‘Learning from Experience'
How to Improve Safety for Patients in Scotland
The Scottish Executive Health Department's Consultation Paper
The UNISON Scotland Response
UNISON Scotland welcomes the opportunity to respond
to the consultation paper on improving patient safety in Scotland.
UNISON Scotland welcomes the establishment of
the new Health Board ‘NHS Quality Improvement Scotland' and believes
that in addition to removing unnecessary duplication of effort
in respect of clinical governance in Scotland, the creation of
this body can also help restore public confidence in the ability
of the NHS to deliver patient care of the highest quality.
UNISON Scotland is encouraged by the executive's
commitment to improving patient safety in Scotland and is supportive
of the executive's aim to promote awareness of risk and patient
safety amongst ALL health workers who assist in the provision
of services for patients.
UNISON Scotland is supportive of the executive's
drive to encourage a ‘reporting' and a ‘safety culture' amongst
NHS Scotland staff. UNISON Scotland believes that improving the
care of patients requires the development of a blame-free culture
in the Scottish health service where lessons are learned from
both good and bad experience. However, UNISON Scotland believes
that to enable a ‘reporting' culture to work effectively within
the NHS, steps have to be taken to ensure that staff are able
to work without fear of intimidation or harassment as a result
of their willingness to report adverse incidents.
UNISON Scotland also believes that staff must
have confidence that lessons will be learned and changes enacted
following the investigation of incidents. UNISON Scotland believes
that the NHS will only benefit from the adoption of a reporting
system if staff in the frontline of patient care have complete
confidence in the ability of the reporting system to produce results.
In the main, UNISON Scotland believes that the
key proposals outlined in the document will provide a good starting
point to improving patient safety in Scotland. However, UNISON
Scotland believes that the overall strategy to improve patient
safety could be reinforced if the Scottish Executive was willing
to act on trade union concerns in relation to hospital cleanliness
and its impact on rates of HAIs.
UNISON Scotland believes that the Scottish Executive
should afford a higher priority to combating HAIs and ensuring
that adequate cleaning and hygiene standards are maintained in
the NHS. In addition, it should remove all private contractors
from cleaning responsibilities within the Scottish Health Service
and show a greater willingness to involve health service trade
unions in the strategy to reduce patient harm in Scotland.
UNISON is Scotland's biggest health union representing thousands
of NHS staff throughout the country. Our members include nursing,
ancillary and clerical staff, whom the NHS depends upon to ensure
the safe and effective functioning of the NHS.
This paper constitutes UNISON Scotland's response to the consultation
document issued by the Scottish Executive entitled: ‘Learning
from experience' How to improve safety for patients in Scotland.
The document sets out the Scottish Executive's proposals for
improving patient safety in Scotland. The document also sets out
the Executive's plans for making Quality Improvement Scotland
the lead agency for patient safety issues in Scotland with responsibility
for developing an agreement with the National Patient Safety Agency
(NPSA) on behalf of NHS Scotland.
In addition, the document sets out the key elements of the Scottish
Executive's strategy to reduce harm in NHS Scotland and pinpoints
five key areas of clinical governance, which it considers important
in its drive to improve patient safety in NHS Scotland. These
- Implementing a reporting and learning system
- Developing an open and fair culture in the NHS and skills
for analyzing incidents
- Developing solutions
- Disseminating Patient Safety Alerts
- Investigating issues of serious concern.
The main thrust of the consultation is concerned with the way
in which Quality Improvement Scotland will manage, monitor and
co-ordinate with the NPSA to improve patient safety in relation
to the five key areas of action highlighted in the document.
Q1 Do you agree that Trusts in Scotland should begin to send
adverse incident data to NPSA when the Agency is ready to implement
its reporting and learning system?
UNISON Scotland agrees that it would be beneficial for Trusts
in Scotland to send adverse incident data to NPSA at the earliest
date. UNISON Scotland believes that the contribution of NHS Scotland
experiences to the NPSA database will facilitate the process of
learning and change within the NHS and enhance the NHS bank of
knowledge on controlling risk.
However, UNISON Scotland has reservations regarding the timetable
for implementation of the reporting system. UNISON Scotland believes
that NHS Trusts should only begin providing data to the NPSA when
adequate numbers of staff have been properly trained, to do otherwise
would only put extra pressure on staff and bring into question
the validity and usefulness of the data collected.
In addition, UNISON Scotland believes that NHS Quality Improvement
must ensure the reliability and compatibility of the computer
systems before implementing the reporting and learning system
and the transfer of data to the NPSA. Only last year the NPSA
were forced to concede that there were significant problems in
relation to "data capture, data transfer and data transmission"
within the reporting system. In addition it was found that computers
in primary care centres and in mental health services did not
integrate well with the NPSA system.
UNISON Scotland believes that NHS Quality Improvement must seek
assurances from the NPSA that these technical problems have been
resolved before implementing the new system and beginning the
transfer of data to the NPSA.
Q2 Do you have any comments on these approaches to implementing
educational support on patient safety in Scotland?
UNISON Scotland welcomes the move to take forward and develop
within NHS Scotland many of the NPSA educational and support initiatives
currently underway in England and Wales. UNISON Scotland believes
that an approach similar to that of the NPSA, with adjustments
suited to Scottish needs, offers the best opportunity to effectively
develop the capacity to report and learn from adverse incidents
and to implement an open and fair culture in NHS Scotland.
In recognition of the fact that the number of adverse incidents
increases when there are more temporary staff employed, UNISON
Scotland would encourage NHS Scotland to ensure that temporary
and agency staff working in the NHS Trusts are provided with induction
training in patient safety.
Q3 How else should the education and training initiatives
to build capacity and change the culture be taken forward in Scotland?
UNISON Scotland believes that trade unions have a clear role
to play in ensuring the success of the strategy to reduce patient
harm in NHS Scotland. UNISON Scotland would like to see this role
developed to enable trade unions to work in partnership with NHS
UNISON Scotland has recently published a practical guide for
its members on how to use the duty of care to ensure safe healthcare
services and a safe working environment for healthcare staff.
It has been published to assist stewards and members in raising
concerns about excessive workloads, poor staffing, inappropriate
grade mix, and a bullying culture, which may prevent concerns
being raised. It also provides practical advice on how to positively
influence service changes and modernisation of services.
UNISON Scotland is disappointed therefore that the document does
not envisage a greater role for trade unions in the development
of the support initiatives and educational tools needed to encourage
reporting and safety conscious working in NHS Trusts.
Q4 Do you have any comments on this approach to the development
of solutions to problems of patient safety in Scotland?
UNISON Scotland welcomes the new approach which emphasises a
more co-ordinated and Scotland wide approach to implementing solutions
to patient safety. UNISON Scotland also welcomes NHS Quality Scotland's
commitment to tackling the "root causes" behind incidents and
the plans to produce guidance and patient safety alerts where
needed to improve patient safety.
UNISON Scotland also believes that in addition to developing
these practical solutions to the problem of patient safety in
Scotland the executive should also take immediate action to bring
to an end the privatisation of hospital cleaning services. UNISON
Scotland believes that until the Scottish Executive starts putting
the issue of patient safety before profits the practical solutions
to improve patient safety currently being developed will not realise
their full potential.
UNISON Scotland has had long held concerns about hospital cleanliness
and its impact on rates of Hospital Acquired Infections. The recent
Audit Scotland report into Hospital Cleaning showed that 38% of
hospitals and wards cleaned by private contractors were in the
category of greatest concern as opposed to only 14% of those hospitals
and wards cleaned by directly employed NHS staff.
We believe that the Scottish Executive should consider adopting
the UNISON Scotland three-point action plan to tackle Hospital
Acquired Infections (HAI). This plan would establish agreed minimum
staffing levels for domestics for every ward and department in
the Scottish Health Service. It would ensure that the day to day
management of domestics is returned to Ward Sisters and Charge
Nurses and also that all private contractors are removed from
the National Health Service. UNISON Scotland believes that only
by adopting this action plan will the NHS be able to demonstrate
significant improvement in the cleanliness of the NHS hospitals
Q5 Are there other ways that Scottish interests should be
involved in the development of ‘solutions'?
As stated previously, UNISON Scotland believes that there is
a greater role for health service trade unions in the development
of solutions to patient safety than is outlined in the document.
UNISON Scotland believes that the input of practical advice from
our members who work at the frontline of patient care in the NHS
can play an important role in the development of solutions to
In addition, UNISON Scotland is concerned that the NPSA has failed
to provide assurances that Scottish expertise in the field of
clinical governance and patient safety will be fully utilised
as a key element within the wider UK research strategy. Scottish
academic institutions and researchers have a proven R&D track
record in these fields which UNISON Scotland believes should be
fully utilised to contribute to the development of solutions not
only in Scotland but in the UK as a whole.
Q6 Do you have any comments on the principles for disseminating
Patient Safety Alerts in Scotland and monitoring whether action has
been taken by NHS Scotland to change ways of working?
UNISON Scotland agrees with the principles for disseminating
Patient Safety Alerts developed by the NPSA. We are pleased that
the alerts are being issued simultaneously to NHS Scotland and
to the NHS in England and Wales and that differences in the nature
of Scottish NHS service arrangements have been recognised and
taken into consideration by the NPSA.
Q7 Do you have any comments on this approach to investigating
issues of serious concern in Scotland?
UNISON Scotland welcomes the new arrangements that will give
NHS Quality Improvement the power to investigate issues of serious
concern on its own initiative. UNISON Scotland anticipates that
this will strengthen the current arrangements in place and hopefully
ensure a fully impartial and independent process of investigation
and reporting of patient safety issues within NHS Scotland.
UNISON Scotland believes that if NHS Quality Improvement is seen
to be free from external influences that this will encourage NHS
staff to develop a wider reporting culture within their own working
environments within NHS Scotland. It will also help assure an
increasingly sceptical public of the Scottish Executive's determination
to improve patient safety in Scotland.
UNISON Scotland also welcomes the Scottish Executive's
commitment to review current arrangement to ensure all staff in
clinical professions have the skills and capabilities to fulfil
their clinical roles effectively. However, UNISON Scotland believes
that continuing development and training should be available for
all NHS staff. The ability of the NHS to improve patient safety
will depend upon all grades of staff being given the opportunity
to access relevant training and knowledge on hazards to patient
safety, not just the select few.
For Further Information Please Contact:
Matt Smith, Scottish Secretary
14, West Campbell Street,
Glasgow G2 6RX
Tel 0141-332 0006 Fax 0141 342 2835
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