Birmingham and Solihull

Noted (AI summary) NHS England and NHS Improvement are writing to ambulance services regarding clinical oversight, including a reminder that Acute Behavioural Disturbance (ABD) calls should have oversight of a senior clinician in the control room and calls should be upgraded to Category 1 if the patient’s condition deteriorates or if the patient is being restrained. The Association of Ambulance Chief Executives (AACE) explains its role and states that it cannot mandate response categories. AACE developed and issued national clinical guidance in 2019, updated in 2020, to UK ambulance clinicians, supported education and presented at conferences and webinars for police and ambulance staff, and continues to develop further guidance around managing patients with extreme agitation. The College of Paramedics clarifies it is not responsible for setting standards for paramedic education, training, or practice, but will ensure its pre-registration curricula review includes the latest evidence on Acute Behavioural Disturbance. The College endorses AACE's response and will share the correspondence with NHS England’s Emergency Call Prioritisation Advisory Group and AACE to propose a review of the current response categorisation of Acute Behavioural Disturbance. NHS Digital provides background information on NHS Pathways, a clinical decision support system used by NHS 111 and some ambulance services, and its governance structure. It states that NHS Pathways is concordant with NICE, the UK Resuscitation Council, and the UK Sepsis Trust guidelines.

Noted (AI summary) NHS England notes that the Trust has responded adequately at a local level and that the matters of concern have been dealt with, and has shared the Regulation 28 Report and both responses with the Regional NHSE/I teams. Immediately following the inquest, the hospital sourced 10 zimmer frames and made them available in the ED; a process for procurement, storage, labeling and auditing of walking frames was fully implemented in early July.

Noted (AI summary) The Trust has taken steps to reduce risk from ligatures, including installing pressure sensor alarms on en-suite bathroom doors, removing door furniture, and establishing a rolling capital programme for ligature works. They are also reviewing therapeutic observational practice, staffing levels, and care plans. HSE states that the safety of the environment for patients, including management of ligature points, falls within the remit of CQC, not HSE, according to a Memorandum of Understanding. NHS Birmingham and Solihull ICB provides supplementary information to the Coroner, in support of the information provided by Birmingham and Solihull Mental Health Foundation Trust, in response to the Regulation 28 Report. The CQC has asked for weekly reports on ward improvements, sought an independent review from NHS England, and will share learning from the inquest with inspectors and registered persons. They are monitoring the trust and will use enforcement powers if regulations are not met.

Noted (AI summary) NHS England notes that EMIS is developing a solution, expected in September 2021, to address the intermittent EMIS system issue which resulted in a booked telephone consultation for Mr Plahe not taking place. NHS Digital will jointly review the solution with EMIS clinicians. The CCG's IT Team worked with EMIS and GP practices to address appointment refreshing issues, issuing guidance after identifying the cause. In response to reoccurring issues after the Windows 10 upgrade, the CCG communicated potential problems and resolution information to all GP practices. Ashfield Surgery updated its induction pack to highlight EMIS issues and steps to address them, shared this information with nursing staff and term locums, and cascaded to Primary Care Networks using EMIS. A Significant Event Analysis was completed and shared. EMIS investigated the reported issue of the appointment book not refreshing, advised the practice to check UDP ports, and states they are investigating potential solutions to improve functionality given the increase in remote working, but offered no concrete actions.

Noted (AI summary) • Following the death of two candidates, the 2000m run was suspended for all Commonwealth Candidates. • Multidisciplinary meetings have taken place, informed by an Evidence-Based Medicine approach, to address the risk of Exertional Collapse Associated with Sickle Cell Trait (ECAST). • Actions taken have been applied to all candidates applying to join the Army, not just non-UK candidates.