Inner South London

Action Planned (AI summary) The LFB has integrated peak activity inspectors into mainstream fire safety inspection teams and reminded all fire safety officers to review premises databases before visits. They are also preparing to tender for a single point of reference premises risk database. Planning Enforcement is committed to identify where compliance checks are necessary through their investigation processes, especially for high-risk buildings. Officers are now able to raise concerns relevant to the Fire Brigade through the Integrated Enforcement initiative.

Action Planned (AI summary) Oxleas NHS Foundation Trust will now document adjustments required for a patient's disability on the Prison Nomis (P-Nomis) system, accessible by prison staff, healthcare, and social services. A fortnightly meeting involving all providers has now convened allowing discussion of patients presenting with disability that may be of concern, to facilitate improved care planning and communication. HMP Belmarsh will be holding monthly training sessions throughout 2023, alongside Oxleas NHS Trust and RGB, for all operational staff. These sessions will focus on encouraging staff to think differently about disability and to improve how they engage with disabled prisoners.

Action Planned (AI summary) Central and North West London NHS Foundation Trust has implemented changes including safety planning for all patients, strengthening processes for recording patient leave, improved training, strengthened scrutiny of serious incident reports and is transitioning to the new national framework, PSIRF. The Department of Health and Social Care notes that the draft Mental Health Bill proposes a statutory duty on clinicians to create a care and treatment plan for relevant patients detained under the Mental Health Act.

Action Planned (AI summary) Tower Bridge Care Home describes arrangements for diabetic foot clinic attendance, communication with GPs and multidisciplinary meetings, and identifies residents with high needs to the consultant geriatrician for face-to-face reviews, since September 2022. They also describe processes for DNAR (Do Not Attempt Resuscitation) orders and managing capacity issues. The RCGP is working to improve communication between secondary and primary care with colleagues across specialities, and with NHS England and NHS Improvement to improve communication links. King's College Hospital has established a working group to improve consent and MCA assessments, reviewing consent and MCA training programmes, and updated the Trust's consent policy. The Trust also initiated a Trust-wide consent audit in September 2022.

Action Planned (AI summary) HMCTS is updating Security and Safety Operating Procedure 4b across all crime courts by the end of May, including publicising random searches and implementing a new Safeguarding policy with training for front line court staff to identify and escalate safeguarding concerns. The 'Working with Suicide & Self-Harm' guide was reviewed, changing a question about suicide risk, and the Probation EQUiP process map was updated for court staff; all London probation staff were reminded to adhere to the 'probation risk to self' EQUiP process maps. London Probation published a new thematic Suicide and Self-Harm Performance and Quality Newsletter on 19 January 2022.

Action Planned (AI summary) The MPS will share the report with relevant departments and review training programmes to include expert evidence-based advice on knife carrying and gang membership in domestic abuse risk assessments. A review of CSU resourcing is underway, with findings to be presented to the MPS Management Board in January 2022.

Action Planned (AI summary) HMPPS implemented a revised version of ACCT in July 2021 that focuses on a person-centred approach, information sharing, improved case reviews and a strengthened post-closure period and shared a learning bulletin about transferring prisoners on an open ACCT which emphasises the importance of good communication and information-sharing. The Department of Health and Social Care is working with partners on the next version of the National Partnership Agreement (NPA) for Prison Healthcare, due in April 2022. NHS England is also reviewing the ACCT process in prisons and healthcare attendance, with findings anticipated in early 2022.

Action Planned (AI summary) DEFRA, DFT, and DHSC will continue to work to improve public awareness of air pollution, including a pilot project with GPs providing air quality advice and information to a range of vulnerable groups. They will also make expertise available to relevant professional organisations. The Mayor of London has implemented measures such as the Ultra Low Emission Zone (ULEZ) and is expanding the monitoring network. They are also supporting health and care system support for vital structural changes. NICE amended its asthma guideline (NG80) in March 2021 to clarify the link between air pollution and asthma and added links to NICE guidelines on air pollution: outdoor air quality and health and indoor air quality at home. The RCGP is in the process of producing a planetary health element of the curriculum that all new GPs will be assessed against and are also planning a high-profile webinar incorporating elements regarding pollution. The RCP will work with specialist societies to raise the profile of air pollution's impacts, review the internal medicine curriculum, increase knowledge among physicians, produce resources for professionals to discuss air pollution with patients, improve incentives for conversations, and urge government to tighten regulations. The NMC will consider the concerns in their evaluation of pre-registration standards, focusing on communication with families, and identify further activity to ensure professionals understand their obligations to communicate clearly with patients about evidence related to managing and preventing ill-health. The BTS intends to build upon work undertaken to date by raising awareness of the effects of poor air quality, producing an updated Position Statement on air quality and lung health, and adding the health care profession voice to the debate on climate change and air pollution through membership of the UK Health Alliance on Climate Change and involvement in the Taskforce for Lung Health. The RCPCH curriculum includes a domain on health promotion, and they are working with NHS England/Improvement and Health Education England to develop asthma competencies for child health professionals and carers. They also declared a climate emergency and published a report on tackling climate change. HEE will write to the relevant medical Royal Colleges, GMC and NMC to highlight that improving awareness of the impact of air pollution on health should be considered when developing curricula. The GMC will review standards for medical education to consider how environmental issues are covered, encourage medical schools to address air pollution in curricula, and promote inclusion of environmental impacts in postgraduate training curricula. HEE will add the theme of environmental impacts to the list of potentially important areas to consider as they progress the credentialing agenda. UKHACC delivered a pilot project with Global Action Plan, funded by Defra and the Clean Air Fund, to educate paediatricians and respiratory health professionals on air pollution advice for patients. The London Borough of Lewisham has expanded monitoring capacity, taken part in the Breathe London project, and refreshed the Joint Strategic Needs Assessment for Air Quality. They also promote air quality monitoring tools via social media and local advertising, and ensure information is positioned on relevant websites and newsletters.

Action Planned (AI summary) Since Mr. Agnew's death, City of London Police officers receive further training on assessing intoxicated persons. First aid training of City of London Police officers now includes training to recognise that snoring in a person with a reduced level of consciousness is a sign of airway obstruction and to perform the "jaw thrust" manoeuvre. The College of Policing will use the coroner's concerns to inform a review of the learning outcomes for the FALP (roads policing) programme, which will take place this year. The College has developed a vulnerability learning programme which supports the PCDA programme. Since 2016, the Mayor of London has established a night transport outreach team that assists rough sleepers on the transport network, helping over 1,020 clients. The team enables drivers and others to refer those of concern to this service.

Action Planned (AI summary) The LAS has implemented leadership training and Acute Behavioural Disturbance (ABD) refresher training. They collaborated on national guidance for ABD for ambulance staff and are sharing updated clinical guidelines via tablet devices. Learning from the death has been presented to the JRCALC guidelines group. The MPS will include information in officer safety and emergency life support training on Acute Behavioural Disturbance (ABD) and de-escalation techniques, the impact of stress on behaviour, and reflection on actions. Supervisors will be trained to identify themselves and liaise with the Safety Officer upon arrival at a scene.

Action Planned (AI summary) The MHRA sought advice from the UK Commission on Human Medicines (CHM) on a range of areas to support the effective and safe use of AAIs. The AAI EWG recommended a number of other measures including reinforcement of the need for all patients at risk of anaphylaxis to carry two AAIs at all times. The FSA is undertaking consumer research to gather information and insights from people with food allergies and is considering the benefits of developing a food allergy safety scheme for allergen management within food businesses. They are supporting businesses to prepare for new allergen labelling rules coming into effect on 1st October 2021. The FSA is establishing a way for people to directly report information regarding anaphylactic reactions caused by food allergies that do not result in death. The MHRA is considering making AAI devices more widely available for use in exceptional, emergency situations.

Action Planned (AI summary) Oxleas NHS Foundation Trust will require consistent recording of service users' and carers' feedback in the MDT template, make risk decisions at every MDT meeting, assign responsibility for updating risk assessments after each MDT, and update the Clinical Risk Assessment and Management Policy accordingly. The Medical Director and Director of Nursing will communicate these standards to all clinicians, facilitated by a team approach to risk management led by Matrons.

Action Planned (AI summary) The trust acknowledges the concerns and will have preliminary discussions regarding providing Mental Health First Aid training to specific Metropolitan Police officers in designated roles by the end of March 2020. They also highlight existing mental health support services available to police officers, including a crisis and assessment team and a Pan London S.136 telephone advice line.