The recently published update to the NHS patient safety strategy outlined a new commitment to explore and address inequalities in patient safety. National medical director's clinical fellow, Cian Wade, is working with the NHS England and NHS Improvement national patient safety team to lead on the first two phases of this work. Cian explains more below.
Across society there has been renewed impetus to address unfair and potentially avoidable differences in health across different patient groups. These inequalities remain pervasive across the UK's population, and have been further highlighted by stark differences in outcomes during the COVID-19 pandemic.
Building on the commitments of the long term plan, NHS England and NHS Improvement has increased its focus on reducing health inequalities. This includes a new programme of work led by the National patient safety team to firstly explore the extent to which the risk of clinical harm is experienced unequally across different patient groups; and then to identify areas for development that may contribute to reducing health inequalities around patient safety.
The first phase of this work has been to review and develop the evidence base for the existence of inequalities in patient safety.
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The first phase of this work has been to review and develop the evidence base for the existence of inequalities in patient safety, as well as probing the underlying causes of these disparities in risk. A review of the existing peer-reviewed literature and grey-literature revealed evidence for harm occurring disproportionately in a variety of patient groups who typically suffer inequality of health outcomes. This includes patients from ethnic minority backgrounds, from deprived socioeconomic backgrounds, patients with learning disabilities, and others.
Crucial in this first phase has been co-production with patient groups and system leaders. As part of this we have been working to describe several patient journeys to exemplify the heightened risk of harm experienced by patients from particular groups. An example of this might be the patient journey of a child from a family who have only recently moved to the UK and currently have limited English language proficiency. Their journey includes an inadvertent 'did not attend' at the allergy clinic, miscommunication over the method of use of an EpiPen, and a delayed presentation to the emergency department with anaphylaxis. The purpose of these patient journeys is to help the focus groups we consulted to articulate where and what the heightened risks of harm facing these patients are, by bringing these issues to life.
This work has identified several key themes that underpin inequalities in patient safety.
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This work has identified several key themes that underpin inequalities in patient safety. The themes are: communication between clinicians and patients/carers; patient involvement in their own safety; accessibility of healthcare; cultural competency of the workforce and system; transitions of care; geographical variation; and data quality. These themes are wide-ranging with some relating more to specific interactions between patients and healthcare professionals and others to the general organisational and cultural principles of our healthcare system. We will be providing more detailed explorations of these themes in order to enable individual healthcare professionals and system leaders to consider what actions they can take in order to reduce inequalities in patient safety.
We are now in the second phase of this work, where we are working with patients, clinicians and system leaders via a series of roundtables, interviews and by collecting exemplar case studies, to gather input on interventions that may help reduce the risk of harm experienced by patients. Using patient journeys is again proving very helpful in this phase as a way to help focus system leaders and clinicians on developing solutions to reduce risk. It helps shift the focus away from the end outcome or harm, to the points along the entire patient journey at which interventions could be made to modify this outcome. This approach also helps us think about solutions for reducing risk for patients while they are in the community, or not in direct contact with healthcare services and professionals.
This solutions-focused phase of our work will inform the ongoing work of the national patient safety team to address inequalities.
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In the example mentioned above, our focus groups suggested that the child's anaphylaxis may have been avoided through the regular use of translators, better follow up regarding the 'did not attend' at allergy clinic, or organising proactive care follow-up with their school nurse. This solutions-focused phase of our work will inform the ongoing work of the national patient safety team to address inequalities. If you or members of your executive team feel you are in a position to contribute, then please reach out to us at patientsafety.enquiries@nhs.net.
As set out in the recently published NHS patient safety strategy update, the intention of this work is to "set specific actions for the national patient safety team, local stakeholders and individual clinicians to address inequalities in patient safety", and more broadly maximise the opportunities to further reduce inequalities through the existing initiatives and programmes of work outlined in the patient safety strategy. The findings from the first and second phases of this work will be used to help direct a more systematic and comprehensive approach over the lifespan of the patient safety strategy. We also hope that the findings will provoke individual clinicians and the wider system into considering what actions they can take to reduce inequalities in patient safety and improve the quality of care for all.
As this work evolves and we share more detailed findings and recommendations, we would encourage you all to consider the implications of our findings for your organisations and your workforce's clinical practice.
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