No such assessment has been made. However, the National Institute of Health Research is funding a study to determine whether using a mixture of re-usable and single-use catheters is as safe and acceptable for intermittent catheterisation as using only single-use catheters.

We are not currently taking any specific steps to ensure patients have access to single use catheters. The decision of which device should be offered to patients remains a clinical one.

The National Institute for Health Research and UK Research and Innovation have jointly commissioned research studies to determine the potential risk to patients and staff from aerosol transmission of COVID-19 and investigate how to mitigate those risks. This includes funding of £433,000 to the AERATOR study at the University of Bristol to investigate aerosolization of COVID-19 and transmission risk at short range from medical procedures.

Additionally, Public Health England have been awarded £337,000 to investigate environmental and airborne transmission routes of COVID-19 including in healthcare settings.

The noble Lord Carter of Coles published a report last year on the provision of aseptic medicines, including some critical care medicines, in England. Recommendations included setting up a network of hub and spoke facilities to prepare ready to administer medicines, providing guidance on standard injectable medicines, and training for aseptic pharmacy staff. NHS England and NHS Improvement are setting up a National Health Service aseptic services transformation implementation board to co-ordinate the implementation of these recommendations.

The recommended changes will improve patient safety by reducing errors in compounding and administering these medicines. Errors in these medicines are not currently specifically tracked but the report recommends that the NHS begins tracking and reducing them.

The creation of regional hub and spoke services could release the equivalent of over 4,000 whole time equivalent nurses each year. This is based on the time taken for nurses to prepare the 14 most commonly used aseptic medicines. The development of a hub and spoke system will offer opportunities for production at scale, relieving pressure on hospital pharmacies.

The noble Baroness is absolutely right to identify some of the very significant health consequences of malnutrition. This is one of the reasons why it has been taken on board as a top priority by not only NHS England but the care system from top to bottom. The start is to have the right screening and to gather the right data so that we can identify where this needs to be improved. She is right that it needs to be integrated into nursing practice so that we not only prevent malnutrition in the first place but, where it does occur, provide the right support to put it right and the right care where there are health consequences for individuals due to clinical, social or economic problems.

Private hospital providers are required by law to notify the Care Quality Commission (CQC) about the following occurrences:

- A serious injury to a person using the service;

- The death of a person using the service;

- An incident relating to the service that is reported to or investigated by the police;

- Something that stops or may stop the service running safely (such as problems with infrastructure, equipment or premises);

- Safeguarding issue such as abuse or allegations of abuse concerning a person using the service if any of the following applies:

1. the person is affected by abuse or alleged abuse
2. the person is an abuser or an alleged abuser; and

- Any application and its outcome or withdrawal to deprive a person of their liberty.

On 8 August 2018, NHS Improvement issued a National Patient Safety Alert to support safe and timely management of hyperkalaemia through a range of resources that would help organisations ensure their clinical staff have easily accessible information to guide prompt investigation, treatment and monitoring options. The resources include clinical practice guidelines from the UK Renal Association on treatment of acute hyperkalaemia in adults and an awareness video from NHS Improvement for hospital staff. A copy of Patient Safety Alert: Resources to support safe and timely management of hyperkalaemia (high level of potassium in the blood) is attached.

National Patient Safety Alerts are issued through the Central Alerting System (CAS); a web-based cascading system for issuing patient safety alerts, important public health messages and other safety critical information and guidance to the National Health Service and others, including independent providers of health and social care.

NHS trusts are required to respond via CAS stating whether they are compliant with the actions and the timescale provided in all patient safety alerts or whether the alert is not relevant to them.

NHS Improvement has been working closely with the Care Quality Commission (CQC) to ensure that inspection teams are aware of national patient safety alerts that have been recently issued and that they review the actions taken in response to national patient safety alerts during their inspections.

In addition, the Department commissioned the CQC to work with NHS Improvement to understand the issues in NHS trusts that contribute to ‘Never Events’; part of this work looked at how effectively trusts use safety guidance and how other system partners support the implementation of safety guidance. A report, Opening the door to change: NHS safety culture and the need for transformation was published at the end of last year and a copy is attached.

On 8 August 2018, NHS Improvement issued a National Patient Safety Alert to support safe and timely management of hyperkalaemia through a range of resources that would help organisations ensure their clinical staff have easily accessible information to guide prompt investigation, treatment and monitoring options. The resources include clinical practice guidelines from the UK Renal Association on treatment of acute hyperkalaemia in adults and an awareness video from NHS Improvement for hospital staff. A copy of Patient Safety Alert: Resources to support safe and timely management of hyperkalaemia (high level of potassium in the blood) is attached.

National Patient Safety Alerts are issued through the Central Alerting System (CAS); a web-based cascading system for issuing patient safety alerts, important public health messages and other safety critical information and guidance to the National Health Service and others, including independent providers of health and social care.

NHS trusts are required to respond via CAS stating whether they are compliant with the actions and the timescale provided in all patient safety alerts or whether the alert is not relevant to them.

NHS Improvement has been working closely with the Care Quality Commission (CQC) to ensure that inspection teams are aware of national patient safety alerts that have been recently issued and that they review the actions taken in response to national patient safety alerts during their inspections.

In addition, the Department commissioned the CQC to work with NHS Improvement to understand the issues in NHS trusts that contribute to ‘Never Events’; part of this work looked at how effectively trusts use safety guidance and how other system partners support the implementation of safety guidance. A report, Opening the door to change: NHS safety culture and the need for transformation was published at the end of last year and a copy is attached.

The accident and emergency (A&E) department at the Friarage Hospital is not closing but transforming into a 24 hours, seven days a week urgent treatment centre (UTC) in line with clinical guidance. The UTC will be able to see all patients with minor illnesses and minor injuries.

It is the responsibility of local National Health Service organisations, when making decisions on service changes, to fully consider any impact on patients. Commissioners also have to consider any impact on health inequalities, including those in rural areas, and the NHS Long Term Plan commits to developing a delivery model for small rural acute hospitals to ensure sustainable and efficient service delivery.

However, the vast majority of the services at the Friarage Hospital will remain unchanged with 89% of patients unaffected by these changes. Patients with serious medical conditions, such as those suffering from a stroke, heart attack and/or trauma already go directly to James Cook University Hospital.

There are robust plans in place to ensure patient safety. In future, a medical consultant will review all emergency cases prior to arrival, via a telephone triage with the ambulance team or general practitioner. More seriously ill patients will be diverted to appropriate hospital sites, typically James Cook or Darlington Memorial. This decision will be based on patient need and the patient’s home location. Where appropriate, patients will be returned to the Friarage once their condition has improved, for the remainder of their hospital stay.

Neither the Department nor NHS England have conducted an assessment of the impact of closures of A&E departments on ambulance services in rural areas.

The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Regulation 18 requires all providers of health and social care to provide sufficient numbers of suitably qualified, competent, skilled and experienced staff to meet the needs of the people using the service at all times.

It is the responsibility of National Health Service trusts and other health providers in England to ensure these staffing requirements are met taking into account local circumstances and professional judgement.

The number of anaesthetists in North Yorkshire is not held centrally. However, in November 2018 there were 1,158 anaesthetists in Yorkshire and the Humber.

The Department has started to roll out an extra 1,500 medical school places for domestic students, with the first 630 places taken up in September 2018. By 2020, five new medical schools will have opened to help deliver the expansion. One of the criteria for medical schools which applied for additional places was to demonstrate a commitment to sending more trainees to rural or coastal areas.

The Patient Experience of Diabetes Services (PEDS) pilot, a module of the National Diabetes Audit, was run last year. While the potential value of this survey is clear, there are other competing priorities for adding modules to existing national audits such as this. There is a robust process for assessing these, as well as which new national audits should be considered. As such, NHS England will review the potential to fund the PEDS survey alongside other Healthcare Quality Improvement Partnership commissioned national audit and associated modules.

Other NHS England surveys capture the experiences of people with a wide range of conditions including diabetes. However, with the exception of the cancer patient experience survey, the information is not collected by specific conditions. As part of a forthcoming review of patient experience surveys, NHS England will consider whether it is best to collect information as it does currently or by specific conditions.