2021

Noted (AI summary) The RCPCH acknowledges the concern about Vitamin D supplementation advice in the Red Book, but states that the current edition already contains relevant guidance. They suggest the issue is one of professional practice rather than a deficiency in College standards. NICE states that their guideline PH56 already recommends including questions about vitamin D supplements in the Red Book, and that the RCPCH is best placed to amend the book's content. NICE will liaise with NHSX and NHS Digital to improve alignment between digital content and NICE guidance. They will consider the coroner's report when the guideline is next reviewed. The Department acknowledges concerns about vitamin D supplementation and highlights existing guidance and the Healthy Start scheme. They refer to an ongoing review into improving health outcomes in babies and young children but do not commit to any specific changes to vitamin D policy.

Noted (AI summary) West Midlands Ambulance Service took immediate action by informing all frontline staff of requirements for medical gas cylinder assembly/disassembly and sharing lessons learned with partner organizations. The CQC acknowledges the concerns but states it is outside of their remit to issue or change formal guidance or policies around oxygen usage or safety, as they are not clinical experts. They will continue to communicate with WMAS and monitor actions taken to improve safety. HSE will support MHRA as the lead authority and will use its communication channels to promote any information/guidance produced by the MHRA. They will also consider if HSE guidance document INDG459 should be updated to reflect any new information/guidance produced. MHRA has commenced a dialogue with the Association of Anaesthetists and the Safe Anaesthesia Liaison Group of the Royal College of Anaesthetists to raise awareness of ignition within valve components of oxygen cylinders. MHRA was represented on a multiagency group which hopes to publish guidance once ratified by the Councils of both the RCoA and the AA.

Noted (AI summary) NHS England and NHS Improvement outline the commissioning of healthcare into prisons is done on a principle of equivalence. They state Advanced Life Support is not appropriate for healthcare professionals working in prisons, as it may lead to staff working outside of their registered professional clinical competencies.

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.