Suffolk & North East Essex Integrated Care System

Safe Care

WHY this is important for people in Suffolk and North East Essex

Safe care, including safe access to effective antibiotics, is essential if everyone in Suffolk and North East Essex is to live well.

As an Integrated Care System we will ensure that:
  • People receive safe care based on best practice
  • People receive safe care designed and provided in partnership with them
  • People with complex care needs receive safe care
  • People will continue to have access to effective antibiotics
What’s the current picture?

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The World Health Organisation highlights that:
  • Antimicrobial resistance threatens the effective prevention and treatment of an ever-increasing range of infections caused by bacteria, parasites, viruses and fungi.
  • Without effective antibiotics, the success of major surgery and cancer chemotherapy would be compromised.
  • In 2016, 490 000 people developed multi-drug resistant TB globally, and drug resistance is starting to complicate the fight against HIV and malaria, as well.

For more information see https://www.who.int/antimicrobial-resistance/en/

LTA - Safe Care
The NHS Patient Safety Strategy 2019 highlights that:
  • Better incident reporting and response could save an extra 160 lives and £13.5 million.
  • If boosting patient safety understanding and capability reduces harm by a modest 2%, an extra 200 lives and £20 million could be saved.
  • Focusing improvement programmes on those areas where most harm is seen could save 568 lives and £65 million.
  • This adds up to 928 lives saved and £98.5 million more available for care per year.
  • It is not possible to quantify all the potential benefits, so this impact will likely be greater.

For more information see https://improvement.nhs.uk/resources/patient-safety-strategy/

Safe care is intrinsically linked to patient experience. NHS Improvement’s Patient experience improvement framework’ (2018) highlights:

Patients … have a positive experience where there is a culture of safety across an organisation that puts the patient first and gives patient experience the highest priority with the implementation of real-time patient feedback.

For more information see https://improvement.nhs.uk/documents/
2885/Patient_experience_improvement
_framework_full_publication.pdf

HOW we plan to make a difference 

    1.1 People receive care that is based on the principles of safe practice.

  • We will implement the new Patient Safety Incident Response Framework from April 2020; and ensure we implement all learning from serious and untoward incidents.
  • We will launch the new Patient Safety Incident Management System from April 2020, and train staff in responding to incidents; establish acute trust-based medical examiner scrutiny of all deaths in acute hospitals by April 2020, and all deaths by April 2021; and have two or more patient representatives on safety-related committees by April 2021.
  • We will adopt a range of safety measurements based on NICE guidelines and other best practice that can apply across the local system. Measures of culture, infrastructure, process and outcomes are all useful in monitoring safe care.

    1.2 People’s health data is secure.

  • We will implement cyber security standards and behaviours for our systems and staff. By summer 2021 we will have 100% compliance with mandated cyber security standards across all NHS organisations in the health and care system.

    2.1 People can look after their own health and wellbeing safety.

  • We will support people who use services to be full partners in their own safety through improved health literacy, improved access to their own data, and ways to report safety incidents. This approach helps people to move from being passive recipients of care to active partners. Support should be provided in an integrated way, and provided by the most appropriate services to help people express their views and make informed decisions.
  • People will have autonomy and independence in their care, for example access to food and drink, and self-medication. Safe care involves not only protecting people from harm, but also helping people to manage their own care safely.

    2.2 People receive safe services co-produced and based on best practice. We will enable this by:

  • Introducing and training Patient Safety Partners to support NHS organisations, beginning in 2019. These Partners will design services and pathways, contribute to safety governance and input into strategy and policy.
  • Nominating a Patient Safety Specialist in every NHS organisation by April 2020. These Specialists will have oversight of, and support embedding patient safety throughout their organisation. They will also link with others in local, regional and national networks.
  • Using data from sources such as staff and patient satisfaction surveys to measure staff perceptions of how safe their services are, and how effectively incidents are managed. The key ingredients for health and care organisations that want to be safe include: staff and people using services who feel physically and psychologically safe; valuing and respecting diversity; a compelling vision; good leadership; a sense of teamwork; openness and support for learning; and kindness and civility.
  • Supporting staff to focus on what constitutes best practice. Best practice must be implemented in all health and care settings. In the NHS the ‘Safety II’ approach includes taking an inquiring approach, learning from excellence, creating a positive culture, providing meaningful positive feedback and a preventative approach to safety.
  • Ensuring independent providers of healthcare contribute to NHS patient safety measures. This includes independent providers submitting patient safety data to the NHS, ensuring commitment to speaking-up, patient involvement and continuous improvement across the system.
  • Implementing Ask Listen Do for people with learning disabilities. Ask Listen Do makes it easier for people, families and paid carers to give feedback, raise concerns and complain, and supports organisations to learn from these experiences and improve.

    3.1 People with deteriorating conditions receive safe care.

  • We will implement the National Patient Safety Improvement Programme. This includes preventing deterioration and sepsis, and adopting and spreading evidence-based interventions.

    3.2 Pregnant women and babies receive safe neonatal care.

  • We will implement the Maternity and Neonatal Safety Improvement Programme. This includes reducing smoking in pregnancy, diabetes in pregnancy, health of pre-term babies, detecting and managing neonatal hypoglycaemia, and managing deterioration in labour and postpartum.

    3.3 People with learning disabilities receive safe care.

  • We will implement the Medicines Safety Improvement Programme and linked measures such as STOMP/STAMP for people with learning disabilities. This includes reducing medication harms, improving medication safety, people and professionals sharing in medication decisions, and developing a safety culture.
  • Care and Treatment Reviews (CTRs) will be carried out before any admission, and in preparation for discharge. Around 80% of people can avoid hospital admission with a pre-admission CTR, reducing their risk of future harm. All areas will be monitored against a 12-point discharge plan to ensure discharges are timely and effective.
  • NHS commissioned care will meet the learning disability improvement standards by March 2024. There are four standards, each supported by a range of metrics which providers are expected to measure themselves against.

    3.4 People with mental health problems receive safe care.

  • We will implement the Mental Health Safety Improvement Programme by April 2020. This includes a safety improvement plan in every trust, reducing restrictive practices, and improving sexual safety for inpatients.

    3.5 People who are frail or at risk of falls receive safe care.

  • We will support programmes to reduce the number of people who have falls. Preventing falls helps to avoid hospital stays and enables people to stay independent in their own homes.
  • We will actively identify people who are frail and provide support from primary and community care services. Proactively identifying frailty enables earlier support to help people stay independent for longer.
  • We will implement measures to improve people’s skin integrity such as Stop the Pressure Programme, lower limb and surgical wounds. Good skin care prevents infection and deterioration in health and mobility.

    3.6 Children and young people receive safe care.

  • We will implement a new Integrated Child Protection Information System by March 2023. The Child Protection Information system will be extended to cover all health care settings, including general practices.

    4.1 People are supported to avoid the need for antibiotic treatments.

  • We will use preventative measures, including vaccines to avoid the need for treatments and the risk of developing anti-microbial resistance.

    4.2 People are prescribed the right antibiotics, and only when it is appropriate. We will enable this by:

  • Implementation and delivery of the government’s new five-year action plan on Antimicrobial Resistance so that prevention of antimicrobial resistance will be based on evidence and best practice.
  • Supporting system-wide improvement, surveillance, infection prevention and control practice, and antimicrobial stewardship. This will ensure resources are available for clinical expertise and senior leadership at all levels.
  • Continuing to optimise use, reduce the need for and unintentional exposure to antibiotics.

    4.3 People have access to a range of effective antibiotic treatments.

  • We will support the development of new antimicrobials. Developing new treatments and making them available alongside current medications widens the options available to clinicians.
  • We will ensure people have access to both old and new treatments.
  • We will use appropriate tools, including diagnostics and electronic prescribing, in both hospitals and community settings.

Following a coalition of partners a test-and-learn approach was agreed to test a new, holistic approach to delivering community care in West Suffolk inspired by the Buurtzorg model developed in the Netherlands. The model provides both nursing and personal care including preventative, holistic care that wrapped around patients and carers (informal network) pulling in support from other professionals (formal network) as required. A key component of the approach tested was to have self-managing teams with no hierarchy, which have both freedom and responsibility.

Following the test-and-learn and the associated learning provided by reports from the Kings Fund and Healthwatch Suffolk, we concluded that the test site was a highly ambitious project which made some significant achievements despite the challenges faced. West Suffolk system leaders recognised that some of the core principles of self-managed teams, delivering health and care within a framework of trusted assessment and working with local communities are excellent foundations of practice for locality teams and should be protected into the future.

The next stage of the project is to implement the Buurtzorg model inspired principles into the developing Integrated Neighbourhood Teams / localities for patients and their carers to benefit from an integrated holistic service based on person and place. The focus will begin in one locality with the associated Integrated Neighbourhood Team with a view to roll out the learning and approach to the remaining localities / teams.

  • More effective sharing of information by integration of child protection systems
  • Fewer pressure ulcers at home, in care homes, and in hospitals
  • A maintained rate at which local health organisations meet or exceed cyber security standards by 2023/24, currently at 83.3%
  • A reduction in the rate of patient safety incidents
  • Patient safety measures meet national and local standards in all NHS, social care and independent providers
  • Safer care through implementation of all patient Safety Improvement Programmes
  • Safer care through implementation of the learning disability improvement standards
  • Appointment of Patient Safety Partners and Patient Safety Specialists
  • Implementation and effectiveness of Ask Listen Do for people with learning disabilities and their carers
  • An increase in Care Treatment Reviews before proposed admission, and when planning discharge
  • Improved prevention of anti-microbial resistance (AMR) through implementation of national AMR programme
  • Improved access to old and new antimicrobials
  • An increase in the number of Antibiotic Guardians

See separate Suite of Supporting Metrics and Baselines

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