Delivering safer care with the National Patient Safety Improvement Programme

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Chief Executive of the West of England Academic Health Science Network and Patient Safety Collaboratives lead Natasha Swinscoe, and Head of Patient Safety Programmes Phil Duncan on how the National Patient Safety Improvement Programme will use continuous quality improvement to deliver safer care.

The opportunity

In 2014, the National Patient Safety Collaborative Programme (NPSCP) was established to address the recommendations in the Berwick report that: ‘The NHS should be given the resources to support and learn from existing collaborative safety improvement networks and to sponsor the development of new regional or sub-regional collaborative networks across the country, potentially aligned to and working with the new Academic Health Science Networks …and every NHS organisation should participate in one or more collaborative improvement networks as the norm.’

Building on the work of the last five years, the revised national patient safety improvement programme (NPSIP), supported by the Patient Safety Collaboratives (PSCs) across England that are commissioned through and hosted by the 15 Academic Health Science Networks (AHSNs), will be a key improvement and delivery arm of the NHS Patient Safety Strategy.

National priorities for 2019/20

Building on the work of the NPSCP, four national priorities have been identified because of their potential to enable the most significant impact on patient safety.  

Here we discuss preventing deterioration and sepsis, and adoption and spread, with medication safety and maternal and neonatal safety covered later.

Preventing deterioration and sepsis

Our work will continue to focus on avoiding harm or death caused by unrecognised or untreated deterioration in a patient’s condition wherever they are being cared for. The successful adoption of version 2 of the national early warning score (NEWS2) across acute and ambulance trusts in England, helped by NPSCP and many others, gives us the platform to improve the management of deterioration across the whole patient journey. 

NEWS2 adoption does not address all the challenges though. Greater impact will be achieved by improving the reliability of the deterioration pathway in three main domains, underpinned by excellent communication between professionals and with patients:

  • Recognition: the expedient recognition of deterioration including sepsis through the reliable monitoring, identification and assessment of all patients’ conditions in all environments. 
  • Response: the reliable activation, timely response and communication of deterioration. 
  • Escalation: the reliable escalation and de-escalation of clinical interventions and review by senior clinicians, to include advance care planning to reduce inappropriate care.

West of England AHSN have used early warning scoring across their system, including primary care, with impact on mortality including from sepsis. PSCs more widely are starting to adopt similar approaches during 2019/20. NHS England and NHS Improvement are also working with the Royal College of Paediatrics and Child Health and Royal College of Nursing to develop a national paediatric early warning system (PEWS) to help improve the recognition and response to deterioration in acutely ill children.

Adoption and spread priorities

We will work to ensure effective evidence-based practice is identified, shared, spread and adopted as quickly as possible. NPSIP will support local and regional approaches for adoption and spread across representative organisations for the following priority interventions:

  • emergency laparotomy care bundle
  • PReCePT
  • emergency department safety checklist
  • chronic obstructive pulmonary disease (COPD) care bundle.

NPSIP will build on NPSCP’s work to enable and build capability by focusing on working with and coaching teams involved with projects that support the national priorities identified by NHS England and NHS Improvement.

Future programme delivery

We will work to achieve the most effective and sustainable regional delivery model with better co-ordination between the 15 PSCs and NHS regional teams and oversight by NHS England and NHS Improvement national teams.

Our key programme objectives for 2020 to 2025 will be to:

  • continue to deliver safety improvement in the four current priority areas
  • develop an improvement pipeline using national insights and recommendations to inform future improvement work for 2020/21 onwards
  • work with ‘test’ organisations to support adoption and spread 
  • support local engagement across all care settings through structured quality improvement safety initiatives
  • continue to support the conditions for a safety culture to flourish
  • build leadership and safety improvement capability across the system
  • support improvements in the measurement of patient safety and publish the learning from and impact of this programme
  • support the NHS to learn from both harm and excellence.

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