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Reviewing patient safety challenges

The NHS wants to be the safest healthcare system in the world – that is its stated aim. As we wait to hear the results of a public consultation1

with a strategy

designed to sit alongside the NHS Long Term Plan, Kate Woodhead RGN DMS, analyses the challenges facing the patient safety movement.

Proposals have been set out by NHS Improvement’s national director of patient safety, Dr Aidan Fowler, as part of a public consultation. The commitment includes a proposal for some of the most important types of avoidable harm to patients to be halved over the next five years in areas such as medication errors and never events, together with development of a “just culture” where frontline staff are supported to speak up when they see things going wrong. We await the publication of this strategy. Meanwhile an eminent source of innovative research has published a view of the challenges ahead, with a more global perspective.2

The patient safety movement

has always been a global one and it seems a pragmatic way forward that high income countries which have similar issues across the board should share solutions and actions, while supporting low and middle income countries to ‘leapfrog’ some of the

painful developments, and find innovation and creativity in the here and now. This will require tremendous collaborative effort and leadership from the various institutions which are currently leading the way.

Patient safety

As has been said many times before – and in many column inches in this journal – patient safety is about making patient care safer and to ensure that harm is not caused intentionally. However, there are some new challenges facing healthcare across the world which will need some concerted collaborative action if we are to save ourselves from harm, looking ahead – for example, antimicrobial resistance. The World Health Organization recently announced a collaborative activity with the Department of Health and Social Care to be called the Global Patient Safety Collaborative. It has been established to aid the movement towards universal health coverage and the

UN Sustainable development goals. The main goal of the Collaborative is to scale up and promote global action for low and middle income countries on patient safety initiatives, in their quest to reduce the risk of avoidable harm and improve the safety of their national health systems.

The patient safety statistic has not changed since the original one calculated in “To err is human,” despite the passage of 20 years, although our knowledge of the detail is greatly enhanced and mountains of research have been done in the interim. In the UK, more than two million incidents are reported each year and, nationally, actions such as lists of never events are updated annually, focusing attention in different areas of care. These continue to happen, and between April 2017 and March 2018 there were 468 incidents reported, provisionally classified as never events.3 According to the consultation document for

the forthcoming strategy, priority areas for harm reduction could include: reducing never events; harm from sepsis; pressure ulcers; gram negative bloodstream infections, such as e-coli; falls; medication errors, improving maternity and neonatal safety; and improving the safety of patients with mental health issues.4

Patient safety improvement

The context in which the report Patient Safety 2030 identifies is all too familiar. The identification of increasingly complex care required to be delivered to an older population with a number of co-morbidities may add to the potential for harm. Put this all into a background of decreasing budgets and ever increasing competitive demands for healthcare spending, then if patient safety is not part of the everyday agenda for healthcare, it will not get a look in. Add to the mix the likelihood of additional deaths and spending on patient infections which do not respond to care due to antimicrobial resistance – we are looking at a somewhat difficult environment in


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