Unclear healthcare delegation
25 items
2 sources
Weak and unclear guidance on the delegation of healthcare responsibilities within schools, leading to insufficient clarity.
Cross-Source Insight
Unclear healthcare delegation has been flagged across 2 independent accountability sources:
5 inquiry recs
20 PFD reports
This issue has been identified by multiple independent accountability bodies, suggesting it is a recurring systemic concern.
Inquiry Recommendations (5)
IHRD-12 — Senior Paediatric Responsibility
Recommendation: Senior paediatric medical staff should hold overall patient responsibility in children's wards accommodating both medical and surgical patients.
Gov response: Arrangements in place for senior paediatric oversight in children's wards.
Accepted
Delivered
IHRD-15 — Consultant Notification on Admission
Recommendation: A consultant fixed with responsibility for a child patient upon an unscheduled admission should be informed promptly of that responsibility and kept informed of the patient's condition, to ensure senior clinical involvement and leadership.
Gov response: Protocols implemented for consultant notification on unscheduled paediatric admissions.
Accepted
Delivered
IHRD-19 — Senior Lead Nurse in Children's Wards
Recommendation: To ensure continuity, all children's wards should have an identifiable senior lead nurse with authority to whom all other nurses report. The lead nurse should understand the care plan relating to each patient, be visible to both patients and staff …
Gov response: Senior lead nurse roles established in children's wards across Trusts.
Accepted
Delivered
IHRD-20 — Consultant-Led Ward Rounds
Recommendation: Children's ward rounds should be led by a consultant and occur every morning and evening.
Gov response: Consultant-led ward rounds implemented in children's wards.
Accepted
Delivered
IHRD-21 — Nurse Attendance at Clinical Interactions
Recommendation: The accountable nurse should, insofar as is possible, attend at every interaction between a doctor and child patient.
Gov response: Guidance issued on nurse attendance during clinical interactions with child patients.
Accepted
No update 2+ yrs
PFD Reports (20)
Christopher O’Donnell
Concerns: The supported living accommodation's policy, which prohibits staff from removing excess medication for safeguarding without resident consent, creates a risk when residents are in mental health crisis.
Responded
Paul Reeves
Concerns: Supported accommodation staff had unclear medication supervision roles and failed to communicate critical welfare concerns about a deteriorating resident to the mental health team, hindering proper assessment.
Responded
Hailey Thompson
Concerns: A GP surgery's care navigator lacked clear pathways and triage tools for urgent paediatric allergy referrals, leading to an inappropriate referral and no auditable record of the handling.
Responded
Pamela Marking
Concerns: Misleading titles and public misunderstanding of Physician Associate roles, coupled with inadequate national guidelines and direct supervision, risk patient safety through PAs working beyond their competency.
Responded
David Bennett
Concerns: Mental health crisis and acute care staff lacked access to crucial patient records, leading to inadequate information sharing and failures in escalating deteriorating mental health, medication reviews, and proper risk assessment.
Responded
Rachel Gibson
Concerns: Unclear responsibilities for checking and administering local anaesthetics, along with inconsistent prescription methods and wide national variations in practice, create significant safety risks.
Responded
Hannah Jacobs
Concerns: Dental staff failed to recognise anaphylaxis symptoms, and allergy plans gave false reassurance for mild reactions. Education is needed on identifying anaphylaxis and using adrenaline auto-injectors if in doubt.
Responded
Hannah Jacobs
Concerns: Insufficient consideration for managing anaphylaxis risk during school commutes highlights a need for better education for schools, patients, and parents on the importance of carrying adrenaline auto-injectors.
Overdue
Catriona Martin
Concerns: There are no guidelines for the delegation of nursing duties to family members, leading to unacceptable care levels and a lack of clear supervision or intervention by the nursing team.
Responded
Katherine Flynn
Concerns: A lack of clear national or standardized trust policy on escalating issues when an external ventricular drain stops draining but oscillates poses a significant patient safety risk.
Overdue
Christian Tuvi
Concerns: A prolonged impasse among organizations regarding safe conveyor operation, coupled with inadequate training and competence assessment for cleaners, resulted in an unsafe system relying on temporary measures.
Responded
Harold Wilberforce
Concerns: A pharmacy delivery agent, lacking training and dementia awareness, moved an elderly patient who had fallen and resisted help. There's a critical lack of clarity regarding staff responsibilities in such situations.
Responded
Alison Dallow
Concerns: Clinical advice on weight-bearing status was unclear, and the hospital's VTE risk reduction policy for outpatients lacked clarity. There was also no documented evidence of information provided to the patient.
Overdue
Samantha Gould
Concerns: There is a national gap in guidance for sharing mental health patient care plans and risk information with pharmacies, enabling vulnerable 16-17 year olds to access overdose medication.
Responded
Amarbai Bhudia
Concerns: Poor communication of medical instructions, inadequate training for nursing and agency staff on NG tube management, and a failure to properly escalate concerns about its function were identified.
Overdue
Stanley Babbs
Concerns: Contrast media, a prescription-only medicine, was administered without a formal prescription, careful dose consideration, or a clearly identified responsible clinician, particularly for high-risk patients.
Responded
Alexander Davidson
Concerns: NHS 111 pathways use unsuitable language for children and cause confusion, while GP surgeries experience delays in uploading 111 notes. There is also a lack of standardized lipase/amylase testing for children and inconsistent ED return patient reviews.
Overdue
Eleanor Brabant
Concerns: Observation policies for vulnerable patients were unclear, staff lacked training on safeguarding and reporting crimes, and nurses misunderstood their powers to detain informal patients. Confusion also existed regarding family involvement in care planning.
Overdue
Marjorie Nesbitt
Concerns: Carers lacked training and clear guidance on how to manage unusual and difficult situations, specifically regarding an overheating client from a heater, leading to a fatal outcome.
Responded
Violet Cloudsdale
Concerns: The care home lacked risk assessments and consent for wheelchair lap-belt use, and unclear guidance on their application raised concerns about unlawful restraint, contributing to a fall.
Overdue