National Patient Safety Alerting Committee

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The National Patient Safety Alerting Committee (NaPSAC) is working to align all bodies and teams that issue national alerts, and make sure that a future system of National Patient Safety Alerts set out clear and effective actions that providers must take on safety-critical issues

Background

The NaPSAC was set up at the request of Secretary of State for Health and Social Care following evidence that the safety advice and guidance issued to the NHS is not achieving the required impact for the safety of patients. There is a need to more clearly identify which nationally-issued advice and guidance is safety-critical and mandatory, so that providers are clear about which actions they must comply with. NHS staff, issuers of alerts, and regulators have a similar interest in addressing the current complexity and variations in safety communications issued by national bodies and teams, so that important action to protect the safety of patients stands out. 

Organisations that currently issue safety messages, notices, letters or alerts include the Chief Medical Officer, Department of Health and Social Care Supply Disruption, the MHRA, NHS Digital, NHS England, NHS Improvement Estates and Facilities, NHS Improvement Patient Safety, and Public Health England. 

The role of NaPSAC

  • developing common standards and thresholds for National Patient Safety Alerts
  • developing a single recognisable consistent format for National Patient Safety Alerts 
  • overseeing the development of a process to ensure all alert issuers reach these common standards and thresholds   

What this means for providers

NaPSAC has all types of healthcare providers within its remit (e.g. acute trusts, community pharmacies, general practices, mental health services), however, the targeting of specific individual alerts to different sectors will vary, depending on the issue being addressed.

The core purpose of NaPSAC is to agree progress and oversee systems that will clearly identify which nationally-issued patient safety advice and guidance is safety-critical. This clarity is important for increasing providers’ understanding about which safety-critical actions must be implemented by them. 

The standards and thresholds agreed by NaPSAC will underpin the CQC inspection of National Patient Safety Alerts and the potential for regulatory response for non-compliance.

Membership of NaPSAC

NaPSAC is chaired by the NHS National Director of Patient Safety, with the CQC Chief Inspector of Hospitals acting as deputy chair.

The following bodies/teams are initially represented at NaPSAC on the basis that they either currently directly issue safety messages, notices, letters or alerts, or intend to develop the facility to do so:

  • DHSC Supply Disruption 
  • MHRA Devices 
  • MHRA Drugs 
  • NHS Digital 
  • NHS England Emergency Preparedness and Response 
  • NHS England Primary Care Operations
  • NHS Improvement’s Estates and Facilities Team 
  • NHS Improvement’s Patient Safety Team 
  • Office of the Chief Medical Officer 
  • Public Health England 

The committee also has patient and public representation.

News and updates

  • CQC published ‘Opening the door to change’ on 19 December 2018 including a recommendation reinforcing the role of NaPSAC ‘The National Patient Safety Alert Committee (NaPSAC) should oversee a standardised patient safety alert system that aligns the processes and outputs of all bodies and teams that issue alerts, and make sure that they set out clear and effective actions that providers must take on safety-critical issues.

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