2023

Noted (AI summary) NHS England is working with Integrated Care Systems to streamline pathways for older adults, including people with dementia, and is focused on improving retention and staff attendance through the NHS People Promise; they will also expand community services including more joined-up care for older people living with frailty and improve falls services. The DHSC acknowledges concerns about resourcing pressures in emergency departments and insufficient provision of care, noting that these are being monitored and that local authorities have a duty to shape their care market.

Noted (AI summary) NICE acknowledges the concerns and notes that its new guideline on adrenal insufficiency covers identification, emergency management, and prevention of adrenal crisis during physiological stress, including trauma. The guideline committee includes paramedic co-optees and other relevant health professionals. NHS England reports that the JRCALC guidelines will be amended to improve understanding of administering steroids in cases of trauma, and that a Regulation 28 Working Group discusses all PFD reports to identify emerging trends. WMAS highlighted existing JRCALC guidance updates regarding steroid usage for adrenal crisis (2017, 2020, 2022), communication to staff via clinical times briefings, and the introduction of steroid emergency cards. WMAS also apologized for an administrative error that led to the lead investigator not receiving the inquest disclosure bundle and stated that the legal team aims to attend as many inquests as possible. AACE is revising JRCALC guidance to emphasize steroid administration to patients suffering trauma or physiological stress, engaging with the Addison's Disease Self-Help Group and The Addison's Clinical Advisory Panel Chair. AACE is also aware of the development of an educational e-learning package for call handlers to improve understanding of Addison's disease and steroid-dependent patients, which will be trialled in Yorkshire and potentially rolled out to other ambulance services. Worcestershire Acute Hospitals NHS Trust has amended its guideline to include clear advice for all patients in the Emergency Department requiring admission, delivered teaching sessions to surgical trainees and T&O junior doctors, shared a lesson of the week, and made changes to ED admission documents to include prompts on time-critical medications. The Society for Endocrinology highlights existing resources and the NICE guideline in development, commits to reviewing resources once NICE guidelines are written and ensuring pre-hospital care is covered more clearly, and is liaising with ambulance services to ensure triage information includes the need to send a category 2 ambulance.

Noted (AI summary) The RFU expresses sympathy and highlights existing RugbySafe resources on responsible drinking and mental wellbeing, including partnerships with Simplyhealth and Looseheadz. They propose no additional specific action at this stage but will keep it under review.

Noted (AI summary) The International Academies of Emergency Dispatch acknowledges the delayed EMS response and identifies contributing factors, including high call volume and Careline's limited information. They suggest that a serious hemorrhage code is equivalent to the initial CAT 3 assignment and that EMDs should stay on the line while providing Dispatch Life Support instructions. Surrey and Borders Partnership NHS Foundation Trust and Surrey County Council are reviewing the cross-agency SCARF process, including information sharing and confidentiality, through a project group. A meeting has already taken place to discuss this. Kingston upon Hull City Council is planning several measures: relocating taxi ranks, designing a signalized crossing, relocating a crossing facility, considering footpath widening, and implementing a 20mph zone. These are in various stages of feasibility, design, and consultation, with timelines specified.

Noted (AI summary) The Department for Levelling Up, Housing and Communities acknowledges the concerns regarding fire safety measures in extra care facilities and outlines existing regulations, guidance, and the role of the Building Safety Regulator. They have forwarded the letter to the Director of Building Safety at the Building Safety Regulator.

Noted (AI summary) NHS England acknowledges the concerns but states that matters relating to interpreters, communication, and family engagement are for local response. Regarding risk assessment documentation, NHS England states that risk assessments are carried out in line with NICE guidance and templates are available within SystmOne. Birmingham and Solihull Mental Health Trust has begun a 3-month pilot to ensure a Consultant Psychiatrist attends MDT meetings at the prison each week. A risk assessment template has been added to the SystemOne software accessible to Trust staff, and is being rolled out with a dissemination plan to ensure completion. TPP acknowledges the coroner's concerns, explains the capabilities of SystmOne, and states that it is working correctly. TPP defers to NHS England and local commissioners regarding specific configurations and usage of the system for mental health assessments in prisons.