Local patient safety collaboratives take shape

Following publication of the Francis Inquiry report and in line with the Berwick review's recommendations in 2013, the government announced plans for new NHS patient safety collaboratives in England in November 2013. NHS England, who are running the programme, hope that the collaboratives will be 'the biggest patient safety initiative in the history of the NHS'.

NHS England are developing the programme with help from NHS Improving Quality and the country’s Academic Health Science Networks (AHSNs), who are tasked with leading the local collaboratives when they are launched.

‘We’ve spent time ensuring the programme will support the kind of locally-owned safety improvement activity that will make a genuinely ground-breaking contribution to the safety of NHS services’, says Mike Durkin, Director of Patient Safety at NHS England.

What are the collaboratives doing?

There will be 15 regional collaboratives across England covering primary, secondary and acute care. Patient safety experts will work with patients and carers, along with frontline staff, management and patient safety academics.

The teams will design, implement and evaluate solutions to local safety priorities. Successful solutions will then be adopted by organisations locally and shared across the country, bringing best practice to similar health providers nationwide.

‘The theory is that every safety problem in the NHS has been fixed somewhere by someone’, says Mike. ‘We need to create a system that means those solutions spread and benefit the whole NHS.’

NHS England has said the collaboratives must:

• involve patients and families in the work more effectively than ever before
• evaluate the process from the start and adapt approaches as lessons are learnt
• empower all staff to be involved
• ensure senior leaders understand problems and back staff to make effective changes.

The local picture

With the principles and funding models now agreed, the AHSNs are preparing to launch the collaboratives in October. This preparatory work involves identifying local priorities for safety improvement across all health care settings – from hospitals to care in custody, local GP practices to mental health trusts.

We spoke to some of the collaboratives to see what local priorities are beginning to emerge.

Dr Tricia Woodhead, Medical Lead for the South West collaborative:
‘We’ve had a region-wide safety collaborative in the south west for five years. With the development of two AHSNs in our area we’re now working out the best approach going forward. We’ll be incorporating key issues such as emergency laparotomy, suicide reduction, acute kidney injury and sepsis. We’ve also prioritised our foundation doctors’ programme, a source of immediate and long-term professional competence that should spread ideas swiftly as doctors move posts over the next five years.’

Dr Chris Streather, Managing Director of the Health Innovation Network South London, leading the South London collaborative:
‘We’re taking a liberal approach to patient safety, across both the inpatient and outpatient system. For example we’ve identified smoking cessation in people with psychiatric illness as a priority. We want to look at the vulnerable people who don’t necessarily have the loudest voices.’

Lesley Massey, Director and lead for the safety programme Advancing Quality Alliance (AQuA), North West England:
‘The two AHSNs within the north west will create individual collaboratives both focusing on medicines safety and medicine optimisation. AHSNs are looking to build upon the considerable safety work already underway within organisations and believe that medication safety is a domain which unites all sectors and from which a system for safety can be developed. This is a fantastic opportunity to work across care pathways and at transitions between primary and secondary care. There is real momentum and a genuine belief that we can make a difference.’

Dr James Mountford, Director of Clinical Quality and Value at UCLPartners, London North East/North Central, Essex and Hertfordshire collaborative:
‘Our partner organisations want to build on their existing work across UCLPartners on reducing mortality, perhaps with additional focus on sepsis, acute kidney injury, and safety in mental health. We also want to link into mainstream training, for example by finding a way to make patient safety more relevant to over 2,500 trainee doctors in north east London. This is a chance to make patient safety part of today’s mainstream education and professional sense of self, and also of how the NHS operates within and across organisations.’

Navigating the challenges ahead

Referred to as the biggest safety initiative in the history of the NHS, everyone we spoke to is very aware of the scale of the task ahead.

‘Perhaps the biggest challenge is keeping patient safety at the top of people’s agendas when they have so much else to consider; funding restrictions, acute sector reconfiguration, uncertainty around the next election’, says Chris Streather.

‘One of the arguments we have to win is that safe care is cost effective, and avoidable harm is in itself expensive. If we set ambitious aims across 15 areas then we have a far better chance of achieving innovative projects that local people really own, than if we adhere to a single rigid national template.’

Mike Durkin agrees: ‘We need to create a nationally consistent measurement model that supports everyone to understand what’s working, to measure progress and to identify which interventions are the most effective. Yet whilst doing so we mustn’t override the fundamental importance of local ownership and leadership.

‘This is not a top-down initiative. It belongs to the local health communities who will provide the energy, ideas and innovations that will make it work.’

Further reading

You may also be interested in our evidence scan: Improvement collaboratives in health care.