NHS England is the responsible organisation for emergency planning and resilience in London. As such, it has well-established contingency plans in place which take effect in the event of emergency departments (EDs) having to temporarily reduce their scope of operations in order to ensure the best standards of patient care, our central concern.

As the Rt. hon. Member is aware, following an unannounced inspection by the Care Quality Commission (CQC) at North Middlesex University Hospital NHS Trust, the CQC issued a Warning Notice. The Warning Notice, published on 6 June 2016, requires the trust to significantly improve the treatment of patients attending its emergency department.

The CQC is responsible for assessing whether the Trust is providing the right standard of care and ensuring that improvement plans meet the level of improvement required.

NHS Improvement is working alongside NHS England and the local health and care system to ensure that the Trust has the resources it needs to ensure that patients receive safe, high quality care.

We are informed by NHS Improvement that, in order to address the poor performance at the Trust’s ED, it has devised a plan titled Safer, Faster, Better. This is a whole system programme with the primary objective of improving performance, patient experience and outcomes for patients.

The General Dental Council (GDC) is an independent statutory body. As the regulator of all registered dentists it has the power to take fitness to practise action, and investigate any complaints made against a dentist who is currently registered with the GDC. The Professional Standards Authority conducts annual reviews of the GDC’s fitness to practise process, to ensure it meets the set professional standards. The Dental Complaints Service, run by the GDC, can assist in resolving complaints raised about private dental treatment provided by all GDC registered dentists in the United Kingdom. Furthermore, if a dentist is registered with the GDC, the GDC has the power to investigate that dentist, whether they are in the UK or not. Therefore, if a dentist is registered with the GDC and was working in the UK but returned to their home country, the GDC would be able to take action. If the dentist does not hold a current registration with the GDC, the GDC cannot investigate further, but an unregistered dentist, whether they have a complaint against them or not, cannot practise in the UK, which ensures UK patient safety, and maintains professional standards.

In the last five years there have been a total of 1,881 Never Events recorded in hospitals in England. The table below provides the specific annual figures of this total.

Never Events cannot be compared year on year as the number of Never Events contained within the Never Events list and definitions of the individual Never Events have been modified each year, so direct comparison is not appropriate.

Data for 2015/16 is still provisional and is yet to be confirmed in the annual data summary.

The information is not available in the format requested. In addition, data are not available at hospital level. The 2012-13 publication does not have trust level data.

Published data on never events from 2012-13 to 2015-16 are available on the NHS England website at:

https://www.england.nhs.uk/patientsafety/never-events/ne-data/

The following table shows the reported never events at the University Hospitals of Morecambe Bay NHS Foundation Trust for 2013-14 and 2015-16. No never events were reported at this Trust in 2014-15. Cumbria Partnership NHS Foundation Trust, which also provides services from the Furness General Hospital and the Westmorland General Hospital, has no reported never events in the published data.

Source: NHS England https://www.england.nhs.uk/patientsafety/never-events/ne-data/

Notes:

1. From April 2014, NHS England published provisional never events data as monthly updates throughout each financial year. Each report updates the previous month’s data as information on never events is reported or amended.
2. The provisional monthly never events data summaries for 2015/16 have been drawn from the STEIS system. Each report includes all Serious Incidents reported as occurring within the indicated timeframe, where they are designated by their reporters as never events at the date the data was extracted. Please note these reports are provisional data and subject to change.
3. As of 1 April 2016, patient safety is now part of NHS Improvement. Never events data publications for 2016/17 financial year and onwards will be published by NHS Improvement.

The provision of cough assist machines is the responsibility of clinical commissioning groups (CCGs). Clinically led CCGs have independence and autonomy to make commissioning decisions for local populations, taking into account the available evidence and individual circumstances, as appropriate.

The evidence base to demonstrate the clinical and cost-effectiveness of the use of cough assist machines in muscle-wasting conditions is not well established. In order to improve the evidence base, the National Institute for Health Research, which is funded through the Department, is seeking to commission research on the clinical and cost-effectiveness of mechanical cough assist devices compared to other methods of sputum clearance. The deadline for outline proposals was 21 January 2016 with full proposals expected for consideration in July.

NHS England has been working with Muscular Dystrophy UK through the Bridging the Gap project to address areas of concern raised by patients and their representatives, one of which is the provision of cough assist machines. The establishment of Bridging the Gap was supported with just under £600,000 awarded by the Department through its Innovation, Excellence and Strategic Development Fund. Through this work, a number of CCGs have now developed commissioning policies which set out the circumstances in which to consider these devices based on one developed by Walsall CCG, which has been shared nationally as an example of good practice by Muscular Dystrophy UK.

On 26 April 2016, my hon. Friend the Parliamentary Under-Secretary of State, met with Muscular Dystrophy UK and a number of patient representatives specifically to hear their concerns about the provision of cough assist machines.

The Health and Social Care Information Centre has advised the general practitioner (GP) Extraction System is not currently flowing data from GP practices and primary care, so data from a community setting is not available.

It is for health and social care providers to develop local nutrition and hydration policies and there are a number of best practice resources and guidelines available to help providers do this.

Nursing staff understand the importance of proper nutrition and will follow guidelines in assessing patients for their ability to swallow safely. From this they can make judgements about a patient’s capability to eat and drink safely and adequately, which will include taking into account whether they are heavily medicated or not.

The National Patient Safety Agency and the Royal College of Nursing published a series of factsheets in 2009, setting out the key characteristics of good nutritional care in healthcare environments.

http://www.nrls.npsa.nhs.uk/resources/?entryid45=59865

It includes the Council of Europe 10 key characteristics of good nutritional care in hospitals, which recommends that all patients are screened on admission to identify the patients who are malnourished or at risk of becoming malnourished; all patients are re-screened weekly; and all patients have a care plan which identifies their nutritional care needs and how they are to be met.

The National Institute for Health and Care Excellence (NICE) Quality standard for nutrition support in adults

www.nice.org.uk/Guidance/QS24

defines clinical best practice for adults in hospital and the community who are at risk of malnutrition. And NICE Nutrition support in adults: Oral nutrition support, enteral tube feeding and parenteral nutrition

www.nice.org.uk/guidance/cg32

offers best practice advice to help healthcare professionals correctly identify people in hospital and the community who need nutrition support, and enable them to choose and deliver the most appropriate nutrition support at the most appropriate time.

A recent search of the National Reporting Learning System was carried out of all medication incidents reported as occurring between the dates 1 October 2014 and 31 December 2015.

This search used key word searches most likely to identify the requested incidents. The search mechanism available does not allow us to confirm that the patients involved with these incidents have Parkinson’s disease but it was focused on medication incidents involving drugs commonly used in Parkinson’s. It is possible that there are additional relevant incidents.

The information requested is provided in the attached table.

Information on annual National Health Service spend on medically assisted nutrition in end of life care is not held centrally.

It is for clinicians with responsibility for the care of people at the end of life to ensure their patients receive care and treatment appropriate to their needs. Similarly, local commissioners are responsible for ensuring the services they commission meet the needs of their local populations.

In 2014 we set out five priorities for care of the dying person which should underpin the care being delivered to all dying people. Alongside the priorities, we set out the duties and responsibilities for all staff with responsibility for looking after dying people and implementation guidance for all providers and commissioners of care. The priorities for care state that an individual plan of care, which includes food and drink, symptom control and psychological, social and spiritual support, is agreed, co-ordinated and delivered with compassion.

In December 2015, the National Institute for Health and Care Excellence published guidance on the care of dying adults in the last days of life, including guidance on medical nutrition and hydration. Clinicians and commissioners should have regard to this guidance when making decisions about care for people at the end of life.

Currently, NHS England has a leadership role for patient safety in the National Health Service and supports providers to identify, understand and manage risks that might affect the safety of patients. The primary source for identifying risks is the National Reporting and Learning System (NRLS). The NRLS operates as a database and holds over 1.4 million locally reported patient safety incidents. These are reviewed to help address the identified issues or risks in the NHS. NHS England alerts NHS trusts of emerging patient safety risks via the National Patient Safety Alerting System – a three-stage alerting process which ensures the timely sharing of relevant safety information. The system also encourages information sharing between organisations so that examples of best practice can be widely adopted.

NHS trusts are expected to review their own patient safety incidents. The revised Serious Incident Framework published in March 2015 has sought to simplify the incident management process and ensure that serious incidents are identified correctly, investigated thoroughly and, most importantly, learned from to prevent the likelihood of similar incidents happening again.

The NHS standard contract also stipulates that providers must consider and respond to the recommendations arising from any audit, Serious Incident report or Patient Safety Incident report.

The Government’s current plans for ensuring the same quality of care in hospitals on all days of the week are focussed on those with urgent and emergency care needs at weekends and those who are already inpatients. It is for individual health economies to determine if they wish to provide elective care at weekends, for example if they can use more efficiently additional resources that are available to meet urgent and emergency care needs.

The proposals are to introduce a safer, fairer contract for junior doctors that will help improve their training experience to better support patient care every day of the week.

Our ambition for the National Health Service to be the safest healthcare system in the world is underpinned by reducing, not increasing, the number of hours junior doctors work each week. The new contract will include improved, legally (and contractually) enforceable safeguards - including that no junior doctor working full time will be expected to work on average more than 48 hours a week, unless they opt-out of the European Working Time Directive in which case it is maximum of an average 56 hours a week. The number of hours that can be worked in any single week by any junior will be limited to 72 (down from 91 currently) and there will be a limit of five consecutive long days or four consecutive nights.

We will also bring the working hours and service delivery of junior doctors within the Care Quality Commission (CQC) inspection regime. Putting patients first is the responsibility of employers and staff. Juniors must feel confident that when they raise safety concerns they are listened to. Where doctors are asked to work in conditions that they believe are unsafe, including being asked to work patterns that put patient safety at risk, they will be asked to use the reporting mechanisms available to them (including alerting their line managers/clinical supervisors, reporting through the local incident reporting system which will upload to the National Reporting and Learning System) to raise the issue with both the board of their trust, and reporting data will be available for the CQC to use during inspections. We would expect trust boards to look at any such report and decide how to respond to it; and we would expect the CQC, when it carries out an inspection, to look at how the board has responded to this and other data reporting safety incidents and concerns.

NHS England is responsible for the National Reporting and Learning System which collates information on patient safety incidents reported by staff working in NHS funded care.

There are plans to develop a new patient safety incident management system and one of the aims will be to make it quicker and easier for staff to report.

There are no current proposals to cap tradeunion facility time although the Trade UnionBill includes a reservepower to do so if it is deemed appropriate.The Department has not assessed the effect on staff morale, productivity and patient safety should this power be implemented and has no evidence that they would be affected.

The Government is clear the reconfiguration of front line health services is a matter for the local NHS.

NHS England has issued guidance on Planning and Delivering Service Change for Patients. As part of this guidance, NHS England specifies that: ‘Based on evidence and national clinical reference groups’ advice, commissioners need to determine the appropriate range of providers and interplay of key access requirements such as travel time.’

All commissioners proposing reconfiguration must include an analysis of travelling times and distances in their Pre-Consultation Business Case. As part of the Best Practice Check guidelines issued by NHS England, commissioners are asked: ‘Has the travel impact of proposed change been modelled for all key populations including analysis of available transport options, public transport schedules and availability/ affordability of car parking?’ and asked to provide evidence of this through a travel impact assessment.

There has been no such correspondence or meetings. These are operational matters for the Lancashire Care NHS Foundation Trust.

The Department commissioned a Review of Choice in End of life Care in 2014 which considered the choices most important to people approaching the end of life, including on where to receive care and die. The Review published its report earlier this year setting out a vision for enabling greater choice. The Department is working with NHS England on how best to achieve this vision and will be setting out its response to the Review later this year.

This information is not collected centrally.

We have written to Derek Brown, Chair of the Lancashire Care NHS Foundation Trust informing him of the hon. Member’s enquiry. He will reply shortly and a copy of the letter will be placed in the Library.

This information is not collected centrally.

We have written to Derek Brown, Chair of the Lancashire Care NHS Foundation Trust informing him of the hon. Member’s enquiry. He will reply shortly and a copy of the letter will be placed in the Library.