Barts Health NHS Trust

Action Planned (AI summary) Barts Health NHS Trust's Haemoglobinopathy Coordinating Centre (HCC) is developing a website with information to support families and has appointed a governance lead to lead on network wide quality improvement and governance. They are also involved in an exhibition to challenge staff attitudes and behaviours towards patients. Maylands Healthcare has undertaken an annual audit of patients with Sickle Cell Disease, proactively contacts them for medication reviews, liaises with specialists, changes medications to electronic repeat dispensing, and shares learning points from Significant Event Analyses with staff. They have also added clear alerts in each clinical record and all clinical staff have undertaken mandatory Sepsis training. The Department of Health and Social Care has introduced an incentive for GPs to identify patients who would benefit most from continuity of care, and has implemented "Jess's Rule", encouraging clinicians to re-evaluate symptoms if a patient's condition remains unresolved after three consultations. NHS England is also working to improve education and awareness of sickle cell disease amongst healthcare staff and for patients and carers. Partnership of East London Co-operatives (PELC) has shared organisational learning regarding the importance of reviewing patient records and included this requirement in staff contracts. They are also implementing an alert within clinical records for all children presenting with sickle cell disease.

Action Planned (AI summary) Whipps Cross Hospital will ensure families are contacted as part of the Patient Safety Incident Review Meeting (PSIRM) process. The Trust has also commissioned a review, to be completed by the end of August 2025, of the governance processes relating to this case with engagement from the Foster family. The Department of Health and Social Care notes that the North London Integrated Care Board, supported by NHS England, will review the governance processes related to the case to identify areas for improvement, with the review to be completed by August 2025.

Action Planned (AI summary) Barts Health NHS Trust is undertaking a Patient Safety Incident Investigation (PSII) to identify opportunities for learning and improvement following a patient fall, and will use the findings to identify actions to improve patient safety, recording actions on Datix.

Action Planned (AI summary) The Trust developed a SOP for patients with learning disabilities in the Emergency Department, including instruction to keep them overnight with a low threshold, and highlighting issues at safety handover. They also ensure discharge letters are printed, and the LD team will audit discharge advice. A training package around communicating with vulnerable patients, including a case study of a patient with LD in the Emergency Department, has been put together and is being delivered at induction and consultant meetings. The Trust is procuring specialist equipment, and has increased reporting radiologists and radiographers. The Department is aware of Barts Health NHS Trust's response and highlights the Down Syndrome Act 2022 and related guidance which is currently being developed following a call for evidence and engagement with lived experience and will be issued for consultation as soon as possible this year. They also mention the Discharge Fund and care transfer hubs to support timely discharge from hospital.

Action Planned (AI summary) Barts Health NHS Foundation Trust will implement actions to improve practices for patients with dementia and/or at risk of falls, including ensuring up-to-date Enhanced Care Assessments, using fall risk ID bands, and mandatory falls risk assessment training for staff. The Trust is conducting a diagnostic assessment on essentials of care and associated patient risk assessments (including falls).

Action Planned (AI summary) The Health Board is developing a Strategic Outline Case for a Health Board wide Electronic Patient Record system to address fragmented care records with a deadline of end of January 2024, and will undertake a significant piece of work to make long term, substantial changes regarding investigations.

Action Planned (AI summary) Barts Health NHS Trust is working through process pathway redesign to reduce pressure in emergency departments and reduce levels of risk. The trust also plans to work alongside North East London to support paediatric flow from the Emergency Department, exploring ambulatory step down from the paediatric ward and increased use of paediatric clinical decision unit to work into the community to support early discharge. Barts Health Trust has updated guidance on managing gastroenteritis in children and revised the Emergency Department's policy on observations prior to discharge, and is prompting clinicians to consider adding urine output assessment to the online patient documentation system; learning summaries from the incident will be shared trust-wide.