NHS England
HSSIB recommends that NHS England includes guidance on engaging temporary staff in learning responses within their 'engaging and involving patients, families and staff following a patient safety incident'. This should be developed in collaboration with providers of temporary staff to the NHS to help assist healthcare providers being able to fully investigate incidents from a systems perspective, enabling learning that can improve patient care.
When we published our guidance document: Engaging and involving patients, families and staff following a patient safety incident to accompany the publication of the Patient Safety Incident Response Framework in August 2022, we made a commitment to revise the document based on feedback about implementation and emerging research findings from the Learn Together research programme. In March 2024 we reconvened our stakeholder group to commence the revision and are pleased to consider HSSIB’s recommendation as part of this work.
Response received on 2 May 2024.
NHS England
HSSIB recommends that NHS England updates the agency worker framework agreement criteria to explicitly require framework agreements to adhere to the staff support principles of the NHS England Patient Safety Incident Response Framework. This will improve patient safety as there is a recognised link between staff having wellbeing concerns and the delivery of patient care.
This has been confirmed with NHS England and both the framework operators:
- The Workforce Alliance
- Health Trust Europe
A full list of NHS England approved framework agreements for the supply of temporary staffing can be found here.
Action planned to deliver safety recommendation:
- Update the framework approval application form for 2024, by September 2024.
Response received on 3 May 2024.
NHS England
HSSIB recommends that NHS England undertakes an evaluation of the risks to patient safety of online consultation tools in general practice, taking into account the findings of this investigation, recent research, and the experiences of general practices. This is to identify and implement actions to support the safe delivery of care using online consultation tools in line with best practice.
NHS England acknowledges the concerns raised by the HSSIB report and is currently undertaking work to enhance digital clinical safety and address HSSIB’s recommendation. NHSE has undertaken a considerable amount of work to enhance the safety of such products.
- In line with the commitment made in the National Digital Clinical Safety Strategy (2021), NHS England is reviewing its approach to the delivery of digital clinical safety training. One of the aims of the review is to improve awareness and understanding of digital clinical safety that supports capacity and capability across the NHS in England, both in healthcare providers and ICBs, to support them in identifying and managing digital clinical safety risks. Additionally, NHSE’s Digital Clinical Informatics Safety Team already offers online and in-person digital patient safety training which is tailored to the specific needs of requesting organisations and supports them in effectively fulfilling their responsibilities.
- The Digital Clinical Informatics Safety Team have recently undertaken a detailed review of the assurance process related to one of the online consultation tools that was made available from the ‘Online Consultations Frameworks’ portfolio to assess the robustness of the assurance process. This retrospective review showed that the assurance process was robust when considered in line with current assurance procedures. Additionally, regular review of some updated NHSE products occurs, and the Digital Clinical Safety Team are currently designing a new strategic approach to the review of all live NHSE products and those assured under historical frameworks.
- NHS England has recently commenced work to review and modernise the Digital Clinical Safety Standards – DCB0129 and DCB0160. These mandatory standards are in place to ensure that healthcare IT suppliers and NHS organisations (including primary care providers) follow structured clinical risk management processes to identify, assess, and mitigate risks associated with digital health technologies both when the products are deployed and throughout their life cycle.
- The key intention of the consultation is to ensure relevance, effectiveness, improve usability, enhance alignment with broader NHS policies and prepare for future risks in new and emerging digital healthcare products. This will include developing an understanding of safety work needed in relation to AI-based products. Pre-consultation focus groups are currently underway, and views are being sought specifically from primary care and ICB colleagues. This work builds on NHS England’s Primary Care Patient Safety Strategy published in September 2024 that outlines specific roles and responsibilities within primary care for digital clinical safety.
- The Digital Clinical Informatics, Patient Safety and Primary Care teams in NHS England have discussed evaluation of online consultation tools and recognise the importance such an evaluation might bring. NHS England has close links to research centres where this kind of work takes place (such as the Health Foundation’s Improvement Analytics Unit) but is not funded to undertake such an evaluation directly. Therefore, our ongoing activities are focused on the points listed above.
- NB recent announcements to abolish NHSE and merge functions with the Department of Health and Social Care may have an impact on the work planned. These impacts, if any, are not yet clear.
Actions planned to deliver safety recommendation:
- Review the Digital Patient Safety Strategy to ensure that training meets the needs of both ICBs and Healthcare Providers alike, by Winter 2025. Organisational lead: Deputy Director for Patient Safety NHSE. Other dependencies identified: Major NHSE and DHSC strategic changes 25-26.
- Publication of the new DCB standards, by Autumn 2026. Organisational lead: CCIO NHSE.
- Development and implementation of an enhanced ‘live’ product review process, by Autumn 2025. Organisational lead: CCIO NHSE. Other dependencies identified: Major NHSE and DHSC strategic changes 25-26.
- Exploring mechanisms for procuring and/or initiating an evaluation of safety of care delivery using online tools, by Autumn 2025. Organisational lead: Deputy Director for Patient Safety NHSE. Other dependencies identified: Major NHSE and DHSC strategic changes 25-26.
Response received on 6 November 2024.
NHS England
HSSIB recommends that NHS England develops mechanisms for assuring that integrated care boards support general practices when implementing online consultation. This is to ensure online consultation tools are procured and implemented in ways that best support patient safety.
- NHSE has been working to update and improve assurance processes across the NHS and to clarify roles and responsibilities between NHSE, ICBs and providers for assurance and performance management activity. This is expected to continue through the process of merging NHSE into the Department of Health and Social Care.
- The work includes strengthening and streamlining the assurance of ICBs in effectively commissioning services, improving service quality and securing transformation. Within this, there is also a specific programme underway to develop a more consistent approach across ICBs to carrying out their delegated responsibilities for commissioning of general practice, including supporting general practice transformation and improvement. ICBs are tasked with developing plans and delivering activity that supports general practice improvement, which will include ensuring that digital tools are implemented safely and effectively. NHSE will work with ICBs to assure these plans and track delivery of activities.
- Under the GPIT Operating Model, those procuring online consultation systems (which will largely be ICBs) are required to apply the provisions of DCB0160 when they are implemented and in the regular review of business and clinical processes. There are assurance processes in place to understand local application of the GPIT Operating Model and delivery of GPIT services. The effectiveness of these processes will be reviewed as part of the work mentioned above.
- In addition, NHSE has made available guidance and best practice tools for supporting the implementation of digital tools and application of clinical safety procedures.
- NB recent announcements to abolish NHSE and merge functions with the Department of Health and Social Care may have an impact on the work planned. These impacts, if any, are not yet clear.
Actions planned to deliver safety recommendation:
- Publish NHS Performance Assessment Framework, by 2025 date TBC. Organisational lead: NHSE. Other dependencies identified: Major NHSE and DHSC strategic changes 25-26. Additional comments: draft published 12 May for consultation.
- Publish details of a new Commissioning and Transformation Support Programme for GP commissioners, by 2025 TBC. Organisational lead: NHSE Primary Care and Community Services team. Other dependencies identified: Major NHSE and DHSC strategic changes 25-26.
Response received on 6 November 2024.
National Guardian’s Office
HSSIB recommends that the National Guardian’s Office, working with relevant stakeholders, identify the barriers that prevent temporary staff from speaking up and develops mechanisms to address those barriers. This will build on their work to explore barriers for other staff groups and enable all workers to contribute to patient safety improvements without fear of reprisal.
We will implement HSSIB’s safety recommendation that the National Guardian’s Office will work with stakeholders to identify the barriers that prevent temporary staff from speaking up and develop mechanisms to address those barriers. This builds upon our work exploring the barriers to speaking up to improve workplace cultures so that all workers – no matter what their contract terms – are confident to speak up.
Given the critical role which temporary workers play in the NHS, it is vital that we ensure that they feel confident to speak up about patient safety and not fear they will lose future opportunities to work in that organisation. Temporary workers can offer valuable insights into practices and quality of care. Freedom to Speak Up guardians are available to all workers – this includes temporary, agency and bank staff.
I echo HSSIB’s recommendation for local level learning and for leaders to ask themselves: How do you ensure that temporary staff know how to speak up and that they feel safe to raise concerns?
We are planning on taking this action forward in 2025/26, subject to funding.
Response received on 5 November 2024.
Department of Health and Social Care |
NHS England
HSSIB recommends that NHS England/Department of Health and Social Care, working with other relevant organisations, reviews and evaluates the implementation of the care co-ordinator role. This is to ensure that all patients with long-term conditions have their care co-ordinated and that they have a single point of contact 24 hours a day, 7 days a week, to help them with any queries or concerns that they may have.
Department of Health and Social Care
HSSIB recommends that the Department of Health and Social Care works with NHS England and other stakeholders, to develop a strategy that ensures that all diseases are given parity and that all people with a long-term condition in primary, secondary, tertiary and community or social care have their care effectively co-ordinated across multiple agencies. This is to ensure that people with long-term health conditions have co-ordinated care plans with effective communication between services and a single point of contact for concerns or questions.