2024

Noted (AI summary) The VMD provides guidance on the use and storage of veterinary controlled drugs and is producing an article reminding vets of their responsibilities. The VMD investigates breaches of the Veterinary Medicines Regulations (VMR) and conducts risk-based inspections of vet practices and wholesalers. The RCVS will consider additional core requirements in the Practice Standards Scheme (PSS) requiring practices to have individualized suicide prevention plans, review the legislative requirements for schedule 2 CDs and decide what provisions may be extended to schedule 3 CDs via RCVS guidance, and explore methods of communicating the legal and regulatory requirements relating to lethal medicines to the profession. The RCVS will continue to engage with the Home Office regarding additional safeguards for controlled drugs used for euthanasia.

Noted (AI summary) UHCW and GEH finalized and shared guidelines for managing acutely unwell kidney transplant renal inpatients, discussed them at the Renal Quality Improvement and Patient Safety meeting, agreed to a Service Level Agreement for UHCW renal team to attend GEH, and have changed internal processes to prioritize interhospital transfers. NHS England expresses condolences and acknowledges concerns, referring to existing service specifications and the GIRFT program, while noting local arrangements are for the involved providers to respond to, and that they will consider these in due course. The UKKA and BTS will share recommendations with kidney care and transplant communities, contact patient associations, and share information with the Royal College of Physicians Patient Safety Committee. George Eliot Hospital received management guidelines from UHCW's Renal Team, shared posters for dissemination on 12 December 2024, and included information on the guidelines in daily briefings from 16-20 December 2024, emailing guidelines to all doctors and consultants on 17 December. UHCW will be the primary specialist transfer centre for all renal patients admitted to peripheral hospitals, regardless of their parent specialist unit, following shared guidelines and SLA. GEH confirms switchboard now has master copy of local specialist centre contact details following UKKA/BTS recommendations.

Noted (AI summary) NHS England expresses condolences and describes the Maternal Medicine Networks established across England; they support revision of the Royal College of Pathologists’ guidelines for urgent reporting of LFTs to incorporate different levels for pregnancy. UHBW will await national guidance from the Royal Colleges regarding a recommended reference range for urgent reporting of LFTs in pregnancy, and then set up a task and finish group to implement these across the Trust. If no national guidance is available, UHBW will look to change the reference range locally. The RCOG acknowledges the concerns raised and highlights existing online learning resources and escalation protocols, while suggesting the Royal College of Pathologists review its guidance on urgent reporting levels of LFTs for pregnant women. The Royal College of Pathologists states that its guidance on communicating critical pathology results is advice to pathologists and that individual cut-offs should be agreed locally with clinicians. The need to agree local cut offs with clinicians will be emphasised in the next revision of this document.

Noted (AI summary) NHS England acknowledges concerns about a patient leaving the hospital before assessment due to waiting times. They note the involvement of the Greater Manchester ICB and refer to existing plans to recover urgent and emergency care services and internal R28 reviews. The trust has implemented a new 'Leaving Against Advice' policy, including documentation and capacity assessments, and has become an early adopter of the NHSE Acuity Tool for standardized ED assessments, including a mental capacity assessment relating to a patient's decision to leave the department.

Noted (AI summary) NHS England acknowledges concerns about the monitoring of Sevoflurane and refers to professional guidance from the Royal Pharmaceutical Society and CQC regulations. They note the hospital's response and mention internal discussions of R28 reports to identify trends. The trust has reduced the amount of sevoflurane stored in each theatre and implemented locked drug cupboards. They are also submitting a business case to purchase and install automated medicines storage cabinets.

Noted (AI summary) The Royal College of Radiologists acknowledges the challenges of diagnosing retrocaecal appendicitis and advocates for prompt assessment by experienced clinicians, including expert surgeons and radiologists while highlighting radiology workforce shortages. It suggests early transfer to specialist centres where paediatric surgeons and radiologists are more available may be needed. The Royal College of Surgeons of England has shared the report with its Specialty Advisory Committee Chairs for consideration during upcoming curricula reviews. They are also exploring whether they can explicitly refer to retrocaecal appendicitis in the Care of the Critically Ill Surgical Patient (CCRISP) and the Clinical Skills in Emergency Surgery courses, and the case will be published as an educational vignette. The RCPCH will share information and suggestions for local improvement from the report with its paediatric members via its patient safety portal and the anonymised information within the report will also be shared for discussion with the RCPCH Clinical Quality in Practice Committee, where further actions may be identified. The RCGP expresses condolences and acknowledges concerns about diagnosing appendicitis, noting the diagnostic challenges of retrocaecal appendicitis and the limited availability of bedside ultrasound. They highlight existing NICE guidance and commit to supporting ongoing educational resources but do not describe specific actions.

Noted (AI summary) NHS England explains the NHS Pathways Clinical Decision Support System and how it is used. They state the exit scripts are for local determination and cancellation of ambulances is outside the remit of the NHS Pathways system. The Department acknowledges concerns about ambulance response times and call handler scripts, and states that NHS England is addressing the script issue. The government highlights its Plan for Change and upcoming 10-Year Health Plan with reforms and investment, and promises to set out improvements to urgent and emergency care by Spring.

Noted (AI summary) TfL intends to implement a permanent pedestrian crossing scheme at the A4/Jersey Road junction in Hounslow by 2026, including signal-controlled crossings. In the interim, temporary customer information signage warning pedestrians to take care when crossing the road will be installed by January 2025. The Department for Transport states that Transport for London (TfL) is responsible for traffic management on its roads, including the pedestrian crossing at issue. The DfT says no consent is required from the Department to enable TfL to make changes to this site, and funding will come from TfL revenue sources. The London Borough of Hounslow is working with TfL to improve traffic conditions on the A4, especially for vulnerable road users. Proposals are being considered for signal-controlled crossings for pedestrians and cyclists across the A4 and Jersey Road, with construction planned for 2026-27, along with interim temporary signage.

Noted (AI summary) NHS England is investing in new units and system transformation to increase access to mental health beds, and London regional colleagues are engaging with the North East London Integrated Care Board on system arrangements for mental health inpatient beds. The Department acknowledges concerns about bed availability and highlights existing initiatives to improve community mental health support and patient flow, referencing published guidance on discharge from mental health inpatient settings.