NHS England and NHS Improvement
HSIB recommends that NHS England and NHS Improvement ensures that effective processes have been implemented in integrated care systems to identify local capability and capacity of their independent acute hospitals.
HSIB understand that elements of this recommendation may have now been taken forward in the elective recovery plan. HSIB has closed this recommendation response and confirmed the closure to the Department of Health and Social Care. This area may be explored further on the establishment of the Healthcare Services Safety Investigations Body (HSSIB).
NHSX
HSIB recommends that NHSX expands its work programme addressing the challenges associated with interoperability of information systems used in healthcare to include transfer of information between the NHS and independent sector in support of safe care delivery.
We read with great interest the report from the Healthcare Safety Investigation Branch (HSIB) regarding the surgical care of NHS patients in independent hospitals. We were deeply concerned that patient care had been compromised as a result of unclear channels of communication between the NHS and the independent sector. It is clear that the robust data flow and sharing of clinical information between health and care organisations across sectors is a prerequisite to being able to provide high-quality patient care. NHSX is committed to supporting local NHS and care organisations to digitise their services, and specifically, connect the health and care systems through data and technology.
Within NHSX, programmes of work are currently underway to improve the flow of data between secondary care trusts and community-based services within Integrated Care Systems (ICSs) - with a view to expanding to interoperability between ICSs over time. In this work, we agree that the independent sector must not be regarded in isolation, but rather as a key component of the ICS in which they sit. This is of particular importance, given their evolving role in supporting the NHS to provide timely care to NHS patients (including urgent NHS elective surgical care, and the delivery of cancer pathways).
To underpin this, we will continue to support providers across the health and care sector in the adoption of Fast Healthcare Interoperability Resources (FHIR) standards, in order to optimise the sharing of information between IT systems used in health and care. We recognise that these endeavours pose questions of cybersecurity, information governance (IG), and clinical safety, which must be addressed if true system-wide interoperability is to be achieved.
Given the operational pressures the health and care system continues to face, national strategic priorities are likely to be revisited over the coming months. A greater emphasis on the evolving role of the independent sector would be well-received, and would serve to galvanise our efforts, and the efforts of other organisations and arms-length bodies (ALBs), in achieving true system-wide interoperability.
Response received on 21 January 2022.
Care Quality Commission
HSIB recommends that the Care Quality Commission reviews and appropriately develops its methodology for regulatory assurance of arrangements between NHS and independent providers for the provision of care across care pathways. This is to include any screening and risk management processes used to ensure the safe transfer of care between providers.
We welcome this report, which identifies vital patient safety issues that the regulatory ecosystem is well placed to address.
In the immediate we will ensure that our current frameworks and guidance sufficiently reference the importance of providers having robust process in place for transfers of care between NHS and Independent acute providers.
Further to that we will ensure that these are given due regard in the development of our new regulatory model, and in our work to respond to related matters, such as the Paterson and Cumberlege reports.
Action: Update our existing inspection guidance to reference screening and risk management processes for transfers of care between NHS and IH providers by Spring 2022. Additionally, we will update our Surgery Core Service Framework Well-Led Prompts.
Action: Include references to relevant guidelines and supporting evidence in our new Single Assessment Framework by Autumn 2022. Additionally, reference will be in evidence categories for surgery.
Response received on 7 January 2022.
Care Quality Commission
HSIB recommends that the Care Quality Commission incorporates regulatory assurance of surgical pathways between providers at a system level when developing its methodology for the regulation of integrated care systems.
Action: Include references to relevant guidelines and supporting evidence in our Framework for assuring ICS by Spring 2022.
Response received on 7 January 2022.
NHS England and NHS Improvement
HSIB recommends that NHS England and NHS Improvement reviews models of perioperative care for their value and impact. This should inform future work to support implementation of a standardised approach, based on evidence, across all healthcare providers that deliver surgical services.
HSIB has closed this recommendation response and has confirmed to the Department of Health and Social Care that no response has been received to this safety recommendation.
NHS England and NHS Improvement
HSIB recommends that NHS England and NHS Improvement establishes a process to ensure that findings of the National Institute for Health Research’s policy research programme into frailty in younger patient groups are reviewed and acted upon.
NHS England recognises the report's conclusions regarding the importance of understanding more about frailty in younger populations (i.e. below the age of 65) and frailty’s associated importance in effective perioperative care.
We identified the need for further research into this area in 2019 following feedback from clinical teams involved in the Specialised Clinical Frailty Network (an improvement collaborative established to embed a focus on frailty in specialised service pathways).
Our proposal and focus in this area led to an NIHR Evidence review into frailty in younger populations and subsequently an agreement for an NIHR funded research programme in this area.
NHSE has been involved in shaping that programme over the last 6 months. Subject to the research applicants final proposal being agreed by NIHR, a number of clinical leaders and policy leads from NHS England will be engaged as that research progresses and we will be keen to review the findings and their implications for national clinical policy as and when they are developed.
Action: NHS England clinical and policy leads to engage with research programme (“Understanding the trajectory of frailty across the life course.“) June 2023, subject to the current research proposal being agreed by NIHR.
Action: NHS England to review findings of research programme and implications for policy June 2024, subject to the current research proposal completing on time (June 2023).
Response received on 15 November 2021.