Better care for patients and service users

This report demonstrates how – in difficult circumstances – trust leaders and staff are coming up with ideas and solutions to deliver better care | NHS Providers

This is the first in a new publication series to promote the work of NHS trusts and foundation trusts in improving care.  This briefing focuses on how trusts have responded to feedback from the Care Quality Commission in a positive and systematic way, encouraging ideas that have made a difference for patients and service users.

The report Providers deliver: better care for patients considers both the leadership approaches and frontline initiatives that underpin improvements in quality. Through 11 case study conversations, it considers some of the frontline work that has contributed to trusts’ improvements in CQC ratings, as well as exploring the role of trust leaders in providing an enabling, supportive environment in which this work has been possible.

Full report: Providers deliver: better care for patients 

See also: NHS Providers blog

National Cardiac Audit Programme

Health Quality Improvement Partnership | October 2019 | National Cardiac Audit Programme 

The Health Quality Improvement Partnership (HQIP)  has published the National Cardiac Audit Programme 2019 Annual Report. The report covers over 300,000 records across five clinical areas: Congenital Heart Disease, Heart Attack, Percutaneous Coronary Interventions (PCI), Adult Surgery and Heart Failure. It highlights quality improvement opportunities under the themes of the need for timely care, the need for specialised care and the need for evidence-based care delivered equitably.

This report focuses on three broad quality improvement (QI) themes:

  • Timely care
  • Specialist care
  • Evidence-based care delivered to a uniformly high standard

There are also five audit specific reports that are also available from HQIP

Full details are available from HQIP


Patient report

Annual report 

NIHR study: Physician associates appear to make a positive contribution to inpatient care

NIHR | August 2019 | Physician associates appear to make a positive contribution to inpatient care

One of the latest Signals from the National Institute of Health Research (NIHR),  looks at the role of physician associate, albeit a  relatively new profession in the UK, but n with over 3,000 students expected to qualify by 2020. Physician associates have to undergo two years’ intensive postgraduate training based upon a medical, rather than nursing, model.  Consequently, upon qualification, they can undertake a range of diagnostic and clinical duties that would otherwise be done by doctors.

Now an NIHR funded study considers the way that physician associates are deployed and the appropriateness as well as the effectiveness of their work in relation to other team members.

A national survey shows that a small but growing number of hospitals are now using physician associates. It concludes that the profession is being restrained by a lack of autonomy, preventing the role from fulfilling its potential. Statutory regulation and prescribing or X-ray ordering rights may help ease the pressure on doctors and strengthen physician associate roles within the team. Evaluation of the impact of these positions as they become more common will be useful (Source: NIHR).

The full study is available from the NIHR


Background Increasing demand for hospital services and staff shortages has led NHS organisations to review workforce configurations. One solution has been to employ physician associates (PAs). PAs are trained over 2 years at postgraduate level to work to a supervising doctor. Little is currently known about the roles and impact of PAs working in hospitals in England.

Objectives (1) To investigate the factors influencing the adoption and deployment of PAs within medical and surgical teams in secondary care and (2) to explore the contribution of PAs, including their impact on patient experiences, organisation of services, working practices, professional relationships and service costs, in acute hospital care.

Methods This was a mixed-methods, multiphase study. It comprised a systematic review, a policy review, national surveys of medical directors and PAs, case studies within six hospitals utilising PAs in England and a pragmatic retrospective record review of patients in emergency departments (EDs) attended by PAs and Foundation Year 2 (FY2) doctors.

Results The surveys found that a small but growing number of hospitals employed PAs. From the case study element, it was found that medical and surgical teams mainly used PAs to provide continuity to the inpatient wards. Their continuous presence contributed to smoothing patient flow, accessibility for patients and nurses in communicating with doctors and releasing doctors’ (of all grades) time for more complex patients and for attending to patients in clinic and theatre settings. PAs undertook significant amounts of ward-based clinical administration related to patients’ care. The lack of authority to prescribe or order ionising radiation restricted the extent to which PAs assisted with the doctors’ workloads, although the extent of limitation varied between teams. A few consultants in high-dependency specialties considered that junior doctors fitted their team better. PAs were reported to be safe, as was also identified from the review of ED patient records. A comparison of a random sample of patient records in the ED found no difference in the rate of unplanned return for the same problem between those seen by PAs and those seen by FY2 doctors. In the ED, PAs were also valued for the continuity they brought and, as elsewhere, their input in inducting doctors in training into local clinical and hospital processes. Patients were positive about the care PAs provided, although they were not able to identify what or who a PA was; they simply saw them as part of the medical or surgical team looking after them. Although the inclusion of PAs was thought to reduce the need for more expensive locum junior doctors, the use of PAs was primarily discussed in terms of their contribution to patient safety and patient experience in contrast to utilising temporary staff.

Limitations PAs work within medical and surgical teams, such that their specific impact cannot be distinguished from that of the whole team. Conclusions PAs can provide a flexible advanced clinical practitioner addition to the secondary care workforce without drawing from existing professions. However, their utility in the hospital setting is unlikely to be fully realised without the appropriate level of regulation and attendant authority to prescribe medicines and order ionising radiation within their scope of practice. Future research Comparative investigation is required of patient experience, outcomes and service costs in single, secondary care specialties with and without PAs and in comparison with other types of advanced clinical practitioners. Funding The National Institute for Health Research Health Services and Delivery Research programme (Source: NIHR).

The full journal article is available from the Health Services and Delivery Research

Where best next? New NHS plan to help patients avoid long hospital stays

NHS England & NHS Improvement | August 2019 | Where best next?

A new campaign is encouraging NHS doctors, nurses and other staff a to ask themselves ‘Why not home? Why not today?’ when planning care for patients recovering from an operation or illness.  ‘Where Best Next?’  aims to reduce the hospital stay of  140,000 people every year spared a hospital stay of three weeks or longer.


As well as being better for those individuals who get home with the right support quicker, the drive could also free up more than 7,000 beds for other patients – the equivalent of building an extra 15 large hospitals.

The campaign, launched on Monday, will see posters and other information placed in hospitals aimed at different staff groups, encouraging them to take practical steps every day to help get patients closer to a safe discharge – whether to their own home or a more suitable alternative in the community (Source: NHS England).

Full details from NHS England 

See also:

NHS England [blog] Valuing 350,000 patients’ time


Helping doctors and nurses to improve care for patients with a learning disability

NHS Digital | August 2019 | Helping doctors and nurses to improve care for patients with a learning disability

NHS Digital have produced Helping doctors and nurses to improve care for patients with a learning disability to help  public health, health professionals, paid social care staff and family members to prevent falls in people with learning disabilities (Source: NHS Digital).

The full document is available from NHS Digital


The Healthcare Safety Investigation Branch launch online feedback form

Healthcare Safety Investigation Branch | August 2019 | Online feedback form launched so you can ‘tell us what you think’

The Healthcare Safety Investigation Branch (HSIB) have launched an online feedback form so that anyone involved in their healthcare safety investigations can tell HSIB what they think.

  • National investigations in general
  • Specific national investigations
  • Maternity investigations
  • HSIB in general

Full details from HSIB

BMJ study: 5 % of patients exposed to preventable harm across medical settings

BMJ | 2019| Prevalence, severity, and nature of preventable patient harm across medical care settings: systematic review and meta-analysis

A systematic review with meta analysis observes that the prevalence of preventable patient harm across a range of settings, their analysis indicates that approximately 1 in 20 patients are exposed to preventable harm. The study findings suggest that preventable patient harm was more prevalent in advanced specialties such as intensive care or surgery. 


Objective To systematically quantify the prevalence, severity, and nature of preventable patient harm across a range of medical settings globally.

Design Systematic review and meta-analysis.

Data sources Medline, PubMed, PsycINFO, Cinahl and Embase, WHOLIS, Google Scholar, and SIGLE from January 2000 to January 2019. The reference lists of eligible studies and other relevant systematic reviews were also searched.

Review methods Observational studies reporting preventable patient harm in medical care. The core outcomes were the prevalence, severity, and types of preventable patient harm reported as percentages and their 95% confidence intervals. Data extraction and critical appraisal were undertaken by two reviewers working independently. Random effects meta-analysis was employed followed by univariable and multivariable meta regression. Heterogeneity was quantified by using the I2 statistic, and publication bias was evaluated.

Results Of the 7313 records identified, 70 studies involving 337 025 patients were included in the meta-analysis. The pooled prevalence for preventable patient harm was 6% (95% confidence interval 5% to 7%). A pooled proportion of 12% (9% to 15%) of preventable patient harm was severe or led to death. Incidents related to drugs (25%, 95% confidence interval 16% to 34%) and other treatments (24%, 21% to 30%) accounted for the largest proportion of preventable patient harm. Compared with general hospitals (where most evidence originated), preventable patient harm was more prevalent in advanced specialties (intensive care or surgery; regression coefficient b=0.07, 95% confidence interval 0.04 to 0.10).

Conclusions Around one in 20 patients are exposed to preventable harm in medical care. Although a focus on preventable patient harm has been encouraged by the international patient safety policy agenda, there are limited quality improvement practices specifically targeting incidents of preventable patient harm rather than overall patient harm (preventable and non-preventable). Developing and implementing evidence-based mitigation strategies specifically targeting preventable patient harm could lead to major service quality improvements in medical care which could also be more cost effective.

The article is available to read in full from the BMJ 

In the news: OnMedica One in 20 patients exposed to preventable harm in medical care