds about the scope and volume of work carried out by doctors is shared with the sector)
  • arrangements for medical indemnity cover for clinicians in the independent sector

The Inquiry will be formally established from January 2018 and is expected to report in summer 2019. The terms of reference and other arrangements relating to how the Inquiry will be conducted – including the exact scope it will cover and how it will work within the system – will be announced at a future date.

Speech On The NHS And Compliance With The Secretary Of State’s Surveillance Camera Code Of Practice

Tony Porter's speech to the national NAHS conference on 21 November 2017 at Birmingham

Tony Porter

Tony Porter

Well – I keep being invited back to speak at this conference despite being the purveyor of some tough messages.

That to me shows a certain determination by the organisers to afford you the delegates an opportunity;

  • to achieve best practice
  • to be exposed to the ever shifting regulatory environment
  • to demonstrate and be accountable for compliance with your statutory and regulatory responsibilities

In the fast paced and exciting world of video surveillance – algorithms attached – on platforms that fly 400m in the air or waltzing around the wards attached to security officers on body cams- it can appear to be a complicated legal and regulatory environment but in reality – not so much.

My question to you today is this; ‘are the delegates here prepared to pick up the mantle of the challenges associated with compliance and accountability before they are told to do so?’

History

OK – Stop -I hear some people saying – ‘what’s this guy talking about?’ Fair enough. I imagine quite a few people weren’t here to hear my excellent ground breaking speeches in 2015 and 2016 – so – with the forbearance of those who were -allow me to repeat myself just a little.

Who am I – for a start?

I am the surveillance Camera Commissioner for England and Wales.

I was appointed by the Home Secretary in 2014 and have recently had my tenure extended by a further 3 years. I am independent from government

You may think from what I am about to say that I am anti – surveillance -I am not. I am anti ‘bad surveillance’ – surveillance that shouldn’t be there, is badly run, its data isn’t protected, its presence and operation isn’t reviewed frequently, or is otherwise conducted in manner which does not engender confidence in the public.. In my previous occupation I was a Commander in charge of Counter Terrorism at New Scotland yard for the Olympics and prior to that head of North West CTU. I was also the Head of Intelligence at Barclays Bank-so I really get surveillance. . I oversee compliance with the Surveillance Camera Code of Practice which is issued by the Secretary of State (the code). It contains 12 guiding principles which if followed will mean cameras are only ever used proportionately, transparently and effectively.

My remit applies to England and Wales and my role is three-fold to:

  • encourage compliance with the code
  • review the operation of the code
  • advise on any amendments to how the code should develop

I submit an Annual Report to the Home Secretary which is laid before Parliament.

The code applies to relevant authorities (police, police crime commission-ers, local authorities and non-regular police forces) who, by virtue of section 33(1) of the Protection of Freedoms Act 2012, must pay due regard to the code.

Also, working within the Protection of Freedoms Act 2012 and the code -my role is to encourage Voluntary Adoption of the code -more of that later. This is where you come in. NHS Trusts, NAHS are not at the moment, relevant authorities but are organisations that may voluntarily adopt it, and I would strongly encourage you to do so.

And here’s the payload – if organizations follow the code, they will not only be able to reflect that they operate an efficient and effective surveillance camera system that is legitimate and transparent, but importantly it will assist with your efforts in complying with the Data Protection Act ( and our clear intent is that you will comply with the new GDPR rules), where you are at risk of extremely large fines from the Information Commissioner’s Office, and other regulatory issues such as compliance with SIA guidelines etc…

I have called however for government to expand its list of relevant authorities provided within the Protection of Freedoms Act 2012 so as to capture organisations such as this. Surveillance, in public space, where such sensitivity exists creates, in my view an overwhelming argument for requiring compliance with the code as a statutory requirement. This is a view which was shared by my colleague, the former ICO, during the Bills consultation phase.

The government has been clear in setting out that it wants an incremental approach to the regulation of surveillance cameras in England and Wales. So how does that look since introduction of my role? Here are some headlines:

  • Local authorities – have improved from a position whereby only 2% demonstrated compliance with any British Standard to 93 % compliance with the code – an outstanding achievement, and commitment by them.
  • Police forces -a relevant authority- slowly gaining traction. The Metropolitan Police Service -22000 Body Worn Cameras – and Greater Manchester Police have achieved compliance via independent certification .
  • Drones -Devon and Cornwall Police have just achieved independent certification for compliance with the code, the first organisation in the UK, actually the World to do so!
  • Automated Number Plate Recognition (ANPR) – National Police Chief ’s Council has written to all police forces in England and Wales requesting that all systems demonstrate compliance with the code within 18 months.
  • Transport for London (TfL) -20000 plus Cameras voluntarily adopted the code because they recognised its importance for reputation and integrity of its operations.
  • Marks and Spencer – a voluntary adopter -have attained full and independent certification across 600 stores, distribution centres and head offices for compliance with the code.
  • Universities – they get the imperative -attract students on grounds of safety and security-it sets a standard and we are seeing many Universities adopting the code.
Support

To support all this work in March this year I released a comprehensive Na-tional Surveillance Camera Strategy. Those of you shifting in your seats thinking -‘I feel uncomfortable’- I urge you to access my web site. The Strategy will inform you of developments.

The ‘Passport to Compliance’ document will guide those of you thinking of buying new systems or significantly adding to existing ones.

The ‘Self Assessment Tool’ and policy on independent certification will pro-vide a very simple guide for you to demonstrate adoption of the code.

Why is NAHS important

There is an increase in the use of surveillance technology in general across society, such as automatic facial recognition, Body Worn Video, Automatic Number Plate Recognition, Unmanned Aerial Vehicles and so on.

All of which are being used across NAHS/Trusts in some form or other

Of course the legitimate use of these systems can provide significant benefits to your organization, and to wider society in general;

  • AFR -patient/ carer access to designated area
  • ANPR-parking across NHS Estates?
  • Body Worn Cameras-for local Security -protection again of carers and public visitors

And since last year the paradigm is shifting even further. We are now seeing all this technology becoming integrated; cameras , linked to sensors, linked to data bases -linked to managerial headaches and a requirement for legal and regulatory compliance.

All such surveillance platforms have potential for privacy invasion – of the highest order

Consider the numbers;

  • 209 clinical commissioning groups
  • 135 acute non-specialist trusts (including 84 foundation trusts)
  • 17 acute specialist trusts (including 16 foundation trusts)
  • 54 mental health trusts (including 42 foundation trusts)
  • 35 community providers (11 NHS trusts, 6 foundation trusts, 17 social enterprises and 1 limited company)
  • The NHS deals with over 1 million patients every 36 hours
  • The total annual attendances at Accident & Emergency departments was 23.372m in 2016/17, 23.5 per cent higher than a decade earlier (18.922m)
  • The total number of outpatient attendances in 2015/16 was 89.436m, an increase of 4.4 per cent on the previous year (85.632m)
Examples of getting surveillance wrong and potential impact

‘Operation Champion’ – an operation established by West Midlands Counter Terrorism Unit a number of years ago to develop a ring of steel (of ANPR cameras) within a local community. This was considered to have been undertaken without the necessary transparency to the public and despite costing £3m, damaged the trust and confidence of local communities and was never operated.

Edward Snowden and the Investigatory Powers Act. Both comment on surveillance that is the different side, the covert side, to the same coin of public space video surveillance.

Surveillance by State agents should be operated with the highest level of discretion and integrity.

How many people are there here, whose organisations use Body Worn Cameras or ANPR would comfortably testify that these systems are run to the highest levels?

Ok -its rhetorical -but I guess you probably don’t have that level of reassur-ance. And you’re right not too! So how do we achieve the correct balance?

So – what have I tried to do?

I had spoken with the Chair of the NHS Protect Security Group (now dises-tablished) to seek to weave in voluntary adoption of the code – as we have successfully done in an ever growing number of organizations elsewhere.

The annual security standards review group, for a second year voted down the proposal to require all Trusts to complete the Self Assessment Tool.

There was considerable argument and debate around the subject and it was ultimately rejected on the grounds that we could not enforce compliance with none mandatory guidance.

The group stated that, if the guidance was to be mandatory for the NHS then there would be no issue in NHS Protect policing the requirements.

Section 33(5)(k) Protection of Freedoms Act 2012 provides the power for the Secretary of State to create a Statutory Instrument to include additional organisations as being a ‘relevant authority’ who must have regard for the code.

To me this seems the only logical way forward. The chair of this group has tried to get NHS Bodies to voluntarily adopt the Secretary of State’s code and failed as it seems that the NHS will only act on mandates, and so he has tried to make it a security management required standard and failed on the same grounds.

So, in 2016, I wrote to government Ministers recommending that they should consider broadening the list of relevant authorities to include the NHS for England and Wales.

Ministers, at this stage were of the view that we were making good progress at that particular time, not only with voluntary adopters of the code, but with the advent of our National Surveillance Camera Strategy. They did however write to Minister of Health to urge greater degree of co-operation by the NHS on a voluntary basis!

Why do I persist? – I shall re-iterate

Hospitals and other healthcare providers have many millions of people pass through their doors – both people who are sometimes at vulnerable points in their lives and the families and friends who visit. Staff are also subject to assaults – over 64,000 in 2014/15. Surveillance cameras play an important role in maintaining public and staff safety, preventing and resolving crimes yet beyond the management of personal data they are not subject to scrutiny and standards and therefore can we be reassured that they are fit for purpose and doing what they are meant to be doing.

Why shouldn’t the NHS be included in a mandate to raise the standards of surveillance camera use?
I believe it’s a real risk for the NHS family to ignore the code and doing so would risk reputational damage through appearing unwilling to engage with the public or follow good practice. I have no powers of sanction or enforcement.

However –It’s not all sweetness and light-I do use my Annual Report to Parliament to highlight compliant organisations and those with much to do. I see that as an option with NHS to further persuade government if necessary.

Maintaining public confidence is an incentive for complying with the code.

Last month I wrote again to my new Minister -Nick Hurd -Minister of State for Policing and the Fire Service. I reminded him that the government’s approach to this legislation is incremental – Paragraph 1.2 of the Surveillance Camera Code re-iterates that.

I reminded him that I committed to conduct a review of the operation and impact of the code in 2016 -which I duly completed. Within that I called for an expansion of organisations within the relevant authority status.

I found then and I find now the argument for the NHS inclusion in the list of statutory relevant authorities to be compelling. I remain committed to the view that;

  • any organisation in receipt of public monies /publicly funded ought to be designated a relevant authority
  • any organisations having obligations under the Human Rights Act should be designated a relevant authority
  • any organisation having capabilities under the Regulation of Investigatory Powers Act 2000 should be designated a relevant authority

I’m not sure my argument was any stronger this time than it was last year – I just delivered it a bit louder as the case remains compelling!

I’m pleased to say that this situation is now being reviewed by the Home Office – together with the Surveillance Code in light of GDPR.

Many of you will be aware that the government is engaged in a consultation exercise regarding the placing of CCTV in abattoires. I have responded to that consultation requesting that, if introduced, it be in line with the Surveillance Camera Code of Practice.

If the arguments proffered by the government about CCTV applies to protect the welfare of pigs and cows it ought to apply to patients in NHS Hospitals.

You will soon hear from Mike Lees -NHS Barnsley – I hope he feels I have set the scene for him and not stolen his thunder. I take the view that repeating a message can be powerful and informative. Mike demonstrates the bright new uplands of well run security operations! I spoke to the Chair of his NHS Barnsley and he was very clear – If Mike gets this right it makes him feel warm about his whole security operation. It keeps people safe, with confidence.

More Cancer Specialists To Be Employed By The NHS

New specialists will speed up cancer diagnoses and improve access to treatment

Cancer Care

Cancer Care

The NHS is to employ more cancer specialists, to speed up cancer diagnoses and get more people into treatment more quickly. The specialists will be trained in areas where there are shortages. It is part of Health Education England’s new Cancer Workforce Plan.

Announcements of extra provision include:

  • 200 clinical endoscopists – to investigate suspected cancers internally
  • 300 reporting radiographers – to identify cancers using x-rays and ultrasound
  • support for clinical nurse specialists – to lead services and provide quality care

The plan is part of a campaign to make sure patients are diagnosed quickly and get better access to innovative treatments that can improve survival rates.

Health Secretary Jeremy Hunt said:

The NHS has made amazing progress in diagnosing and treating cancer – it’s incredible that 7,000 people are alive today who would not have been had mortality rates stayed the same as in 2010.

We want to save more lives and to do that we need more specialists who can investigate and diagnose cancer quickly. These extra specialists will go a long way to help the NHS save an extra 30,000 lives by 2020.