2016

Action Planned (AI summary) Bateman Engineering has changed the design of their cabs to include seat restraints, and now fits them on all vehicles before they leave the workshop. HSE will raise the issue of seat restraints on self-propelled sprayers at the next appropriate meeting for consideration in future revisions of applicable standards and will consider revising guidance to better inform the choice of vehicle when working on slopes.

Action Planned (AI summary) The College of Policing will add specific reference to 'containment' to the ABD/PA chapter of the National Personal Safety Manual and clarify that, in certain circumstances, prone restraint carries a risk of death, within the next scheduled update.

Action Planned (AI summary) The Department of Health acknowledged concerns about BiPAP machine design and power supply resilience. It will review relevant sections of the Hospital Technical Memorandum (HTM) as part of its wider technical guidance programme and consider the issue of alerts, but believes current HTM guidance is adequate. St George's will install a UPS/IPS backup system in the Richmond ADU, with completion expected in summer 2016, to address power supply concerns. Nursing staff are also undertaking twice-weekly checks of emergency call bell systems.

Action Planned (AI summary) The Trust is reviewing its CMHT Standard Operating Procedure (SOP) to standardize screening processes across all teams, ensuring appropriate staff expertise and multi-disciplinary team discussions. A randomised audit will be undertaken across CMHTs to ensure governance around the screening process, with completion expected in September 2016.

Action Planned (AI summary) The Trust will reiterate the importance of recording all relevant data on the IAPT system through internal communications. The Trust is also part of a national 'Sign up to Safety' movement and is relaunching its campaign to reduce suicides.

Action Planned (AI summary) Greater Manchester will raise concerns about volumes/strengths of prescribed controlled drugs and provide guidance to prescribers, as well as examine its reporting system to identify high-volume prescribers. They will highlight prescribing volumes in the national Care Quality Commission "Controlled Drugs Vigilance Newsletter" and use local newsletters, with some CCGs already working with practices to reduce high doses. The Home Office notes the concerns and states information from the investigation has been added to the Yellow Card Scheme to monitor substances suspected of being misused. The Home Secretary has commissioned the ACMD to explore potential medical and social harms arising from the illicit supply of medicines.

Action Planned (AI summary) Staffordshire County Council proposes to not reinstate a 'Keep Clear' marking and install a short section of guardrail at the junction of Ball Haye Street and Fountain Street in Leek. These measures are proposed to be funded from the 2016/17 financial year Capital Programme.

Action Planned (AI summary) NELFT and CCGs will review care pathways for patients with anti-social personality disorder, ensuring support to access existing services per NICE guidelines and develop a communication plan. The review, commencing in May 2016, aims to identify service gaps and consider developing local personality disorder networks, with completion expected by 30 September 2016.