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100186

	registered interest
	date	21/10/2014
	answering body	Department of Health
	answering dept id	17
	answering dept short name	Health
	answering dept sort name	Health
	hansard heading	Patients: Safety
	house id	1
	legislature	25259 pref label House of Commons
	question text	To ask the Secretary of State for Health, whether missed or inadequate hydrocortisone administration is included in the NHS list of Never Events.
	tabling member constituency	Oxford East
	tabling member printed	Mr Andrew Smith
	uin	211233
	answer	answer is ministerial correction date of answer 28/10/2014 answer text <p>Missed or inadequate hydrocortisone administration is not currently included in the list of ‘never events’.</p><p> </p><p> </p><p> </p><p>We can confirm that the current list of Never Events is under review and there is a consultation underway which opened online on the 6 October 2014 and closes on 31 October 2014.</p><p> </p> answering member constituency Mid Norfolk answering member printed George Freeman question first answered 28/10/2014 15:28:25 question first ministerially corrected 28/10/2014 16:30:53 answering member 4020 label Biography information for George Freeman previous answer version 24770 answering member constituency Battersea answering member printed Jane Ellison answering member 3918
	tabling member	95 label Biography information for Mr Andrew Smith

1019458

	registered interest
	date	03/12/2018
	answering body	Department of Health and Social Care
	answering dept id	17
	answering dept short name	Health and Social Care
	answering dept sort name	Health and Social Care
	hansard heading	Patients: Safety
	house id	1
	legislature	25259 pref label House of Commons
	question text	To ask the Secretary of State for Health and Social Care, pursuant to the Answer of 17 October to Question 177600 on Patients, how many patient safety incidents were recorded as absconder or missing patient by hospitals in England and Wales in the National Reporting and Learning System in each NHS trust in the latest period for which information is available.
	tabling member constituency	Stockport
	tabling member printed	Ann Coffey
	uin	198237
	answer	answer is ministerial correction date of answer 11/12/2018 answer text <p>During the period 1 October 2017 to 31 March 2018, the National Reporting and Learning System (NRLS) recorded 12,405 cases of ‘missing or absconded patient’ from a National Health Service trust hospital in England and Wales, including incidents involving a mental health patient. This category on the NRLS also includes patients who left without signing a ‘discharge against medical advice’ form and those who failed to return from agreed leave, on time.</p><p> </p><p>The attached tables show a breakdown of these cases by NHS trust for both England and Wales respectively. If a NHS trust does not appear in these tables, this is because the number of incidents is ‘0’.</p><p> </p><p>During the same period, the NRLS recorded 6,186 cases of ‘missing or absconded patient’ involving a mental health patient in England and Wales. This breaks down as 5,946 in England and 240 in Wales. This category on the NRLS also includes patients who left without signing a ‘discharge against medical advice’ form and those who failed to return from agreed leave on time.</p> answering member constituency Gosport answering member printed Caroline Dinenage grouped question UIN 198238 question first answered 11/12/2018 13:31:32 answering member 4008 label Biography information for Dame Caroline Dinenage attachment 1 file name PQ198237,198238.docx title PQ198237,198238 attached table
	tabling member	458 label Biography information for Ann Coffey

1046792

	registered interest
	date	23/01/2019
	answering body	Department of Health and Social Care
	answering dept id	17
	answering dept short name	Health and Social Care
	answering dept sort name	Health and Social Care
	hansard heading	Patients: Safety
	house id	1
	legislature	25259 pref label House of Commons
	question text	To ask the Secretary of State for Health and Social Care, how many incidents recorded in the National Patient Safety Agency's National Reporting and Learning System were classified as never events in each year since 2008.
	tabling member constituency	Leicester South
	tabling member printed	Jonathan Ashworth
	uin	211764
	answer	answer is ministerial correction date of answer 31/01/2019 answer text <p>The following table shows data collected on Never Events from 2010/11, the first year when data was available. Never Events are serious incidents or errors that should never occur if proper safety procedures are followed.</p><p><em> </em></p><p>Never Events Data was collected by the National Reporting and Learning System (NRLS) and the Strategic Executive Information System (StEIS) until 2013. Since April 2013 data has been collected from StEIS only. The data from these two systems are not directly comparable due to differences in the way incidents are identified and reported. The number of events, and definitions of events contained in the Never Event List, are modified regularly, so direct year-on-year comparisons are not appropriate.</p><p> </p><p>The data for 2017/18 is provisional and still to be confirmed in the annual data summary.</p><p> </p><p>Number of Never Events</p><table><tbody><tr><td><p>Year</p></td><td><p>Data Source</p></td><td><p>Total</p></td></tr><tr><td rowspan="2"><p>2010/11</p></td><td><p>NRLS</p></td><td><p>56</p></td></tr><tr><td><p>StEIS</p></td><td><p>166</p></td></tr><tr><td rowspan="2"><p>2011/12</p></td><td><p>NRLS</p></td><td><p>163</p></td></tr><tr><td><p>StEIS</p></td><td><p>326</p></td></tr><tr><td rowspan="2"><p>2012/13</p></td><td><p>NRLS</p></td><td><p>237</p></td></tr><tr><td><p>StEIS</p></td><td><p>329</p></td></tr><tr><td><p>2013/14</p></td><td><p>StEIS</p></td><td><p>338</p></td></tr><tr><td><p>2014/15</p></td><td><p>StEIS</p></td><td><p>306</p></td></tr><tr><td><p>2015/16</p></td><td><p>StEIS</p></td><td><p>345</p></td></tr><tr><td><p>2016/17</p></td><td><p>StEIS</p></td><td><p>445</p></td></tr><tr><td><p>2017/18 (provisional)</p></td><td><p>StEIS</p></td><td><p>393 (April 2017-January 2018) 76 (February-March 2018)*</p></td></tr></tbody></table><p> </p><p>Note:</p><p>*Revised framework and list of Never Events from 1 February 2018</p> answering member constituency Gosport answering member printed Caroline Dinenage question first answered 31/01/2019 17:20:06 answering member 4008 label Biography information for Dame Caroline Dinenage
	tabling member	4244 label Biography information for Jonathan Ashworth

1131259

	registered interest
	date	11/06/2019
	answering body	Department of Health and Social Care
	answering dept id	17
	answering dept short name	Health and Social Care
	answering dept sort name	Health and Social Care
	hansard heading	Patients: Safety
	house id	1
	legislature	25259 pref label House of Commons
	question text	To ask the Secretary of State for Health and Social Care, what steps he is taking to support global patient safety.
	tabling member constituency	North Antrim
	tabling member printed	Ian Paisley
	uin	263152
	answer	answer is ministerial correction date of answer 19/06/2019 answer text <p>Patient safety in the National Health Service is a key priority for the Government. We also remain committed to building on the momentum we have established to address patient safety challenges globally.</p><p>The United Kingdom-led World Health Assembly Resolution, ‘Global Action on Patient Safety’, was adopted on 28 May 2019. It urges all countries to prioritise safety in the delivery of universal health coverage and establishes an annual World Patient Safety Day on 17 September.</p><p>The Government is committed to maintaining its leadership role on global patient safety.</p> answering member constituency Gosport answering member printed Caroline Dinenage question first answered 19/06/2019 16:18:53 answering member 4008 label Biography information for Dame Caroline Dinenage
	tabling member	4129 label Biography information for Ian Paisley

1132763

	registered interest
	date	18/06/2019
	answering body	Department of Health and Social Care
	answering dept id	17
	answering dept short name	Health and Social Care
	answering dept sort name	Health and Social Care
	hansard heading	Patients: Safety
	house id	1
	legislature	25259 pref label House of Commons
	question text	What steps he is taking to ensure NHS patient safety.
	tabling member constituency	Stafford
	tabling member printed	Jeremy Lefroy
	uin	911420
	answer	answer is ministerial correction date of answer 18/06/2019 answer text <p>Patient safety remains a key priority for the National Health Service. NHS Improvement and NHS England are developing a new National Patient Safety Strategy that will sit alongside the NHS Long Term Plan.</p><p>The strategy will be published this summer and will build on existing work to provide a coherent framework that the whole NHS can recognise and support</p> answering member constituency Gosport answering member printed Caroline Dinenage question first answered 18/06/2019 15:03:47 answering member 4008 label Biography information for Dame Caroline Dinenage
	tabling member	4109 label Biography information for Jeremy Lefroy

1144629

	registered interest
	date	04/09/2019
	answering body	Department of Health and Social Care
	answering dept id	17
	answering dept short name	Health and Social Care
	answering dept sort name	Health and Social Care
	hansard heading	Patients: Safety
	house id	1
	legislature	25259 pref label House of Commons
	question text	To ask the Secretary of State for Health and Social Care, what steps the Government is taking to ensure that patient safety will be protected in the event that the UK leaves the EU without a deal.
	tabling member constituency	Newcastle-under-Lyme
	tabling member printed	Paul Farrelly
	uin	286668
	answer	answer is ministerial correction date of answer 09/09/2019 answer text <p>The Department is working with its partners across Government, the National Health Service, arm’s length bodies, local authorities, industry and the wider health and care system to ensure that all relevant parties are prepared for exiting the European Union.</p><p>The quality and safety of patient care is paramount in our preparedness plans.</p><p>The work being undertaken includes securing continued supplies of medicines, medical devices and clinical products, and ensuring that the NHS continues to have sufficient staff to maintain quality of care and the safety of patients.</p> answering member constituency Kingswood answering member printed Chris Skidmore question first answered 09/09/2019 18:55:01 answering member 4021 label Biography information for Chris Skidmore
	tabling member	1436 label Biography information for Paul Farrelly

1167456

	registered interest
	date	30/10/2019
	answering body	Department of Health and Social Care
	answering dept id	17
	answering dept short name	Health and Social Care
	answering dept sort name	Health and Social Care
	hansard heading	Patients: Safety
	house id	1
	legislature	25259 pref label House of Commons
	question text	To ask the Secretary of State for Health and Social Care, what steps his Department is taking to ensure that patients play an active role in promoting their own safety.
	tabling member constituency	South West Surrey
	tabling member printed	Mr Jeremy Hunt
	uin	7681
	answer	answer is ministerial correction date of answer 04/11/2019 answer text <p>The NHS Patient Safety Strategy, published in July 2019, sets out plans to create patient safety partners – patients, carers, families and lay people involved at all levels in National Health Service organisations - to improve safety. This work includes empowering patients to become active partners in their own safety.</p><p>The National Patient Safety team is working with patient and public voice representatives and wider NHS stakeholders on a framework for involving Patient Safety Partners. This is expected to be published in 2019/20.</p><p> </p><p> </p><p> </p><p><strong> </strong></p><p><strong> </strong></p> answering member constituency Mid Bedfordshire answering member printed Ms Nadine Dorries question first answered 04/11/2019 16:09:56 answering member 1481 label Biography information for Ms Nadine Dorries
	tabling member	1572 label Biography information for Jeremy Hunt

1173522

	registered interest
	date	27/01/2020
	answering body	Department of Health and Social Care
	answering dept id	17
	answering dept short name	Health and Social Care
	answering dept sort name	Health and Social Care
	hansard heading	Patients: Safety
	house id	1
	legislature	25259 pref label House of Commons
	question text	To ask the Secretary of State for Health and Social Care, what assessment he has made of the effect on patient safety of the implementation of the Health and Care (Staffing) (Scotland) Act 2019; and if he will make a statement.
	tabling member constituency	Leicester South
	tabling member printed	Jonathan Ashworth
	uin	8301
	answer	answer is ministerial correction date of answer 04/02/2020 answer text <p>It is a matter for the devolved Government for Scotland to make any assessment of the effects on patient safety of the implementation of their legislation.</p><p>When any such assessment is made available we will review it as we review a range of evidence on the provision of healthcare.</p><p> </p><p> </p><p> </p><p> </p> answering member constituency Mid Bedfordshire answering member printed Ms Nadine Dorries question first answered 04/02/2020 15:25:31 answering member 1481 label Biography information for Ms Nadine Dorries
	tabling member	4244 label Biography information for Jonathan Ashworth

1352440

	registered interest
	date	03/09/2021
	answering body	Department of Health and Social Care
	answering dept id	17
	answering dept short name	Health and Social Care
	answering dept sort name	Health and Social Care
	hansard heading	Patients: Safety
	house id	1
	legislature	25259 pref label House of Commons
	question text	To ask the Secretary of State for Health and Social Care, who is responsible for monitoring the implementation of the (a) national patient safety recommendations and (b) maternity safety recommendations made by the Healthcare Safety Investigation Branch.
	tabling member constituency	South West Surrey
	tabling member printed	Jeremy Hunt
	uin	41766
	answer	answer is ministerial correction date of answer 16/11/2021 answer text <p>Responsibility for monitoring the implementation of the Healthcare Safety Investigation Branch’s (HSIB) national patient safety recommendations rest with the recipient organisations. The National Patient Safety Committee, coordinated by NHS England and NHS Improvement, has established a pilot to examine how the implementation of all the HSIB’s national recommendations could be monitored, the potential resources required and information that may aid future evaluation. The National Patient Safety Committee’s draft report on the pilot is currently undergoing review and is expected to be finalised this year.</p><p>Responsibility for monitoring the implementation of the maternity safety recommendations made by the HSIB rests with individual National Health Service trusts. The HSIB works closely with trusts on addressing emerging themes from the investigations and has quarterly review meetings where trusts provide feedback on the actions being taken to implement the recommendations. The HSIB will raise any immediate concerns to the Department and NHS England and NHS Improvement via governance and assurance meetings.</p> answering member constituency Lewes answering member printed Maria Caulfield grouped question UIN 41767 41768 question first answered 16/11/2021 12:36:30 answering member 4492 label Biography information for Maria Caulfield previous answer version 19499 answering member constituency Mid Bedfordshire answering member printed Ms Nadine Dorries answering member 1481 label Biography information for Ms Nadine Dorries
	tabling member	1572 label Biography information for Jeremy Hunt

1352441

	registered interest
	date	03/09/2021
	answering body	Department of Health and Social Care
	answering dept id	17
	answering dept short name	Health and Social Care
	answering dept sort name	Health and Social Care
	hansard heading	Patients: Safety
	house id	1
	legislature	25259 pref label House of Commons
	question text	To ask the Secretary of State for Health and Social Care, how many of the 39 national patient safety recommendations made by the Healthcare Safety Investigation Branch in 2020-21 his Department has assessed as having been implemented in full.
	tabling member constituency	South West Surrey
	tabling member printed	Jeremy Hunt
	uin	41767
	answer	answer is ministerial correction date of answer 16/11/2021 answer text <p>Responsibility for monitoring the implementation of the Healthcare Safety Investigation Branch’s (HSIB) national patient safety recommendations rest with the recipient organisations. The National Patient Safety Committee, coordinated by NHS England and NHS Improvement, has established a pilot to examine how the implementation of all the HSIB’s national recommendations could be monitored, the potential resources required and information that may aid future evaluation. The National Patient Safety Committee’s draft report on the pilot is currently undergoing review and is expected to be finalised this year.</p><p>Responsibility for monitoring the implementation of the maternity safety recommendations made by the HSIB rests with individual National Health Service trusts. The HSIB works closely with trusts on addressing emerging themes from the investigations and has quarterly review meetings where trusts provide feedback on the actions being taken to implement the recommendations. The HSIB will raise any immediate concerns to the Department and NHS England and NHS Improvement via governance and assurance meetings.</p> answering member constituency Lewes answering member printed Maria Caulfield grouped question UIN 41766 41768 question first answered 16/11/2021 12:36:30 answering member 4492 label Biography information for Maria Caulfield previous answer version 19481 answering member constituency Bury St Edmunds answering member printed Jo Churchill answering member 4380
	tabling member	1572 label Biography information for Jeremy Hunt

142210

	registered interest
	date	06/11/2014
	answering body	Department of Health
	answering dept id	17
	answering dept short name	Health
	answering dept sort name	Health
	hansard heading	Patients: Safety
	house id	1
	legislature	25259 pref label House of Commons
	question text	To ask the Secretary of State for Health, how many patient safety incidents have been reported to the National Reporting and Learning System in each month since May 2010.
	tabling member constituency	Wolverhampton South West
	tabling member printed	Paul Uppal
	uin	213780
	answer	answer is ministerial correction date of answer 18/11/2014 answer text <p>We do not hold information on the number of patient safety incidents that have occurred in England in each year since 2000. Patient Safety Incidents occurring in the National Health Service are reported to the National Reporting and Learning System (NRLS) whose primary purpose is to enable learning from patient safety incidents. The NRLS was established in late 2003 as a largely voluntary scheme for reporting patient safety incidents, and therefore it does not provide the definitive number of patient safety incidents occurring in the NHS. However, from 1 April 2010 it became mandatory for all providers registered with the Care Quality Commission (including all NHS trusts and foundation trusts) in England to report all serious patient safety incidents to the Care Quality Commission. To avoid duplication of reporting, providers of NHS services are encouraged to report all incidents resulting in death or severe harm to the NRLS which then reports them to the Care Quality Commission.</p><p> </p><p> </p><p> </p><p>At present, more than 100,000 patient safety incidents (including those resulting in no harm) are reported to the NRLS each month. However, these data are collated on a quarterly, rather than monthly basis. Detailed breakdowns on incidents reported are published twice-yearly and can be accessed via the following link:</p><p> </p><p> </p><p> </p><p><a href="http://www.nrls.npsa.nhs.uk/resources/collections/quarterly-data-summaries/" target="_blank">http://www.nrls.npsa.nhs.uk/resources/collections/quarterly-data-summaries/</a></p><p> </p><p> </p><p> </p><p>The most recent spreadsheet providing quarterly data for the number of patient safety incidents reported to the NRLS from October 2003 to June 2014 is attached.</p><p> </p><p> </p><p> </p><p>The NRLS is a dynamic reporting system, and the number of incidents recorded as occurring at any point in time may increase as a greater proportion of incidents are reported. Experience in other industries has shown that as an organisation’s reporting culture matures, staff become more likely to report incidents.</p><p> </p> answering member constituency Central Suffolk and North Ipswich answering member printed Dr Daniel Poulter grouped question UIN 213775 question first answered 18/11/2014 16:22:48 answering member 3932 label Biography information for Dr Dan Poulter attachment 1 file name NRLS Quarterly Data Workbook- Patient Safety Incidents.xls title Patient Safety Incidents- October 2003- June 2014
	tabling member	4078 label Biography information for Paul Uppal

142212

	registered interest
	date	06/11/2014
	answering body	Department of Health
	answering dept id	17
	answering dept short name	Health
	answering dept sort name	Health
	hansard heading	Patients: Safety
	house id	1
	legislature	25259 pref label House of Commons
	question text	To ask the Secretary of State for Health, how many patient safety alerts have occurred in each month since May 2010.
	tabling member constituency	Wolverhampton South West
	tabling member printed	Paul Uppal
	uin	213781
	answer	answer is ministerial correction date of answer 18/11/2014 answer text <p>Patient safety alerts are a crucial part of NHS England’s work to alert the healthcare system rapidly to risks and provide guidance on preventing potential incidents that may lead to harm or death. They are publications providing urgent information to healthcare providers via the Central Alerting System. Prior to the establishment of NHS England, patient safety alerts were issued by the National Patient Safety Agency (NPSA).</p><p> </p><p> </p><p> </p><p>We do not record the number of patient safety alerts issued by month; however, a list of alerts with their issue dates for the period 2013-2014 is attached.</p><p> </p><p> </p><p> </p><p>A full list of alerts issued by NPSA from 2002-2012 can be viewed at:</p><p> </p><p> </p><p> </p><p><a href="http://www.nrls.npsa.nhs.uk/alerts/" target="_blank">http://www.nrls.npsa.nhs.uk/alerts/</a></p><p> </p><p> </p><p> </p><p><strong> </strong></p><p> </p> answering member constituency Central Suffolk and North Ipswich answering member printed Dr Daniel Poulter question first answered 18/11/2014 16:15:31 answering member 3932 label Biography information for Dr Dan Poulter attachment 1 file name Patient safety alerts.xlsx title List of Patient Safety Alerts 2013-14
	tabling member	4078 label Biography information for Paul Uppal

142222

	registered interest
	date	06/11/2014
	answering body	Department of Health
	answering dept id	17
	answering dept short name	Health
	answering dept sort name	Health
	hansard heading	Patients: Safety
	house id	1
	legislature	25259 pref label House of Commons
	question text	To ask the Secretary of State for Health, what recent assessment he has made of the uptake of the Sign up to Safety campaign in each (a) region and (b) clinical commissioning group area.
	tabling member constituency	Wolverhampton South West
	tabling member printed	Paul Uppal
	uin	213774
	answer	answer is ministerial correction date of answer 18/11/2014 answer text <p>As at the end of October 2014, a total number of 136 organisations have agreed to participate in the Sign up to Safety campaign. A breakdown by Academic Health Science Network (AHSN) is as follows:</p><p> </p><table><tbody><tr><td><p><strong> </strong></p><p>By AHSN region</p></td><td> </td></tr><tr><td><p>Yorkshire and Humber</p></td><td><p>9</p></td></tr><tr><td><p>West of England</p></td><td><p>7</p></td></tr><tr><td><p>West Midlands</p></td><td><p>8</p></td></tr><tr><td><p>Wessex</p></td><td><p>4</p></td></tr><tr><td><p>London</p></td><td><p>24</p></td></tr><tr><td><p>South West Peninsula</p></td><td><p>5</p></td></tr><tr><td><p>Oxford</p></td><td><p>4</p></td></tr><tr><td><p>North West Coast</p></td><td><p>15</p></td></tr><tr><td><p>North East and North Cumbria</p></td><td><p>8</p></td></tr><tr><td><p>Kent, Surrey and Sussex</p></td><td><p>13</p></td></tr><tr><td><p>Greater Manchester</p></td><td><p>9</p></td></tr><tr><td><p>Eastern</p></td><td><p>11</p></td></tr><tr><td><p>East Midlands</p></td><td><p>16</p></td></tr><tr><td><p>Other</p></td><td><p>3</p></td></tr><tr><td> </td><td><p>136</p></td></tr></tbody></table><p> </p><p> </p><p> </p><p>The information has not been split by clinical commissioning group. However 16 clinical commissioning groups have signed up to the campaign to date.</p><p> </p><p> </p><p> </p><p><strong> </strong></p><p> </p><p><strong> </strong></p><p> </p> answering member constituency Central Suffolk and North Ipswich answering member printed Dr Daniel Poulter question first answered 18/11/2014 15:40:10 answering member 3932 label Biography information for Dr Dan Poulter
	tabling member	4078 label Biography information for Paul Uppal

142224

	registered interest
	date	06/11/2014
	answering body	Department of Health
	answering dept id	17
	answering dept short name	Health
	answering dept sort name	Health
	hansard heading	Patients: Safety
	house id	1
	legislature	25259 pref label House of Commons
	question text	To ask the Secretary of State for Health, how many patient safety incidents have occurred in England in each year since 2000.
	tabling member constituency	Wolverhampton South West
	tabling member printed	Paul Uppal
	uin	213775
	answer	answer is ministerial correction date of answer 18/11/2014 answer text <p>We do not hold information on the number of patient safety incidents that have occurred in England in each year since 2000. Patient Safety Incidents occurring in the National Health Service are reported to the National Reporting and Learning System (NRLS) whose primary purpose is to enable learning from patient safety incidents. The NRLS was established in late 2003 as a largely voluntary scheme for reporting patient safety incidents, and therefore it does not provide the definitive number of patient safety incidents occurring in the NHS. However, from 1 April 2010 it became mandatory for all providers registered with the Care Quality Commission (including all NHS trusts and foundation trusts) in England to report all serious patient safety incidents to the Care Quality Commission. To avoid duplication of reporting, providers of NHS services are encouraged to report all incidents resulting in death or severe harm to the NRLS which then reports them to the Care Quality Commission.</p><p> </p><p> </p><p> </p><p>At present, more than 100,000 patient safety incidents (including those resulting in no harm) are reported to the NRLS each month. However, these data are collated on a quarterly, rather than monthly basis. Detailed breakdowns on incidents reported are published twice-yearly and can be accessed via the following link:</p><p> </p><p> </p><p> </p><p><a href="http://www.nrls.npsa.nhs.uk/resources/collections/quarterly-data-summaries/" target="_blank">http://www.nrls.npsa.nhs.uk/resources/collections/quarterly-data-summaries/</a></p><p> </p><p> </p><p> </p><p>The most recent spreadsheet providing quarterly data for the number of patient safety incidents reported to the NRLS from October 2003 to June 2014 is attached.</p><p> </p><p> </p><p> </p><p>The NRLS is a dynamic reporting system, and the number of incidents recorded as occurring at any point in time may increase as a greater proportion of incidents are reported. Experience in other industries has shown that as an organisation’s reporting culture matures, staff become more likely to report incidents.</p><p> </p> answering member constituency Central Suffolk and North Ipswich answering member printed Dr Daniel Poulter grouped question UIN 213780 question first answered 18/11/2014 16:22:48 answering member 3932 label Biography information for Dr Dan Poulter attachment 1 file name NRLS Quarterly Data Workbook- Patient Safety Incidents.xls title Patient Safety Incidents- October 2003- June 2014
	tabling member	4078 label Biography information for Paul Uppal

143393

	registered interest
	date	07/11/2014
	answering body	Department of Health
	answering dept id	17
	answering dept short name	Health
	answering dept sort name	Health
	hansard heading	Patients: Safety
	house id	1
	legislature	25259 pref label House of Commons
	question text	To ask the Secretary of State for Health, what steps he is taking to promote the Sign up to Safety campaign; and if he will make a statement.
	tabling member constituency	Bromley and Chislehurst
	tabling member printed	Robert Neill
	uin	213871
	answer	answer is ministerial correction date of answer 19/11/2014 answer text <p>The Sign up to Safety campaign was launched on 24 June 2014. Each organisation that has joined the campaign has committed to improving patient safety through the implementation of a Safety Improvement Plan. The Safety Improvement Plan builds on the pledges the organisation set out when joining. The pledges are expanded in more detail in the plan, which sets out what the organisation wants to achieve and by when. Each organisation is expected to demonstrate how they will measure the local impact of their aims over the next three years via a measurement section within their plans. They will then implement their aims over the next three years.</p><p> </p><p> </p><p> </p><p>The Sign up to Safety campaign is being promoted by means of:</p><p> </p><p>- a national campaign website;</p><p> </p><p>- regional and national presentations at events across the country delivered by the Campaign Director, the Secretary of State and others;</p><p> </p><p>- Twitter with over 1,500 followers;</p><p> </p><p>- a blog by the Campaign Director;</p><p> </p><p>- an online seminar programme (webinars);</p><p> </p><p>- through partner organisations including NHS England, Care Quality Commission, Monitor, NHS Trust Development Authority, NHS Litigation Authority, Health Education England, and NHS Improving Quality;</p><p> </p><p>- mini poster campaigns, such as the Safe Care Costs Less, and individual events, such as the launch of the Patient Briefing Video; and</p><p> </p><p>- through participant websites and local events.</p><p> </p><p> </p><p> </p><p>As at the end of October 2014, a total number of 136 organisations have agreed to participate in the Sign up to Safety campaign. Each participant organisation is expected to set out how they will contribute to the campaign’s three year objective via their Safety Improvement Plan – they are expected to quantify the expected impact of their actions on a reduction of avoidable harm and saving lives. The measurement and evaluation of the impact at a regional and national level will be led by NHS England working with NHS Improving Quality as part of the integrated measurement strategy for both the campaign and the Patient Safety Collaborative programme. This will include the National Reporting and Learning System, harms via the Safety Thermometer and mortality rates, case studies of individual organisations and patient record reviews.</p><p> </p><p> </p><p> </p><p><strong> </strong></p><p> </p><p><strong> </strong></p><p> </p> answering member constituency Central Suffolk and North Ipswich answering member printed Dr Daniel Poulter grouped question UIN 213870 213872 question first answered 19/11/2014 15:47:48 answering member 3932 label Biography information for Dr Dan Poulter
	tabling member	1601 label Biography information for Sir Robert Neill

143394

	registered interest
	date	07/11/2014
	answering body	Department of Health
	answering dept id	17
	answering dept short name	Health
	answering dept sort name	Health
	hansard heading	Patients: Safety
	house id	1
	legislature	25259 pref label House of Commons
	question text	To ask the Secretary of State for Health, whether the Sign up to Safety campaign is on course to achieve its three-year objective to (a) reduce avoidable harm by 50 per cent and (b) save 6,000 lives.
	tabling member constituency	Bromley and Chislehurst
	tabling member printed	Robert Neill
	uin	213872
	answer	answer is ministerial correction date of answer 19/11/2014 answer text <p>The Sign up to Safety campaign was launched on 24 June 2014. Each organisation that has joined the campaign has committed to improving patient safety through the implementation of a Safety Improvement Plan. The Safety Improvement Plan builds on the pledges the organisation set out when joining. The pledges are expanded in more detail in the plan, which sets out what the organisation wants to achieve and by when. Each organisation is expected to demonstrate how they will measure the local impact of their aims over the next three years via a measurement section within their plans. They will then implement their aims over the next three years.</p><p> </p><p> </p><p> </p><p>The Sign up to Safety campaign is being promoted by means of:</p><p> </p><p>- a national campaign website;</p><p> </p><p>- regional and national presentations at events across the country delivered by the Campaign Director, the Secretary of State and others;</p><p> </p><p>- Twitter with over 1,500 followers;</p><p> </p><p>- a blog by the Campaign Director;</p><p> </p><p>- an online seminar programme (webinars);</p><p> </p><p>- through partner organisations including NHS England, Care Quality Commission, Monitor, NHS Trust Development Authority, NHS Litigation Authority, Health Education England, and NHS Improving Quality;</p><p> </p><p>- mini poster campaigns, such as the Safe Care Costs Less, and individual events, such as the launch of the Patient Briefing Video; and</p><p> </p><p>- through participant websites and local events.</p><p> </p><p> </p><p> </p><p>As at the end of October 2014, a total number of 136 organisations have agreed to participate in the Sign up to Safety campaign. Each participant organisation is expected to set out how they will contribute to the campaign’s three year objective via their Safety Improvement Plan – they are expected to quantify the expected impact of their actions on a reduction of avoidable harm and saving lives. The measurement and evaluation of the impact at a regional and national level will be led by NHS England working with NHS Improving Quality as part of the integrated measurement strategy for both the campaign and the Patient Safety Collaborative programme. This will include the National Reporting and Learning System, harms via the Safety Thermometer and mortality rates, case studies of individual organisations and patient record reviews.</p><p> </p><p> </p><p> </p><p><strong> </strong></p><p> </p><p><strong> </strong></p><p> </p> answering member constituency Central Suffolk and North Ipswich answering member printed Dr Daniel Poulter grouped question UIN 213870 213871 question first answered 19/11/2014 15:47:48 answering member 3932 label Biography information for Dr Dan Poulter
	tabling member	1601 label Biography information for Sir Robert Neill

143397

	registered interest
	date	07/11/2014
	answering body	Department of Health
	answering dept id	17
	answering dept short name	Health
	answering dept sort name	Health
	hansard heading	Patients: Safety
	house id	1
	legislature	25259 pref label House of Commons
	question text	To ask the Secretary of State for Health, what progress organisations which have participated in the Sign up to Safety campaign have made on fulfilling the pledges in that campaign; and if he will make a statement.
	tabling member constituency	Bromley and Chislehurst
	tabling member printed	Robert Neill
	uin	213870
	answer	answer is ministerial correction date of answer 19/11/2014 answer text <p>The Sign up to Safety campaign was launched on 24 June 2014. Each organisation that has joined the campaign has committed to improving patient safety through the implementation of a Safety Improvement Plan. The Safety Improvement Plan builds on the pledges the organisation set out when joining. The pledges are expanded in more detail in the plan, which sets out what the organisation wants to achieve and by when. Each organisation is expected to demonstrate how they will measure the local impact of their aims over the next three years via a measurement section within their plans. They will then implement their aims over the next three years.</p><p> </p><p> </p><p> </p><p>The Sign up to Safety campaign is being promoted by means of:</p><p> </p><p>- a national campaign website;</p><p> </p><p>- regional and national presentations at events across the country delivered by the Campaign Director, the Secretary of State and others;</p><p> </p><p>- Twitter with over 1,500 followers;</p><p> </p><p>- a blog by the Campaign Director;</p><p> </p><p>- an online seminar programme (webinars);</p><p> </p><p>- through partner organisations including NHS England, Care Quality Commission, Monitor, NHS Trust Development Authority, NHS Litigation Authority, Health Education England, and NHS Improving Quality;</p><p> </p><p>- mini poster campaigns, such as the Safe Care Costs Less, and individual events, such as the launch of the Patient Briefing Video; and</p><p> </p><p>- through participant websites and local events.</p><p> </p><p> </p><p> </p><p>As at the end of October 2014, a total number of 136 organisations have agreed to participate in the Sign up to Safety campaign. Each participant organisation is expected to set out how they will contribute to the campaign’s three year objective via their Safety Improvement Plan – they are expected to quantify the expected impact of their actions on a reduction of avoidable harm and saving lives. The measurement and evaluation of the impact at a regional and national level will be led by NHS England working with NHS Improving Quality as part of the integrated measurement strategy for both the campaign and the Patient Safety Collaborative programme. This will include the National Reporting and Learning System, harms via the Safety Thermometer and mortality rates, case studies of individual organisations and patient record reviews.</p><p> </p><p> </p><p> </p><p><strong> </strong></p><p> </p><p><strong> </strong></p><p> </p> answering member constituency Central Suffolk and North Ipswich answering member printed Dr Daniel Poulter grouped question UIN 213871 213872 question first answered 19/11/2014 15:47:48 answering member 3932 label Biography information for Dr Dan Poulter
	tabling member	1601 label Biography information for Sir Robert Neill

1468132

	registered interest
	date	07/06/2022
	answering body	Department of Health and Social Care
	answering dept id	17
	answering dept short name	Health and Social Care
	answering dept sort name	Health and Social Care
	hansard heading	Patients: Safety
	house id	1
	legislature	25259 pref label House of Commons
	question text	To ask the Secretary of State for Health and Social Care, what assessment he has made of the impact of (a) staffing levels and (b) response times on patient safety in the most recent period for which data is available.
	tabling member constituency	Kingston upon Hull North
	tabling member printed	Dame Diana Johnson
	uin	13658
	answer	answer is ministerial correction date of answer 20/06/2022 answer text <p>No specific assessment has been made. Data on patient safety incidents is collected and reported through the National Reporting and Learning System (NRLS). However, the NRLS is a largely voluntary scheme for reporting patient safety incidents and does not provide the actual number of patient safety incidents occurring in the National Health Service.</p> answering member constituency Lewes answering member printed Maria Caulfield question first answered 20/06/2022 14:21:47 answering member 4492 label Biography information for Maria Caulfield
	tabling member	1533 label Biography information for Dame Diana Johnson

1471039

	registered interest
	date	16/06/2022
	answering body	Department of Health and Social Care
	answering dept id	17
	answering dept short name	Health and Social Care
	answering dept sort name	Health and Social Care
	hansard heading	Patients: Safety
	house id	1
	legislature	25259 pref label House of Commons
	question text	To ask the Secretary of State for Health and Social Care, what progress he has made on the appointment of a new patient safety commissioner.
	tabling member constituency	Enfield North
	tabling member printed	Feryal Clark
	uin	19728
	answer	answer is ministerial correction date of answer 23/06/2022 answer text <p>On 20 June 2022, Henrietta Hughes was announced as the Government’s preferred candidate for the role of Patient Safety Commissioner. This role is subject to a pre-scrutiny appointment hearing by the Health and Social Care Committee on 5 July 2022.</p><p> </p> answering member constituency Lewes answering member printed Maria Caulfield question first answered 23/06/2022 11:53:50 answering member 4492 label Biography information for Maria Caulfield
	tabling member	4822 label Biography information for Feryal Clark

1568112

	registered interest
	date	18/01/2023
	answering body	Department of Health and Social Care
	answering dept id	17
	answering dept short name	Health and Social Care
	answering dept sort name	Health and Social Care
	hansard heading	Patients: Safety
	house id	1
	legislature	25259 pref label House of Commons
	question text	To ask the Secretary of State for Health and Social Care, what assessment the Department has made of the number of patients who are avoidably harmed during routine medical procedures and surgeries.
	tabling member constituency	Hendon
	tabling member printed	Dr Matthew Offord
	uin	126603
	answer	answer is ministerial correction date of answer 24/01/2023 answer text <p>The National Reporting and Learning System (NRLS) provides a national database of reported patient safety incidents for the National Health Service in England. This data is published as official statistics alongside commentary. Within NRLS data, it is not possible to determine easily if the reported incidents took place during medical procedures and surgery that can be considered ‘routine’. The most recent publication for 2021/22 was published in October 2022 and available at the following link:</p><p><a href="https://www.england.nhs.uk/patient-safety/national-patient-safety-incident-reports/national-patient-safety-incident-reports-13-october-2022/" target="_blank">https://www.england.nhs.uk/patient-safety/national-patient-safety-incident-reports/national-patient-safety-incident-reports-13-october-2022/</a></p><p>The total number of patient safety incidents reported was 2,345,815. Most incidents are reported as causing no harm, 70.6% or low harm, 26.0%. Fewer than 4% of incidents reported caused higher degrees of harm, of which 0.5% were categorised as severe harm or death. NHS England reviews information in these two categories to characterise new, emerging and under-recognised risks and determine how they might be addressed.</p><p>The Learn from Patient Safety Events service will this year fully replace the NRLS. It will change the way information is collected to make it easier for providers to record and learn from patient safety incidents.</p><p>The Government continues to pursue higher patient safety standards and a transparent, learning culture in order to support the NHS to achieve continuous improvement in safety and to reduce harmful events happening in the first place.</p> answering member constituency Lewes answering member printed Maria Caulfield question first answered 24/01/2023 14:34:19 answering member 4492 label Biography information for Maria Caulfield
	tabling member	4006 label Biography information for Dr Matthew Offord

1581586

	registered interest
	date	27/01/2023
	answering body	Department of Health and Social Care
	answering dept id	17
	answering dept short name	Health and Social Care
	answering dept sort name	Health and Social Care
	hansard heading	Patients: Safety
	house id	1
	legislature	25259 pref label House of Commons
	question text	To ask the Secretary of State for Health and Social Care, how many patient safety incidents were reported as a result of ambulance service delays in each year since 2010.
	tabling member constituency	Slough
	tabling member printed	Mr Tanmanjeet Singh Dhesi
	uin	134052
	answer	answer is ministerial correction date of answer 01/02/2023 answer text <p>Information on patient safety incidents is not held in the format requested.</p><p>Information on patient safety incidents, including those relating to ambulance services, is published by NHS England as part of the National Reporting and Learning System and is available at the following link: <a href="https://www.england.nhs.uk/patient-safety/national-patient-safety-incident-reports/" target="_blank">https://www.england.nhs.uk/patient-safety/national-patient-safety-incident-reports/</a></p> answering member constituency Colchester answering member printed Will Quince question first answered 01/02/2023 12:26:38 answering member 4423 label Biography information for Will Quince
	tabling member	4638 label Biography information for Mr Tanmanjeet Singh Dhesi

164366

	registered interest
	date	24/11/2014
	answering body	Department of Health
	answering dept id	17
	answering dept short name	Health
	answering dept sort name	Health
	hansard heading	Patients: Safety
	house id	1
	legislature	25259 pref label House of Commons
	question text	To ask the Secretary of State for Health, what progress he has made on implementing the recommendations of the Berwick report into Improving the Safety of Patients in England, published in August 2013.
	tabling member constituency	Wolverhampton South West
	tabling member printed	Paul Uppal
	uin	215725
	answer	answer is ministerial correction date of answer 01/12/2014 answer text <p>The Government has put in place a number of measures to support National Health Service orgnisations to respond positively to the Berwick Report ‘<em>Improving the Safety of Patients in England</em>’’ including greater transparency, openness and candour; ensuring safe staffing levels; creating a culture of learning and development with the establishment of 15 Patient Safety Collaboratives; and making patient safety a primary goal with a new ambition to halve avoidable harm and save 6,000 lives over the next three years, underpinned by the Sign up to Safety campaign.</p><p> </p> answering member constituency Central Suffolk and North Ipswich answering member printed Dr Daniel Poulter question first answered 01/12/2014 17:23:17 answering member 3932 label Biography information for Dr Dan Poulter
	tabling member	4078 label Biography information for Paul Uppal

164370

	registered interest
	date	24/11/2014
	answering body	Department of Health
	answering dept id	17
	answering dept short name	Health
	answering dept sort name	Health
	hansard heading	Patients: Safety
	house id	1
	legislature	25259 pref label House of Commons
	question text	To ask the Secretary of State for Health, what plans he has to increase the use of patient experience surveys in the NHS to inform patient safety initiatives; and if he will make a statement.
	tabling member constituency	Copeland
	tabling member printed	Mr Jamie Reed
	uin	215718
	answer	answer is ministerial correction date of answer 27/11/2014 answer text <p>Patient experience surveys are a valuable source of evidence and the results are used in a range of ways, including the assessment of National Health Service performance as well as in regulatory activities such as registration, monitoring ongoing compliance and reviews. The Care Quality Commission has developed a new Intelligent Monitoring tool to give inspectors a clear picture of the areas of care that need to be followed up within an NHS acute trust or a specialist NHS trust. The system is built on a set of indicators that look at a range of information including patient experience, staff experience and performance.</p><p> </p><p> </p><p> </p><p>In addition to the patient experience surveys hospital boards and other providers and commissioners of services can also consider the results of the Friends and Family Test (FFT) to consider the implications for quality and safety. While not a traditional survey, the FFT provides near real-time feedback to identify both good and poor quality patient experience. A NHS England review of the FFT found that it is performing well as a service improvement tool, with 85% of trusts reporting that it is being used to improve patient experience, and 78% saying that FFT has increased the emphasis placed on patient experience in their trusts.</p><p> </p><p> </p><p> </p> answering member constituency Mid Norfolk answering member printed George Freeman question first answered 27/11/2014 17:09:16 answering member 4020 label Biography information for George Freeman
	tabling member	1503 label Biography information for Mr Jamie Reed

164371

	registered interest
	date	24/11/2014
	answering body	Department of Health
	answering dept id	17
	answering dept short name	Health
	answering dept sort name	Health
	hansard heading	Patients: Safety
	house id	1
	legislature	25259 pref label House of Commons
	question text	To ask the Secretary of State for Health, what assessment he has made of the relationship between cost savings to the NHS and improved patient safety; and if he will make a statement.
	tabling member constituency	Stockton North
	tabling member printed	Alex Cunningham
	uin	215712
	answer	answer is ministerial correction date of answer 27/11/2014 answer text <p>The Department commissioned Frontier Economics to investigate the costs of unsafe care in the National Health Service. The final report, <em>Exploring the cost of unsafe care</em> <em>in the NHS</em> suggests that the costs of preventable, adverse events is likely to be more than £1 billion per year, but could be up to £2.5 billion annually. The report, which was published on 16 October, is available at:</p><p> </p><p> </p><p> </p><p><a href="http://www.frontier-economics.com/publications/exploring-the-costs-of-unsafe-care-in-the-nhs/" target="_blank">http://www.frontier-economics.com/publications/exploring-the-costs-of-unsafe-care-in-the-nhs/</a></p><p> </p><p> </p><p> </p><p>The Sign up to Safety campaign launched in June is now working with healthcare organisations to make the NHS one of the safest healthcare systems in the world and contribute to the goal to halve avoidable harm and save 6,000 lives over the next three years.</p><p> </p><p> </p><p> </p><p>It is difficult to disaggregate direct cash releasing savings from this evidence which must take into account the upfront costs of investing in safer care.</p><p> </p><p><strong> </strong></p><p> </p><p><strong> </strong></p><p> </p><p><strong> </strong></p><p> </p><p><strong> </strong></p><p> </p><p><strong> </strong></p><p> </p><p><strong> </strong></p><p> </p><p><strong> </strong></p><p> </p> answering member constituency Central Suffolk and North Ipswich answering member printed Dr Daniel Poulter question first answered 27/11/2014 16:45:29 answering member 3932 label Biography information for Dr Dan Poulter
	tabling member	4122 label Biography information for Alex Cunningham

164380

	registered interest
	date	24/11/2014
	answering body	Department of Health
	answering dept id	17
	answering dept short name	Health
	answering dept sort name	Health
	hansard heading	Patients: Safety
	house id	1
	legislature	25259 pref label House of Commons
	question text	To ask the Secretary of State for Health, what the rates of (a) pulmonary embolism, (b) blood-stream infection and (c) foreign body left in after procedure has been in England in each year since 2000.
	tabling member constituency	Wolverhampton South West
	tabling member printed	Paul Uppal
	uin	215682
	answer	answer is ministerial correction date of answer 01/12/2014 answer text <p><strong> </strong></p><p> </p><p>The Health and Social Care Information Centre (HSCIC) has provided data on (a) a count of finished admission episodes (FAEs) where there was a primary diagnosis of pulmonary embolism and the number of FAEs as a rate per 100,000 of the total number of FAEs and (b) a count of finished consultant episodes (FCEs) with a primary or secondary diagnosis of pulmonary embolism and the number of FCEs as a rate per 100,000 of the total number FCEs, for the years 2000-01 to 2012-13.</p><p> </p><p>This is summarised in the following table:</p><p> </p><table><tbody><tr><td><p>Year</p></td><td><p>FAEs with primary diagnosis of &quot;pulmonary embolism&quot;</p></td><td><p>Rate per 100,000 of total FAEs</p></td><td><p>FCEs with primary or secondary diagnosis of &quot;pulmonary embolism&quot;</p></td><td><p>Rate per 100,000 of total FCEs</p></td></tr><tr><td><p>2000-01</p></td><td><p>15,179</p></td><td><p>136.5</p></td><td><p>32,937</p></td><td><p>268.6</p></td></tr><tr><td><p>2001-02</p></td><td><p>14,735</p></td><td><p>133.0</p></td><td><p>33,537</p></td><td><p>271.8</p></td></tr><tr><td><p>2002-03</p></td><td><p>15,536</p></td><td><p>136.6</p></td><td><p>37,093</p></td><td><p>291.8</p></td></tr><tr><td><p>2003-04</p></td><td><p>16,095</p></td><td><p>136.3</p></td><td><p>39,196</p></td><td><p>294.8</p></td></tr><tr><td><p>2004-05</p></td><td><p>15,621</p></td><td><p>129.1</p></td><td><p>40,059</p></td><td><p>292.3</p></td></tr><tr><td><p>2005-06</p></td><td><p>16,347</p></td><td><p>128.9</p></td><td><p>43,360</p></td><td><p>300.6</p></td></tr><tr><td><p>2006-07</p></td><td><p>16,629</p></td><td><p>128.1</p></td><td><p>46,685</p></td><td><p>315.8</p></td></tr><tr><td><p>2007-08</p></td><td><p>16,948</p></td><td><p>125.7</p></td><td><p>49,114</p></td><td><p>319.8</p></td></tr><tr><td><p>2008-09</p></td><td><p>18,214</p></td><td><p>128.7</p></td><td><p>56,029</p></td><td><p>345.2</p></td></tr><tr><td><p>2009-10</p></td><td><p>19,763</p></td><td><p>135.9</p></td><td><p>62,367</p></td><td><p>371.1</p></td></tr><tr><td><p>2010-11</p></td><td><p>20,908</p></td><td><p>140.4</p></td><td><p>67,477</p></td><td><p>390.7</p></td></tr><tr><td><p>2011-12</p></td><td><p>21,525</p></td><td><p>143.3</p></td><td><p>70,466</p></td><td><p>403.5</p></td></tr><tr><td><p>2012-13</p></td><td><p>23,578</p></td><td><p>155.7</p></td><td><p>79,058</p></td><td><p>446.3</p></td></tr></tbody></table><p> </p><p> </p><p> </p><p> </p><p> </p><p>Public Health England (PHE) collects data on blood stream infections caused by bacteria (bacteraemia) relating to specific organisms as part of its mandatory Healthcare Associated Infection surveillance programmes.</p><p> </p><p>Microbiology laboratories in England, Wales and Northern Ireland also voluntarily submit data to PHE relating to episodes of bacteraemia and blood stream infections caused by fungi (fungaemia).</p><p> </p><p>The data summarised in Tables 1-3, taken from PHE’s mandatory surveillance programmes, represent bacteraemia cases reported in England resulting from: Methicillin-resistant Staphylococcus aureus (MRSA); Methicillin-susceptible Staphylococcus aureus (MSSA) and E.coli where comparable data is available. Rates of all reported cases per 100,000 population are included, where available.</p><p> </p><table><tbody><tr><td colspan="8"><p>Table 1a: All reported cases of MRSA bacteraemia (April 2007-March 2014)</p><p> </p></td></tr><tr><td><p>Financial year</p></td><td><p>April 2007 to March 2008</p></td><td><p>April 2008 to March 2009</p></td><td><p>April 2009 to March 2010</p></td><td><p>April 2010 to March 2011</p></td><td><p>April 2011 to March 2012</p></td><td><p>April 2012 to March 2013</p></td><td><p>April 2013 to March 2014</p></td></tr><tr><td><p>Count</p></td><td><p>4,451</p></td><td><p>2,935</p></td><td><p>1,898</p></td><td><p>1,481</p></td><td><p>1,116</p></td><td><p>924</p></td><td><p>862</p></td></tr><tr><td><p>Rate per 100,000 population</p></td><td><p> </p></td><td><p> </p></td><td><p>3.6</p></td><td><p>2.8</p></td><td><p>2.1</p></td><td><p>1.7</p></td><td><p>1.6</p></td></tr></tbody></table><p> </p><p><em>Note: </em>Data is available at: <a href="https://www.gov.uk/government/statistics/mrsa-bacteraemia-annual-data" target="_blank">https://www.gov.uk/government/statistics/mrsa-bacteraemia-annual-data</a></p><p> </p><p> </p><p> </p><table><tbody><tr><td colspan="4"><p>Table 2: All reported cases of MSSA bacteraemia (April 2011 - March 2014)</p><p> </p></td></tr><tr><td><p>Financial year</p></td><td><p>April 2011 to March 2012</p></td><td><p>April 2012 to March 2013</p></td><td><p>April 2013 to March 2014</p></td></tr><tr><td><p>Count</p></td><td><p>8,767</p></td><td><p>8,812</p></td><td><p>9,290</p></td></tr><tr><td><p>Rate per 100,000 population</p></td><td><p>16.5</p></td><td><p>16.5</p></td><td><p>17.4</p></td></tr></tbody></table><p> </p><p><em>Note: </em>Data is available at: <a href="https://www.gov.uk/government/statistics/mssa-bacteraemia-annual-data" target="_blank">https://www.gov.uk/government/statistics/mssa-bacteraemia-annual-data</a></p><p> </p><p> </p><p> </p><table><tbody><tr><td colspan="3"><p>Table 3: All reported cases of <em>E. coli </em>bacteraemia (April 2012-March 2014)</p><p> </p></td></tr><tr><td><p>Financial year</p></td><td><p>April 2012 to March 2013</p></td><td><p>April 2013 to March 2014</p></td></tr><tr><td><p>Count</p></td><td><p>32,309</p></td><td><p>34,275</p></td></tr><tr><td><p>Rate per 100,000 population</p></td><td><p>60.4</p></td><td><p>64.1</p></td></tr></tbody></table><p> </p><p><em>Note: </em>Data is available at: <a href="https://www.gov.uk/government/statistics/escherichia-coli-e-coli-bacteraemia-annual-data" target="_blank">https://www.gov.uk/government/statistics/escherichia-coli-e-coli-bacteraemia-annual-data</a></p><p> </p><p>The data summarised in Table 4, taken from PHE’s voluntary surveillance database, represents all voluntarily reported patient episodes involving either bacteraemia and/or fungaemia for the period of January 2008 to December 2012 in England, Wales and Northern Ireland.</p><p> </p><table><tbody><tr><td colspan="6"><p>Table 4: Patient episodes involving either bacteraemia and/or fungaemia 2008-2012, England, Wales and Northern Ireland</p><p> </p></td></tr><tr><td><p>Calendar Year</p></td><td><p>2008</p></td><td><p>2009</p></td><td><p>2010</p></td><td><p>2011</p></td><td><p>2012</p></td></tr><tr><td><p>Count</p></td><td><p>95,931</p></td><td><p>94,190</p></td><td><p>92,867</p></td><td><p>94,166</p></td><td><p>95,647</p></td></tr></tbody></table><p> </p><p><em>Note: </em>Data extracted from the Public Health England (PHE) voluntary surveillance database, LabBase2, on 3 December 2013.</p><p> </p><p> </p><p> </p><p>Before 2009, information was not collated on foreign bodies retained after procedures (which is classed as a ‘never event’) and so we are unable to provide data for the period prior to 2009.</p><p> </p><p> </p><p> </p><p>In 2009-10, there were nine retained foreign objects post procedure reported during this period.</p><p> </p><p>In 2010-11, there were 67 retained foreign object never events reported to Strategic Executive Information System (STEIS) and 22 reported to the National Reporting and Learning Service (NRLS).</p><p> </p><p>In 2011-12, there were 161 retained foreign object never events reported to STEIS and 86 reported to the NRLS in 2011-12.</p><p> </p><p>In 2012-13, there were 130 retained foreign object never events reported to STEIS and 124 reported to the NRLS in 2012-13 (please note incidents are potentially reported to both systems but the exact degree of overlap of reported incidents during the period 2010-11 and 2011-12 is unclear).</p><p> </p><p> </p><p> </p><p>Since April 2013 reports made to the NRLS and STEIS have been directly reconciled to provide a single total and provisional data published by NHS England shows 123 retained object never events were reported in 2013-14 and 44 in the six months to September 2014:</p><p> </p><p> </p><p> </p><p><a href="http://www.england.nhs.uk/ourwork/patientsafety/never-events/ne-data/" target="_blank">http://www.england.nhs.uk/ourwork/patientsafety/never-events/ne-data/</a></p><p> </p><p> </p><p> </p><p>Methods for identifying and collating the data from two systems (NRLS and STEIS) have changed over the years, with specific reporting fields for Never events replacing keyword searches, and year-end attempts to reconcile events reported in both systems replaced with direct communication as and when incidents were reported. This is a further reason why events from the earlier years are not directly comparable. The numbers of Never Events reported for 2010-11 and 2011-12 were reported in Annex A of the ‘<em>The never events policy framework: An update to the never events policy</em>’</p><p> </p><p> </p><p> </p><p><a href="https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/213046/never-events-policy-framework-update-to-policy.pdf" target="_blank">https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/213046/never-events-policy-framework-update-to-policy.pdf</a></p><p> </p><p> </p><p> </p><p>It should be noted that the updated policy expanded the list of never events from 8 to 25 in 2012 and the detail of definitions of retained foreign objects was also clarified in The never events list; 2013/14 update:</p><p> </p><p> </p><p> </p><p><a href="http://www.england.nhs.uk/wp-content/uploads/2013/12/nev-ev-list-1314-clar.pdf" target="_blank">http://www.england.nhs.uk/wp-content/uploads/2013/12/nev-ev-list-1314-clar.pdf</a>.</p><p> </p><p> </p><p> </p><p>Note numbers in different years are not directly comparable due to these definitional changes.</p><p> </p><p> </p><p> </p><p><strong> </strong></p><p> </p><p><strong> </strong></p><p> </p> answering member constituency Central Suffolk and North Ipswich answering member printed Dr Daniel Poulter question first answered 01/12/2014 17:19:54 answering member 3932 label Biography information for Dr Dan Poulter
	tabling member	4078 label Biography information for Paul Uppal

164381

	registered interest
	date	24/11/2014
	answering body	Department of Health
	answering dept id	17
	answering dept short name	Health
	answering dept sort name	Health
	hansard heading	Patients: Safety
	house id	1
	legislature	25259 pref label House of Commons
	question text	To ask the Secretary of State for Health, how many hospitals have been rated poor with regards to open and honest reporting of patient safety incidents in each month since May 2010.
	tabling member constituency	Wolverhampton South West
	tabling member printed	Paul Uppal
	uin	215683
	answer	answer is ministerial correction date of answer 01/12/2014 answer text <p>As at 28 November 2014, 91 trusts were recorded as poor (red) against the open and honest reporting indicator. Data prior to June 2014 is not available in this form.</p><p> </p> answering member constituency Central Suffolk and North Ipswich answering member printed Dr Daniel Poulter question first answered 01/12/2014 17:30:33 answering member 3932 label Biography information for Dr Dan Poulter
	tabling member	4078 label Biography information for Paul Uppal

1657261

	registered interest
	date	01/09/2023
	answering body	Department of Health and Social Care
	answering dept id	17
	answering dept short name	Health and Social Care
	answering dept sort name	Health and Social Care
	hansard heading	Patients: Safety
	house id	1
	legislature	25259 pref label House of Commons
	question text	To ask the Secretary of State for Health and Social Care, what steps he is taking to ensure that the NHS responds to concerns raised by staff about potential harm to patients (a) appropriately and (b) swiftly.
	tabling member constituency	Solihull
	tabling member printed	Julian Knight
	uin	196896
	answer	answer is ministerial correction date of answer 25/09/2023 answer text <p>Last year, NHS England rolled out a strengthened Freedom to Speak Up policy, which covers the importance of listening to concerns and responding to concerns that are raised. All organisations providing services within the National Health Service are expected to adopt the updated national policy by 31 January 2024 at the latest. The National Guardian’s Office has also produced a training package aimed at all workers, including managers and senior leaders, which underlines the importance of responding to and acting on staff concerns.</p><p>There is also a network of Freedom to Speak Up Guardians, covering every trust, whose role includes ensuring the person who raises a concern is responded to and receives feedback on the actions taken.</p><p>Following the outcome of the trial of Lucy Letby, NHS England wrote to all NHS trusts to further emphasise the importance of NHS leaders listening to the concerns of patients, families and staff and following whistleblowing procedures.</p> answering member constituency Lewes answering member printed Maria Caulfield question first answered 25/09/2023 14:03:11 answering member 4492 label Biography information for Maria Caulfield
	tabling member	4410 label Biography information for Julian Knight

1657271

	registered interest
	date	01/09/2023
	answering body	Department of Health and Social Care
	answering dept id	17
	answering dept short name	Health and Social Care
	answering dept sort name	Health and Social Care
	hansard heading	Patients: Safety
	house id	1
	legislature	25259 pref label House of Commons
	question text	To ask the Secretary of State for Health and Social Care, whether there are protocols in place for mandatory external reviews after internal concerns on patient safety are raised within the NHS.
	tabling member constituency	Solihull
	tabling member printed	Julian Knight
	uin	196906
	answer	answer is ministerial correction date of answer 14/09/2023 answer text <p>From 2015, the National Health Service has followed the Serious Incident Framework to guide its response to serious incidents in the NHS. Details of this framework are available at the following link:</p><p><a href="https://www.england.nhs.uk/patient-safety/serious-incident-framework/" target="_blank">https://www.england.nhs.uk/patient-safety/serious-incident-framework/</a></p><p> </p><p>In response to evidence that this framework was not leading to sufficient patient safety improvement, the new Patient Safety Incident Response Framework (PSIRF) was developed, tested, and is now being implemented across the NHS. All NHS organisations contracted under the NHS standard contract are expected to transition to PSIRF in autumn 2023. More information is available at the following link:</p><p> </p><p><a href="https://www.england.nhs.uk/patient-safety/incident-response-framework/" target="_blank">https://www.england.nhs.uk/patient-safety/incident-response-framework/</a></p><p> </p><p>PSIRF has guidance for oversight bodies, including integrated care boards and NHS England regional teams, describing when it may be appropriate for those bodies to consider commissioning an independent patient safety incident investigation. The guidance is available at the following link:</p><p><a href="https://www.england.nhs.uk/wp-content/uploads/2022/08/B1465-4.-Oversight-roles-and-responsibilities-specification-v1-FINAL.pdf" target="_blank">https://www.england.nhs.uk/wp-content/uploads/2022/08/B1465-4.-Oversight-roles-and-responsibilities-specification-v1-FINAL.pdf</a></p><p> </p><p>Providers can also commission invited reviews from Royal Colleges, including in response to patient safety concerns. These provide independent and objective advice to provider boards. The reviews support but do not replace the processes of healthcare regulatory bodies, including the Care Quality Commission and the General Medical Council, or the provider’s own procedures for addressing and managing patient safety.</p><p> </p><p>NHS England will refresh ‘Maintaining High Professional Standards in the Modern NHS’, in line with current best practice and learning from incidents and reviews.</p> answering member constituency Lewes answering member printed Maria Caulfield grouped question UIN 196902 question first answered 14/09/2023 14:44:23 answering member 4492 label Biography information for Maria Caulfield
	tabling member	4410 label Biography information for Julian Knight

1657277

	registered interest
	date	01/09/2023
	answering body	Department of Health and Social Care
	answering dept id	17
	answering dept short name	Health and Social Care
	answering dept sort name	Health and Social Care
	hansard heading	Patients: Safety
	house id	1
	legislature	25259 pref label House of Commons
	question text	To ask the Secretary of State for Health and Social Care, what guidance his Department provides hospitals on involving the police in investigations related to patient harm.
	tabling member constituency	Solihull
	tabling member printed	Julian Knight
	uin	196912
	answer	answer is ministerial correction date of answer 12/09/2023 answer text <p>NHS England’s Serious Incident Framework sets out the key principles of serious incident management and defines the roles and responsibilities of those involved in the management of serious incidents, including the police and those providing National Health Service healthcare services.</p><p>The Department’s ‘Memorandum of understanding: investigating patient safety incidents involving unexpected death or serious untoward harm’, published in 2006, also provides a source for reference where a serious incident occurs in a healthcare setting and an investigation is also required by the police, the Health and Safety Executive and/or the coroner. The NHS, the Association of Chief Police Officers (now the National Police Chiefs' Council) and the Health and Safety Executive are party to this agreement.</p> answering member constituency Lewes answering member printed Maria Caulfield question first answered 12/09/2023 10:06:51 answering member 4492 label Biography information for Maria Caulfield
	tabling member	4410 label Biography information for Julian Knight

166013

	registered interest
	date	25/11/2014
	answering body	Department of Health
	answering dept id	17
	answering dept short name	Health
	answering dept sort name	Health
	hansard heading	Patients: Safety
	house id	1
	legislature	25259 pref label House of Commons
	question text	To ask the Secretary of State for Health, how the findings of the friends and family test are being used to improve patient safety in the NHS.
	tabling member constituency	Wolverhampton South West
	tabling member printed	Paul Uppal
	uin	215852
	answer	answer is ministerial correction date of answer 02/12/2014 answer text <p>The Friends and Family Test (FFT) was implemented as a mechanism to provide near real-time feedback to identify both good and poor quality patient experience. Whilst the FFT aims to capture overall patient experience, part of the experience that patients may choose to comment on is whether they felt their care was safe. This information can then be used by providers to consider what they do well and make improvements where feedback is less positive. Commissioners and regulators monitor the results of the FFT and the Care Quality Commission (CQC) uses the data - together with other data such as mortality rates and ‘never events’ - as part of its new ‘Hospital Intelligence Monitoring’. The monitoring service gives the CQC an understanding of areas of care that need to be further investigated by inspectors:</p><p> </p><p> </p><p> </p><p><a href="http://www.cqc.org.uk/public/hospital-intelligent-monitoring" target="_blank">http://www.cqc.org.uk/public/hospital-intelligent-monitoring</a></p><p> </p><p> </p><p> </p><p>In April 2014, the Staff FFT was introduced to allow staff feedback on NHS Services based on recent experience. The Staff FFT asks staff to rate and comment on where they work as a place to work and as a place of care. This information can then be used by employers to consider what they do well and make improvements where feedback is less positive.</p><p> </p><p> </p><p> </p><p>Commissioners and regulators also monitor the results of the Staff FFT, and the CQC uses this data as part of their Intelligent Monitoring system. The response to this question is also displayed as a key patient safety indicator on NHS Choices:</p><p> </p><p> </p><p> </p><p><a href="http://www.nhs.uk/NHSEngland/thenhs/patient-safety/Pages/patient-safety-indicators.aspx" target="_blank">http://www.nhs.uk/NHSEngland/thenhs/patient-safety/Pages/patient-safety-indicators.aspx</a></p><p> </p><p> </p><p> </p><p>In addition, hospital boards and other providers and commissioners of services can consider the results of the FFT to consider the implications for quality and safety. A NHS England review of the FFT found that it is performing well as a service improvement tool, with 85% of trusts reporting that it is being used to improve patient experience, and 78% saying that FFT has increased the emphasis placed on patient experience in their trusts.</p><p> </p><p> </p><p> </p><p> </p><p> </p> answering member constituency Central Suffolk and North Ipswich answering member printed Dr Daniel Poulter question first answered 02/12/2014 17:04:04 answering member 3932 label Biography information for Dr Dan Poulter
	tabling member	4078 label Biography information for Paul Uppal

1663502

	registered interest
	date	13/10/2023
	answering body	Department of Health and Social Care
	answering dept id	17
	answering dept short name	Health and Social Care
	answering dept sort name	Health and Social Care
	hansard heading	Patients: Safety
	house id	1
	legislature	25259 pref label House of Commons
	question text	To ask the Secretary of State for Health and Social Care, what assessment he has made of the level of public awareness of the National Reporting and Learning System; and whether he is taking steps to raise awareness of the system.
	tabling member constituency	Lewisham, Deptford
	tabling member printed	Vicky Foxcroft
	uin	201356
	answer	answer is ministerial correction date of answer 23/10/2023 answer text <p>The National Reporting and Learning System (NRLS) has been in operation since 2003 and supports NHS England to fulfil statutory duties relating to the collation of and learning from patient safety incident reports.</p><p> </p><p>NRLS is principally a secondary use service and collects patient safety incident records that are recorded on healthcare providers’ Local Risk Management Systems (LRMS). The primary use of patient safety incident records is by the provider organisation that collects the data on its own LRMS and uses the information to support local safety improvement efforts. NRLS was created to support the national collation of patient safety incident records from LRMS and some of the existing LRMS predate the introduction of the NRLS.</p><p> </p><p>Given its age, NRLS is being replaced with the new Learn From Patient Safety Events (LFPSE) service. More information is available at the following link:</p><p> </p><p><a href="https://www.england.nhs.uk/patient-safety/learn-from-patient-safety-events-service/" target="_blank">https://www.england.nhs.uk/patient-safety/learn-from-patient-safety-events-service/</a></p><p> </p><p>NRLS, and its replacement LFPSE, support the collation of patient safety incident records from members of the public as well as from LRMS. NRLS does this through the Patient and Public eForm, which is available at the following link:</p><p> </p><p><a href="https://www.england.nhs.uk/patient-safety/report-patient-safety-incident/#public" target="_blank">https://www.england.nhs.uk/patient-safety/report-patient-safety-incident/#public</a></p><p> </p><p>As part of the development of the LFPSE service, work is underway to determine how best to support the future collection of patient safety incidents information from patients and the public. A report on the first stage of this work, published in October 2023, is available at the following link:</p><p> </p><p><a href="https://www.england.nhs.uk/publication/the-learn-from-patient-safety-events-lfpse-service-patient-and-family-discovery-report/" target="_blank">https://www.england.nhs.uk/publication/the-learn-from-patient-safety-events-lfpse-service-patient-and-family-discovery-report/</a></p><p> </p><p>Information on how patient safety incident records are collated and used by NHS England is available at the following link:</p><p> </p><p><a href="https://www.england.nhs.uk/patient-safety/using-patient-safety-events-data-to-keep-patients-safe/" target="_blank">https://www.england.nhs.uk/patient-safety/using-patient-safety-events-data-to-keep-patients-safe/</a></p><p> </p><p>No data is held on patient safety incident recording prior to the introduction of the NRLS in 2003. Data on the number of patient safety incidents collected by NRLS is available at the following link:</p><p> </p><p><a href="https://www.england.nhs.uk/patient-safety/national-patient-safety-incident-reports/" target="_blank">https://www.england.nhs.uk/patient-safety/national-patient-safety-incident-reports/</a></p> answering member constituency Lewes answering member printed Maria Caulfield grouped question UIN 201357 201358 question first answered 23/10/2023 11:52:59 answering member 4492 label Biography information for Maria Caulfield
	tabling member	4491 label Biography information for Vicky Foxcroft

1663503

	registered interest
	date	13/10/2023
	answering body	Department of Health and Social Care
	answering dept id	17
	answering dept short name	Health and Social Care
	answering dept sort name	Health and Social Care
	hansard heading	Patients: Safety
	house id	1
	legislature	25259 pref label House of Commons
	question text	To ask the Secretary of State for Health and Social Care, how the National Reporting and Learning System works alongside independent reports to individual (a) clinics, (b) hospitals, (c) Patient Advice and Liaison Services and (d) Clinical Commissioning Groups which are dealt with in-house.
	tabling member constituency	Lewisham, Deptford
	tabling member printed	Vicky Foxcroft
	uin	201357
	answer	answer is ministerial correction date of answer 23/10/2023 answer text <p>The National Reporting and Learning System (NRLS) has been in operation since 2003 and supports NHS England to fulfil statutory duties relating to the collation of and learning from patient safety incident reports.</p><p> </p><p>NRLS is principally a secondary use service and collects patient safety incident records that are recorded on healthcare providers’ Local Risk Management Systems (LRMS). The primary use of patient safety incident records is by the provider organisation that collects the data on its own LRMS and uses the information to support local safety improvement efforts. NRLS was created to support the national collation of patient safety incident records from LRMS and some of the existing LRMS predate the introduction of the NRLS.</p><p> </p><p>Given its age, NRLS is being replaced with the new Learn From Patient Safety Events (LFPSE) service. More information is available at the following link:</p><p> </p><p><a href="https://www.england.nhs.uk/patient-safety/learn-from-patient-safety-events-service/" target="_blank">https://www.england.nhs.uk/patient-safety/learn-from-patient-safety-events-service/</a></p><p> </p><p>NRLS, and its replacement LFPSE, support the collation of patient safety incident records from members of the public as well as from LRMS. NRLS does this through the Patient and Public eForm, which is available at the following link:</p><p> </p><p><a href="https://www.england.nhs.uk/patient-safety/report-patient-safety-incident/#public" target="_blank">https://www.england.nhs.uk/patient-safety/report-patient-safety-incident/#public</a></p><p> </p><p>As part of the development of the LFPSE service, work is underway to determine how best to support the future collection of patient safety incidents information from patients and the public. A report on the first stage of this work, published in October 2023, is available at the following link:</p><p> </p><p><a href="https://www.england.nhs.uk/publication/the-learn-from-patient-safety-events-lfpse-service-patient-and-family-discovery-report/" target="_blank">https://www.england.nhs.uk/publication/the-learn-from-patient-safety-events-lfpse-service-patient-and-family-discovery-report/</a></p><p> </p><p>Information on how patient safety incident records are collated and used by NHS England is available at the following link:</p><p> </p><p><a href="https://www.england.nhs.uk/patient-safety/using-patient-safety-events-data-to-keep-patients-safe/" target="_blank">https://www.england.nhs.uk/patient-safety/using-patient-safety-events-data-to-keep-patients-safe/</a></p><p> </p><p>No data is held on patient safety incident recording prior to the introduction of the NRLS in 2003. Data on the number of patient safety incidents collected by NRLS is available at the following link:</p><p> </p><p><a href="https://www.england.nhs.uk/patient-safety/national-patient-safety-incident-reports/" target="_blank">https://www.england.nhs.uk/patient-safety/national-patient-safety-incident-reports/</a></p> answering member constituency Lewes answering member printed Maria Caulfield grouped question UIN 201356 201358 question first answered 23/10/2023 11:52:59 answering member 4492 label Biography information for Maria Caulfield
	tabling member	4491 label Biography information for Vicky Foxcroft

1663504

	registered interest
	date	13/10/2023
	answering body	Department of Health and Social Care
	answering dept id	17
	answering dept short name	Health and Social Care
	answering dept sort name	Health and Social Care
	hansard heading	Patients: Safety
	house id	1
	legislature	25259 pref label House of Commons
	question text	To ask the Secretary of State for Health and Social Care, how patient safety incidents were reported before the introduction of the National Reporting and Learning System (NRLS); and what data he holds on the number of such incidents recorded in (a) each of the five years (i) before and (ii) after the introduction of the NRLS and (b) in each of the last five years.
	tabling member constituency	Lewisham, Deptford
	tabling member printed	Vicky Foxcroft
	uin	201358
	answer	answer is ministerial correction date of answer 23/10/2023 answer text <p>The National Reporting and Learning System (NRLS) has been in operation since 2003 and supports NHS England to fulfil statutory duties relating to the collation of and learning from patient safety incident reports.</p><p> </p><p>NRLS is principally a secondary use service and collects patient safety incident records that are recorded on healthcare providers’ Local Risk Management Systems (LRMS). The primary use of patient safety incident records is by the provider organisation that collects the data on its own LRMS and uses the information to support local safety improvement efforts. NRLS was created to support the national collation of patient safety incident records from LRMS and some of the existing LRMS predate the introduction of the NRLS.</p><p> </p><p>Given its age, NRLS is being replaced with the new Learn From Patient Safety Events (LFPSE) service. More information is available at the following link:</p><p> </p><p><a href="https://www.england.nhs.uk/patient-safety/learn-from-patient-safety-events-service/" target="_blank">https://www.england.nhs.uk/patient-safety/learn-from-patient-safety-events-service/</a></p><p> </p><p>NRLS, and its replacement LFPSE, support the collation of patient safety incident records from members of the public as well as from LRMS. NRLS does this through the Patient and Public eForm, which is available at the following link:</p><p> </p><p><a href="https://www.england.nhs.uk/patient-safety/report-patient-safety-incident/#public" target="_blank">https://www.england.nhs.uk/patient-safety/report-patient-safety-incident/#public</a></p><p> </p><p>As part of the development of the LFPSE service, work is underway to determine how best to support the future collection of patient safety incidents information from patients and the public. A report on the first stage of this work, published in October 2023, is available at the following link:</p><p> </p><p><a href="https://www.england.nhs.uk/publication/the-learn-from-patient-safety-events-lfpse-service-patient-and-family-discovery-report/" target="_blank">https://www.england.nhs.uk/publication/the-learn-from-patient-safety-events-lfpse-service-patient-and-family-discovery-report/</a></p><p> </p><p>Information on how patient safety incident records are collated and used by NHS England is available at the following link:</p><p> </p><p><a href="https://www.england.nhs.uk/patient-safety/using-patient-safety-events-data-to-keep-patients-safe/" target="_blank">https://www.england.nhs.uk/patient-safety/using-patient-safety-events-data-to-keep-patients-safe/</a></p><p> </p><p>No data is held on patient safety incident recording prior to the introduction of the NRLS in 2003. Data on the number of patient safety incidents collected by NRLS is available at the following link:</p><p> </p><p><a href="https://www.england.nhs.uk/patient-safety/national-patient-safety-incident-reports/" target="_blank">https://www.england.nhs.uk/patient-safety/national-patient-safety-incident-reports/</a></p> answering member constituency Lewes answering member printed Maria Caulfield grouped question UIN 201356 201357 question first answered 23/10/2023 11:52:59 answering member 4492 label Biography information for Maria Caulfield
	tabling member	4491 label Biography information for Vicky Foxcroft

1668521

	registered interest
	date	08/11/2023
	answering body	Department of Health and Social Care
	answering dept id	17
	answering dept short name	Health and Social Care
	answering dept sort name	Health and Social Care
	hansard heading	Patients: Safety
	house id	1
	legislature	25259 pref label House of Commons
	question text	To ask the Secretary of State for Health and Social Care, what accountability mechanisms are included in the NHS England Learn from Patient Safety Events system to hold (a) commissioners and (b) providers to account on patient safety (i) records and (ii) incidences.
	tabling member constituency	Strangford
	tabling member printed	Jim Shannon
	uin	805
	answer	answer is ministerial correction date of answer 15/11/2023 answer text <p>Any unexpected or unintended incident which could have or did lead to harm to one or more patients can be recorded on the Learn from Patient Safety Events (LFPSE) service, to support local and national learning. This would include incidents caused by surgical fires or burns.</p><p>Providers are encouraged to foster a positive safety culture among their staff, and ensure an appropriate local focus on incident recognition, recording, and response.</p><p>Recording onto LFPSE is a voluntary process, except where reporting to NHS England fulfils duties for other statutory mandatory requirements, such as reporting notifiable incidents to the Care Quality Commission (CQC). NHS England shares all such data with the CQC. Notifiable incidents include events resulting in “serious harm” or the death of a service user, and therefore the most serious surgical fires or burns are subject to mandatory reporting. However, providers are encouraged to record all patient safety incidents, irrespective of the level of harm, to support local and national learning.</p><p>Published National Safety Standards for Invasive Procedures include a requirement for a risk assessment and management plan to minimise the risk of surgical fires in the perioperative environment. They require that multidisciplinary team training should involve rehearsal and analysis of typical and emergency scenarios, such as a surgical fire, and that prior to surgery, any fire risk and the management plan are discussed and confirmed.</p><p>LFPSE is not designed for performance management. However, it supports certain oversight functions within providers, including the ability to review all records submitted by staff, and to mark them as either meeting certain other requirements, such as notification to the CQC, or not. This supports good governance within the provider, encouraging scrutiny of recorded events, and the fulfilment of other statutory or national policy reporting requirements. LFPSE data is being made available to integrated care boards and regional teams to facilitate their roles in safety oversight and provider improvement support.</p><p>NHS England does not hold or collect information on the number of surgical fires which occur. Although incidents where serious harm and death are captured within LFPSE, and trusts may choose to record lower levels of harm, there is no category for surgical fires within the existing reporting system with which they could be counted and therefore any count would not be definitive.</p> answering member constituency Lewes answering member printed Maria Caulfield grouped question UIN 804 806 807 808 question first answered 15/11/2023 17:25:08 answering member 4492 label Biography information for Maria Caulfield
	tabling member	4131 label Biography information for Jim Shannon

1690168

	registered interest
	date	19/02/2024
	answering body	Department of Health and Social Care
	answering dept id	17
	answering dept short name	Health and Social Care
	answering dept sort name	Health and Social Care
	hansard heading	Patients: Safety
	house id	2
	legislature	25277 pref label House of Lords
	question text	To ask His Majesty's Government what assessment they have made of the comments by the Royal College of Nursing that the fall in each of the past three years in applications to university nursing courses is a direct threat to patient safety, and what actions they are taking to improve patient safety in England.
	tabling member printed	Lord Allen of Kensington
	uin	HL2513
	answer	answer is ministerial correction date of answer 29/02/2024 answer text <p>The number of applicants continues to outstrip the places on offer. Nursing training places are competitive, and lead to an attractive and important career in the National Health Service.</p><p>Record numbers of nurses are now working in the NHS, and the first ever NHS Long Term Workforce Plan, backed by over £2.4 billion of funding, will add 24,000 more nurse and midwifery training places by 2031.</p><p>Over the last decade, the Government and system partners have delivered major initiatives to advance patient safety in the NHS. This includes implementing the first NHS Patient Safety Strategy, establishing the independent Health Services Safety Investigations Body to address the most serious patient safety incidents, and appointing the first Patient Safety Commissioner to champion the patient voice in relation to the safety of medicines and medical devices.</p> answering member printed Lord Markham question first answered 29/02/2024 16:15:39 answering member 4948 label Biography information for Lord Markham
	tabling member	4304 label Biography information for Lord Allen of Kensington

1692731

	registered interest
	date	29/02/2024
	answering body	Department of Health and Social Care
	answering dept id	17
	answering dept short name	Health and Social Care
	answering dept sort name	Health and Social Care
	hansard heading	Patients: Safety
	house id	1
	legislature	25259 pref label House of Commons
	question text	To ask the Secretary of State for Health and Social Care, how her Department records instances of near misses for (a) surgical fires and (b) other patient safety incidences.
	tabling member constituency	Strangford
	tabling member printed	Jim Shannon
	uin	16354
	answer	answer is ministerial correction date of answer 08/03/2024 answer text <p>Any unexpected or unintended incident which could have or did lead to harm to one or more patients can be recorded on the Learn from Patient Safety Events (LFPSE) service, to support local and national learning. This can include surgical fires or burns. We are informed that NHS England does not define the severity of harm related to surgical fires or burns specifically. Grading the severity of harm related to a patient safety incident that is recorded on LFPSE, should be done using NHS England’s guidance on recording patient safety events and levels of harm, which asks that near miss events be graded as no harm. The guidance is available at the following link:</p><p> </p><p><a href="https://www.england.nhs.uk/long-read/policy-guidance-on-recording-patient-safety-events-and-levels-of-harm/" target="_blank">https://www.england.nhs.uk/long-read/policy-guidance-on-recording-patient-safety-events-and-levels-of-harm/</a></p><p> </p><p>If a surgical fire or burn is assessed locally and constitutes a patient safety event, it would fall under the scope of the Care Quality Commission’s (CQC) Regulations 16 or 18, and must be reported to the CQC. This means that the most serious surgical fires or burns which result in serious harm or the death of a service user, are subject to mandatory reporting. NHS trusts can comply with this requirement by recording patient safety events using the LFPSE service, and NHS England shares all such data with the CQC, who are responsible for regulating compliance with CQC regulations. CQC Regulations 16 and 18 are available respectively, at the following links:</p><p> </p><p><a href="https://www.cqc.org.uk/guidance-providers/regulations/regulation-16-notification-death-service-user" target="_blank">https://www.cqc.org.uk/guidance-providers/regulations/regulation-16-notification-death-service-user</a></p><p> </p><p><a href="https://www.cqc.org.uk/guidance-providers/regulations-enforcement/regulation-18-notification-other-incidents" target="_blank">https://www.cqc.org.uk/guidance-providers/regulations-enforcement/regulation-18-notification-other-incidents</a></p><p> </p><p>Although the recording of wider patient safety events onto LFPSE is a voluntary process, providers are encouraged to record all patient safety incidents, irrespective of the level of harm, to support local and national learning.</p><p> </p><p>The LFPSE service and its predecessor, the National Reporting and Learning System, do not have specific categories for surgical fires or burns. Determining how many patient safety events related to surgical fires or burns were recorded by National Health Service providers in each of the last five years would require a search of the free text of recorded patient safety events, using key words, and a subsequent expert clinical review of all potential records to determine relevance to the question. This could only be provided at disproportionate cost.</p> answering member constituency Lewes answering member printed Maria Caulfield grouped question UIN 16353 16355 question first answered 08/03/2024 14:06:43 answering member 4492 label Biography information for Maria Caulfield
	tabling member	4131 label Biography information for Jim Shannon

1700337

	registered interest
	date	12/04/2024
	answering body	Department of Health and Social Care
	answering dept id	17
	answering dept short name	Health and Social Care
	answering dept sort name	Health and Social Care
	hansard heading	Patients: Safety
	house id	1
	legislature	25259 pref label House of Commons
	question text	To ask the Secretary of State for Health and Social Care, how many never events occurred within NHS England in each year since 2019; and how many and what proportion of these incidents involved Physician Associates in each year.
	tabling member constituency	South Shields
	tabling member printed	Mrs Emma Lewell-Buck
	uin	21054
	answer	answer is ministerial correction date of answer 17/04/2024 answer text <p>Information on Never Events is published by NHS England, and all available data on Never Events is available at the following link:</p><p><a href="https://eur03.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.england.nhs.uk%2Fpatient-safety%2Fnever-events-data%2F&amp;data=05%7C02%7Cjonathan.stones%40dhsc.gov.uk%7C01ce069ba0534a13ed8d08dc5d394868%7C61278c3091a84c318c1fef4de8973a1c%7C1%7C0%7C638487747817797496%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C0%7C%7C%7C&amp;sdata=OXO3AEoXR3j0kiT5wETru35oEd3BrgsFWwvxdso0HI4%3D&amp;reserved=0" target="_blank">https://www.england.nhs.uk/patient-safety/never-events-data/</a></p><p>NHS England does not collect specific data relating to Physician Associate involvement in Never Events, and as such the information is not held.</p> answering member constituency Lewes answering member printed Maria Caulfield question first answered 17/04/2024 08:58:36 answering member 4492 label Biography information for Maria Caulfield
	tabling member	4277 label Biography information for Mrs Emma Lewell-Buck

1701431

	registered interest
	date	16/04/2024
	answering body	Department of Health and Social Care
	answering dept id	17
	answering dept short name	Health and Social Care
	answering dept sort name	Health and Social Care
	hansard heading	Patients: Safety
	house id	1
	legislature	25259 pref label House of Commons
	question text	To ask the Secretary of State for Health and Social Care, what assessment she has made of the effectiveness of NHS speak up guardians in (a) primary and (b) secondary care settings.
	tabling member constituency	York Central
	tabling member printed	Rachael Maskell
	uin	22064
	answer	answer is ministerial correction date of answer 22/04/2024 answer text <p>Freedom to Speak Up Guardians are a valued channel through which concerns can be raised, and have handled over 100,000 cases since the National Guardian’s Office first started collecting data in 2017. This represents over 100,000 opportunities for learning and improvement. In 2022/23 alone over 25,000 cases were raised with Freedom to Speak Up Guardians and over four-fifths, or 82.2% of those who gave feedback to their Freedom to Speak Up Guardian, said they would speak up again.</p> answering member constituency Pendle answering member printed Andrew Stephenson question first answered 22/04/2024 10:55:12 answering member 4044 label Biography information for Andrew Stephenson
	tabling member	4471 label Biography information for Rachael Maskell

177532

	registered interest
	date	03/02/2015
	answering body	Department of Health
	answering dept id	17
	answering dept short name	Health
	answering dept sort name	Health
	hansard heading	Patients: Safety
	house id	1
	legislature	25259 pref label House of Commons
	question text	To ask the Secretary of State for Health, how many Strategic Executive Information System reports dating from before the Health and Social Care Act 2012 are waiting conclusion.
	tabling member constituency	Liverpool, Wavertree
	tabling member printed	Luciana Berger
	uin	223214
	answer	answer is ministerial correction date of answer 10/02/2015 answer text <p>Data and information safeguarding was strengthened under the Health and Social Care Act 2012. When data was extracted on 4 February the Strategic Executive Information System (STEIS) held reports of 1,255 Serious Incidents whose status was not classified as ‘closed’. It is not possible to determine from the database which of these incidents had been resolved locally.</p><p> </p><p> </p><p> </p><p>The principles for responding to Serious Incidents are set out in the current Serious Incident Framework, published in March 2013, and this includes the roles and responsibilities of providers and commissioners including effective governance and learning from a serious incident.</p><p> </p><p> </p><p> </p><p>NHS England is currently refreshing the Serious Incident Framework to take account of supporting all the guidance produced since March 2013 over 2013-14 and to reflect operational feedback on the implementation of the 2013 Framework.</p><p> </p> answering member constituency Central Suffolk and North Ipswich answering member printed Dr Daniel Poulter question first answered 10/02/2015 18:02:58 answering member 3932 label Biography information for Dr Dan Poulter
	tabling member	4036 label Biography information for Luciana Berger

178541

	registered interest
	date	09/02/2015
	answering body	Department of Health
	answering dept id	17
	answering dept short name	Health
	answering dept sort name	Health
	hansard heading	Patients: Safety
	house id	1
	legislature	25259 pref label House of Commons
	question text	To ask the Secretary of State for Health, with reference to Patient Safety Alert: Improving medication error incident reporting and learning, published by NHS England on 20 March 2014, which NHS trusts have (a) indentified a board-level director with responsibility for overseeing medication error incident reporting and learning, (b) e-mailed the contact details of a Medication Safety Officer to the Central Alerting System and (c) identified a multi-professional group to regularly review medication error incident reports.
	tabling member constituency	Newcastle upon Tyne North
	tabling member printed	Catherine McKinnell
	uin	223770
	answer	answer is ministerial correction date of answer 24/02/2015 answer text <p>Data was extracted on 10 February 2015 from the Central Alerting System (CAS) and the table attached shows that 244 trusts* have recorded that they have completed the actions required by the Alert including the information requested above.</p><p> </p><p> </p><p> </p><p><em>*Note:</em> This figure is based on the names that trusts are registered under in CAS.</p><p> </p> answering member constituency Central Suffolk and North Ipswich answering member printed Dr Daniel Poulter question first answered 24/02/2015 14:27:11 answering member 3932 label Biography information for Dr Dan Poulter attachment 1 file name Table of actions.docx title CAS- Trusts with contact details&completed actions
	tabling member	4125 label Biography information for Catherine McKinnell

178543

	registered interest
	date	09/02/2015
	answering body	Department of Health
	answering dept id	17
	answering dept short name	Health
	answering dept sort name	Health
	hansard heading	Patients: Safety
	house id	1
	legislature	25259 pref label House of Commons
	question text	To ask the Secretary of State for Health, with reference to Patient Safety Alert: Improving medication error incident reporting and learning, published by NHS England on 20 March 2014, what progress he has made in developing the National Medication Safety Network; and what channels are available for patient groups to make representations to the National Medication Safety Network.
	tabling member constituency	Newcastle upon Tyne North
	tabling member printed	Catherine McKinnell
	uin	223771
	answer	answer is ministerial correction date of answer 24/02/2015 answer text <p>NHS England, in collaboration with the Medicines and Healthcare products Regulatory Agency (MHRA), has carried out the following activities in relation to developing the National Medication Safety Network:</p><p> </p><p> </p><p> </p><p>- Undertaken nine web events with presentations and recordings posted to the <a href="http://www.patientsafetyfirst.nhs.uk/" target="_blank">www.patientsafetyfirst.nhs.uk</a> web forum accessed by Medication Safety Officers (MSOs). A total of 699 MSOs have participated in these formal web meetings.</p><p> </p><p>- Run a conference for MSOs on 19 January 2015 with keynote speakers from NHS England, MHRA and the National Reporting and Learning System with 150 MSOs in attendance.</p><p> </p><p>- Run dedicated web events for the 18 Community Pharmacy MSOs.</p><p> </p><p>- Are arranging one-day regional meetings on 10 March 2015 (London), 15 July 2015 (Midlands) 12 May (South), 14 October (North) inviting 70-100 MSOs. A key aim of these events is to provide the opportunity for MSOs to feedback in person to NHS England and the MHRA on development of the MSO role.</p><p> </p><p>- We have dedicated (0.4 full-time equivalent) support for development of the MSO role from the Specialist Pharmacy Service. The remit includes monitoring of engagement by MSOs in the network.</p><p> </p><p> </p><p> </p><p>Although the NHS England Medication Safety team have not yet received any formal representations from national patient groups, MSOs have been encouraged to liaise with their local organisation ‘patient and public voice’ leads to help recruit patients onto their medication safety committees.</p><p> </p><p> </p><p> </p><p>Members of the public and patient groups can also make enquiries directly to NHS England.</p><p> </p> answering member constituency Central Suffolk and North Ipswich answering member printed Dr Daniel Poulter question first answered 24/02/2015 14:08:53 answering member 3932 label Biography information for Dr Dan Poulter
	tabling member	4125 label Biography information for Catherine McKinnell

225215

	registered interest
	date	04/03/2015
	answering body	Department of Health
	answering dept id	17
	answering dept short name	Health
	answering dept sort name	Health
	hansard heading	Patients: Safety
	house id	1
	legislature	25259 pref label House of Commons
	question text	To ask the Secretary of State for Health, how many and what proportion of NHS staff have signed up to the five NHS Sign up to Safety pledges.
	tabling member constituency	Liverpool, Wavertree
	tabling member printed	Luciana Berger
	uin	226441
	answer	answer is ministerial correction date of answer 09/03/2015 answer text <p>To date 236 organisations from across the National Health Service in England have signed up to the campaign and made their five pledges on behalf of all of their members of staff. This includes 86% of acute, 68% of community and 54% of mental health providers and 50% of ambulance trusts plus a range of other health related organisations at frontline regional and national level<strong>*</strong>.</p><p> </p><p> </p><p> </p><p>Individuals everywhere are also able to sign up to the campaign and make their own pledges online. Currently we have around 250 individuals who have done this so far from a wide variety of organisation types. The campaign has focused in its first year on engaging organisations and in its second year will focus on individual involvement.</p><p> </p><p> </p><p> </p><p>Organisations who have joined the Sign up to Safety community commit to turning their five pledges into a personalised Safety Improvement Plan. These plans are derived from working with their staff on what matters to them and sets out their ambition and focus for the next three years for how their staff will take action to support the NHS shared goal of halving avoidable harm and saving lives.</p><p> </p><p> </p><p> </p><p><strong>*</strong>Percentage figures derive from publicly available numbers from 2013, accessible on the NHS Confederation’s website.</p><p> </p> answering member constituency Central Suffolk and North Ipswich answering member printed Dr Daniel Poulter question first answered 09/03/2015 15:59:39 answering member 3932 label Biography information for Dr Dan Poulter
	tabling member	4036 label Biography information for Luciana Berger

227871

	registered interest
	date	17/03/2015
	answering body	Department of Health
	answering dept id	17
	answering dept short name	Health
	answering dept sort name	Health
	hansard heading	Patients: Safety
	house id	1
	legislature	25259 pref label House of Commons
	question text	To ask the Secretary of State for Health, how many Never events were investigated by NHS England in each year since 2012; how many and what proportion of those events related to mental health patients; what criteria NHS England uses to investigate incidents reported to the Strategic Executive Information System; and what mechanisms exist to ensure that actions and recommendations relating to the investigation of such incidents are implemented locally.
	tabling member constituency	Liverpool, Wavertree
	tabling member printed	Luciana Berger
	uin	227903
	answer	answer is ministerial correction date of answer 23/03/2015 answer text <p>NHS England does not investigate individual ‘never events’ since this is the responsibility of the provider of care within which the serious incident occurred.</p><p> </p><p> </p><p> </p><p>Never events are types of Serious Incidents as defined by the Serious Incident Framework (available online at: <a href="http://www.england.nhs.uk/wp-content/uploads/2013/03/sif-guide.pdf" target="_blank">http://www.england.nhs.uk/wp-content/uploads/2013/03/sif-guide.pdf</a>) and must be reported to the Strategic Executive Information System (STEIS) and investigated in accordance with this Framework. There are 25 never events categories defined in the current list within the companion Never Events Policy Framework which is available online at:</p><p> </p><p> </p><p> </p><p><a href="https://www.gov.uk/government/publications/healthcare-never-events-policy-framework-update" target="_blank">https://www.gov.uk/government/publications/healthcare-never-events-policy-framework-update</a></p><p> </p><p> </p><p> </p><p>The number of never events reported is published monthly by category on NHS England’s website:</p><p> </p><p> </p><p> </p><p><a href="http://www.england.nhs.uk/ourwork/patientsafety/never-events/ne-data/" target="_blank">http://www.england.nhs.uk/ourwork/patientsafety/never-events/ne-data/</a></p><p> </p><p> </p><p> </p><p>Although there are two never event categories directly relevant to mental health (13. ‘Suicide using non-collapsible rails’ and 14. ‘Escape of a transferred prisoner’), never event reports are not classified by care setting.</p><p> </p><p> </p><p> </p><p>There were 338 never events reported to the STEIS in financial year 2013/14, one of which involved the escape of a transferred patient from a mental health facility. In 2012/13 290 never events were reported to STEIS, one of which again involved the escape of a transferred patient from a mental health facility. There were no reports in either year associated with the category ‘suicide using a collapsible rail’. Mental health patients may have experienced never events in other categories.</p><p> </p><p> </p><p> </p><p>As described within the Serious Incident Framework, it is the provider of the care, within which the serious incident occurred, that is responsible for reporting, investigating and responding to the serious incident. Commissioners are accountable for quality-assuring the robustness of their providers’ investigations and the development and implementation of effective actions by the provider, to prevent recurrence of similar incidents. Serious incident investigations should be closed by the relevant commissioner when they are satisfied that the investigation report and action plan meet the required standard. Providers and commissioners are expected to establish mechanisms for monitoring on-going or long-term actions to ensure they are fully implemented.</p><p> </p> answering member constituency Central Suffolk and North Ipswich answering member printed Dr Daniel Poulter question first answered 23/03/2015 17:53:29 answering member 3932 label Biography information for Dr Dan Poulter
	tabling member	4036 label Biography information for Luciana Berger

227872

	registered interest
	date	17/03/2015
	answering body	Department of Health
	answering dept id	17
	answering dept short name	Health
	answering dept sort name	Health
	hansard heading	Patients: Safety
	house id	1
	legislature	25259 pref label House of Commons
	question text	To ask the Secretary of State for Health, how many categories of a Never ever event there are which must be reported to the Strategic Executive Information System; and how many and what proportion of those categories are relevant to mental health.
	tabling member constituency	Liverpool, Wavertree
	tabling member printed	Luciana Berger
	uin	227904
	answer	answer is ministerial correction date of answer 23/03/2015 answer text <p>There are 25 serious incident categories classified as ‘never events’. All of these incidents must be reported to the Strategic Executive Information System. A never event is a serious, largely preventable patient safety incident that should not occur if the available preventative measures are implemented. Although there are two never event categories which are directly relevant to mental health (<em>13.</em> <em>Suicide using non-collapsible rails</em> and <em>14.</em> <em>Escape of a transferred prisoner</em>) never event reports are not classified by care setting.</p><p> </p> answering member constituency Central Suffolk and North Ipswich answering member printed Dr Daniel Poulter question first answered 23/03/2015 17:54:24 answering member 3932 label Biography information for Dr Dan Poulter
	tabling member	4036 label Biography information for Luciana Berger

228161

	registered interest
	date	18/03/2015
	answering body	Department of Health
	answering dept id	17
	answering dept short name	Health
	answering dept sort name	Health
	hansard heading	Patients: Safety
	house id	1
	legislature	25259 pref label House of Commons
	question text	To ask the Secretary of State for Health, with reference to his Department's recent report, Culture change in the NHS, Cm 9009, whether he plans to place responsibility for patient safety alerts within (a) NHS England or (b) an arms-length organisation.
	tabling member constituency	Denton and Reddish
	tabling member printed	Andrew Gwynne
	uin	228119
	answer	answer is ministerial correction date of answer 23/03/2015 answer text <p>Healthcare providers are expected to implement all the actions contained in a patient safety alert that are relevant to them and ensure that all relevant parts of their organisation and staff are aware of the information and/or the required changes. Providers should be scrutinising the implementation of their alerts and satisfying themselves that the alerts are complete by the designated deadline.</p><p> </p><p> </p><p> </p><p>NHS England publishes monthly data about any trusts who have failed to declare compliance with stage one, two, or three of the National Patient Safety Alerting System’s (NaPSAS) alerts by their set due date. Provider compliance should also be an integral part of the commissioners’ responsibilities for improving quality.</p><p> </p><p> </p><p> </p><p>As part of its inspections, the Care Quality Commission (CQC) looks at how providers respond to patient safety alerts as evidence of how effectively they manage and address safety concerns, and how they use this as learning to improve their safety systems and processes. CQC is continuing to develop and embed its approach to the use of data and intelligence across all the sectors it regulates as an integral part of its new approach to inspections, and has given greater prominence to safety alerts in its revised surveillance model. CQC’s Intelligent Monitoring system for the Acute Sector includes a composite indicator around completion of safety alerts and CQC is currently considering whether this can be implemented for the other sectors it regulates. This contributes to providers’ overall risk scores, which inform both the scheduling and prioritisation of inspections and the identification of focus areas for inspections.</p><p> </p><p> </p><p> </p><p>Monitor is responsible for ensuring NHS foundation trusts are well-led so that they can provide quality care on a sustainable basis and would expect to be alerted by their providers of anything that might have a bearing on compliance with their licence including where there are significant issues regarding compliance with patient safety alerts. The NHS Trust Development Authority (TDA), as part of its oversight and escalation process, uses quality surveillance monitoring which it reviews on a monthly basis and which it uses to hold trusts to account for the timely compliance with alerts. This is undertaken via the TDA’s regular integrated delivery meetings with the trusts.</p><p> </p><p> </p><p> </p><p>The Government has agreed to consider with relevant organisations the options for transferring NHS England’s responsibilities for safety to a single national body and this will include responsibility for patent safety alerts. No decision has yet been taken about the specific functions to be transferred and until such time, NHS England will continue to be responsible for these functions.</p><p> </p><p> </p><p> </p> answering member constituency Central Suffolk and North Ipswich answering member printed Dr Daniel Poulter grouped question UIN 228067 228068 question first answered 23/03/2015 17:55:34 answering member 3932 label Biography information for Dr Dan Poulter
	tabling member	1506 label Biography information for Andrew Gwynne

228187

	registered interest
	date	18/03/2015
	answering body	Department of Health
	answering dept id	17
	answering dept short name	Health
	answering dept sort name	Health
	hansard heading	Patients: Safety
	house id	1
	legislature	25259 pref label House of Commons
	question text	To ask the Secretary of State for Health, how many NHS trusts and foundation trusts have had action taken against them for not implementing guidance from patient safety alerts since May 2010; and what action was taken in each such case.
	tabling member constituency	Denton and Reddish
	tabling member printed	Andrew Gwynne
	uin	228067
	answer	answer is ministerial correction date of answer 23/03/2015 answer text <p>Healthcare providers are expected to implement all the actions contained in a patient safety alert that are relevant to them and ensure that all relevant parts of their organisation and staff are aware of the information and/or the required changes. Providers should be scrutinising the implementation of their alerts and satisfying themselves that the alerts are complete by the designated deadline.</p><p> </p><p> </p><p> </p><p>NHS England publishes monthly data about any trusts who have failed to declare compliance with stage one, two, or three of the National Patient Safety Alerting System’s (NaPSAS) alerts by their set due date. Provider compliance should also be an integral part of the commissioners’ responsibilities for improving quality.</p><p> </p><p> </p><p> </p><p>As part of its inspections, the Care Quality Commission (CQC) looks at how providers respond to patient safety alerts as evidence of how effectively they manage and address safety concerns, and how they use this as learning to improve their safety systems and processes. CQC is continuing to develop and embed its approach to the use of data and intelligence across all the sectors it regulates as an integral part of its new approach to inspections, and has given greater prominence to safety alerts in its revised surveillance model. CQC’s Intelligent Monitoring system for the Acute Sector includes a composite indicator around completion of safety alerts and CQC is currently considering whether this can be implemented for the other sectors it regulates. This contributes to providers’ overall risk scores, which inform both the scheduling and prioritisation of inspections and the identification of focus areas for inspections.</p><p> </p><p> </p><p> </p><p>Monitor is responsible for ensuring NHS foundation trusts are well-led so that they can provide quality care on a sustainable basis and would expect to be alerted by their providers of anything that might have a bearing on compliance with their licence including where there are significant issues regarding compliance with patient safety alerts. The NHS Trust Development Authority (TDA), as part of its oversight and escalation process, uses quality surveillance monitoring which it reviews on a monthly basis and which it uses to hold trusts to account for the timely compliance with alerts. This is undertaken via the TDA’s regular integrated delivery meetings with the trusts.</p><p> </p><p> </p><p> </p><p>The Government has agreed to consider with relevant organisations the options for transferring NHS England’s responsibilities for safety to a single national body and this will include responsibility for patent safety alerts. No decision has yet been taken about the specific functions to be transferred and until such time, NHS England will continue to be responsible for these functions.</p><p> </p><p> </p><p> </p> answering member constituency Central Suffolk and North Ipswich answering member printed Dr Daniel Poulter grouped question UIN 228068 228119 question first answered 23/03/2015 17:55:34 answering member 3932 label Biography information for Dr Dan Poulter
	tabling member	1506 label Biography information for Andrew Gwynne

228188

	registered interest
	date	18/03/2015
	answering body	Department of Health
	answering dept id	17
	answering dept short name	Health
	answering dept sort name	Health
	hansard heading	Patients: Safety
	house id	1
	legislature	25259 pref label House of Commons
	question text	To ask the Secretary of State for Health, what plans (a) his Department, (b) NHS England and (c) the Care Quality Commission have to ensure that patient safety alert guidance is implemented; and how his Department plans to monitor compliance with that guidance.
	tabling member constituency	Denton and Reddish
	tabling member printed	Andrew Gwynne
	uin	228068
	answer	answer is ministerial correction date of answer 23/03/2015 answer text <p>Healthcare providers are expected to implement all the actions contained in a patient safety alert that are relevant to them and ensure that all relevant parts of their organisation and staff are aware of the information and/or the required changes. Providers should be scrutinising the implementation of their alerts and satisfying themselves that the alerts are complete by the designated deadline.</p><p> </p><p> </p><p> </p><p>NHS England publishes monthly data about any trusts who have failed to declare compliance with stage one, two, or three of the National Patient Safety Alerting System’s (NaPSAS) alerts by their set due date. Provider compliance should also be an integral part of the commissioners’ responsibilities for improving quality.</p><p> </p><p> </p><p> </p><p>As part of its inspections, the Care Quality Commission (CQC) looks at how providers respond to patient safety alerts as evidence of how effectively they manage and address safety concerns, and how they use this as learning to improve their safety systems and processes. CQC is continuing to develop and embed its approach to the use of data and intelligence across all the sectors it regulates as an integral part of its new approach to inspections, and has given greater prominence to safety alerts in its revised surveillance model. CQC’s Intelligent Monitoring system for the Acute Sector includes a composite indicator around completion of safety alerts and CQC is currently considering whether this can be implemented for the other sectors it regulates. This contributes to providers’ overall risk scores, which inform both the scheduling and prioritisation of inspections and the identification of focus areas for inspections.</p><p> </p><p> </p><p> </p><p>Monitor is responsible for ensuring NHS foundation trusts are well-led so that they can provide quality care on a sustainable basis and would expect to be alerted by their providers of anything that might have a bearing on compliance with their licence including where there are significant issues regarding compliance with patient safety alerts. The NHS Trust Development Authority (TDA), as part of its oversight and escalation process, uses quality surveillance monitoring which it reviews on a monthly basis and which it uses to hold trusts to account for the timely compliance with alerts. This is undertaken via the TDA’s regular integrated delivery meetings with the trusts.</p><p> </p><p> </p><p> </p><p>The Government has agreed to consider with relevant organisations the options for transferring NHS England’s responsibilities for safety to a single national body and this will include responsibility for patent safety alerts. No decision has yet been taken about the specific functions to be transferred and until such time, NHS England will continue to be responsible for these functions.</p><p> </p><p> </p><p> </p> answering member constituency Central Suffolk and North Ipswich answering member printed Dr Daniel Poulter grouped question UIN 228067 228119 question first answered 23/03/2015 17:55:34 answering member 3932 label Biography information for Dr Dan Poulter
	tabling member	1506 label Biography information for Andrew Gwynne

228872

	registered interest
	date	20/03/2015
	answering body	Department of Health
	answering dept id	17
	answering dept short name	Health
	answering dept sort name	Health
	hansard heading	Patients: Safety
	house id	1
	legislature	25259 pref label House of Commons
	question text	To ask the Secretary of State for Health, whether face-down physical restraint is included in the list of never ever events that must be reported to the Strategic Executive Information System.
	tabling member constituency	Liverpool, Wavertree
	tabling member printed	Luciana Berger
	uin	228605
	answer	answer is ministerial correction date of answer 25/03/2015 answer text <p>Face-down physical restraint is not included in the list of Never Events contained within the Never Events Framework that must be reported to the Strategic Executive Information System.</p><p> </p><p> </p><p> </p><p>Use of face-down restraint is, however, a patient safety incident that should be reported and submitted to the National Reporting and Learning System. Any serious harm resulting from the use of face-down restraint would be reportable to the Strategic Executive Information System as a Serious Incident.</p><p> </p> answering member constituency Central Suffolk and North Ipswich answering member printed Dr Daniel Poulter question first answered 25/03/2015 12:42:02 answering member 3932 label Biography information for Dr Dan Poulter
	tabling member	4036 label Biography information for Luciana Berger

229164

	registered interest
	date	23/03/2015
	answering body	Department of Health
	answering dept id	17
	answering dept short name	Health
	answering dept sort name	Health
	hansard heading	Patients: Safety
	house id	1
	legislature	25259 pref label House of Commons
	question text	To ask the Secretary of State for Health, what assessment he has made of the effect of the abolition of the Patient Safety Agency and the transfer of its responsibility for the National Reporting and Learning System to NHS England on the number of patient safety alerts issued between June 2012 and December 2013.
	tabling member constituency	Oldham East and Saddleworth
	tabling member printed	Debbie Abrahams
	uin	228685
	answer	answer is ministerial correction date of answer 26/03/2015 answer text <p>Responsibility for issuing patient safety advice to the healthcare system in the form of patient safety alerts transferred from the National Patient Safety Agency to NHS England in June 2012. Between June 2012 – December 2013 one Patient Safety Alert (NHS/PSA/W/2013/001: ‘Placement devices for nasogastric tube insertion DO NOT replace initial position checks’) was issued on 5 December 2013. To date, all providers have reported this alert as either ‘complete’ or ‘action not required’.</p><p> </p><p> </p><p> </p><p>During the period in question NHS England maintained a constant review of patient safety incidents reported to the National Reporting and Learning System involving death and severe harm and, had an urgent patient safety issue needing alerting been identified, an alert would have been issued.</p><p> </p><p> </p><p> </p> answering member constituency Mid Norfolk answering member printed George Freeman question first answered 26/03/2015 14:20:27 answering member 4020 label Biography information for George Freeman
	tabling member	4212 label Biography information for Debbie Abrahams

421242

	registered interest
	date	14/10/2015
	answering body	Department of Health
	answering dept id	17
	answering dept short name	Health
	answering dept sort name	Health
	hansard heading	Patients: Safety
	house id	2
	legislature	25277 pref label House of Lords
	question text	To ask Her Majesty’s Government what research is being undertaken to establish the impact of the safeguarding policy for patients on the behaviour of nurses in attending to the needs of patients.
	tabling member printed	Lord Mawson
	uin	HL2613
	answer	answer is ministerial correction date of answer 28/10/2015 answer text <p>No central research has been commissioned to assess the impact of safeguarding policies for patients on the behaviour of nurses in attending to the needs of patients. Research may have been commissioned at a local level; however, this data is not collected centrally.</p><br /><p>The Care Act 2014, which placed adult safeguarding on a statutory footing for the first time, made clear the responsibilities of agencies in relation to adult safeguarding with a greater focus on the prevention of abuse and neglect.</p><br /><p>The Department is clear in statutory guidance supporting the Care Act that workers across a wide range of organisations, and not just those in frontline health and social care roles, need to be vigilant on behalf of those unable to protect themselves.</p><br /><p>Commissioners and providers will have clear policies and procedures that set out the roles of nurses and all other staff in relation to safeguarding and the training and support that is required in order for them to fulfil those roles.</p><br /><p>The Department and NHS England’s Compassion in Practice nursing strategy was published in December 2012 and is based around six core values: Care, Compassion, Competence, Communication, Courage, and Commitment. The vision aims to embed these values, known as the 6C’s, in all nursing, midwifery and care-giving settings throughout the NHS and social care to improve care for patients. A copy of the strategy is attached and can be found at:</p><br /><p><a href="http://www.england.nhs.uk/nursingvision/" target="_blank">http://www.england.nhs.uk/nursingvision/</a></p> answering member printed Lord Prior of Brampton question first answered 28/10/2015 12:21:43 answering member 127 label Biography information for Lord Prior of Brampton attachment 1 file name compassion-in-practice.pdf title Compassion in Practice
	tabling member	3830 label Biography information for Lord Mawson