Helen Hughes
@helenh49
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Chief Executive of Patient Safety Learning. Passionate about patient safety (obvs) & social justice. Feminist. Love Wales & Penge. Views my own etc
Penge, London SE20
Joined October 2009
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So many share with us
@ptsafetylearn
that this is their experience of raising patient safety concerns. This must change
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Very troubling. What if NHS staff caught Covid at work, occupational exposure due to inadequate PEE. Does this change the advice? Any lawyers want to comment?
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Excruciating tooth pain. Rang 111. Call back in 5 mins from empathetic adviser. In 20 mins at Croydon HC. I was listened to examined, had an X-ray & my rotten wisdom tooth extracted. Knowledgable advice and kindness. All for the NHS charge of £21.60. Excellent service. 💗 the NHS
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As an ex CEO of EHRC I’m very surprised that 1. Policy advice is being communicated by tweet 2. That EHRC can’t apply a rational approach to a new disease & disability without case law or employment tribunal
@long_covid
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@trishgreenhalgh
My friend couldn’t be at his beloved grandmother’s funeral. These people are callous and heartless. They knew the distress and pain at the time and still they laughed
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@ShaunLintern
@thetimes
It’s about RETENTION, not just recruitment. Stop the haemorrhaging of great staff by putting them in situations where they can’t deliver the care safely that they want to deliver and have been trained for
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@prof_tweet
The husband of a leading US patient campaigner died because his regular cancer check results were filed without professional review. This administrative system failure could have been picked up if the test results had been shared with the family. ‘Trust us’ doesn’t always work
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Off to the Global Ministerial Summit on Patient Safety. Thought I’d take some relevant reading with me
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“Despite the rarity of Maddy’s condition and the heroic efforts of many of our clinical teams, we acknowledge and apologise for the omissions in her care. We will reflect carefully on the findings of the coroner.” Does that read like a sincere sorry?
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‘The whole system should be listening continuously to patients and acting on their feedback.’
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‘.of the approximately 750 children who will drown next year, about 375 of them will do so within 25 yards of a parent or other adult. According to the CDC, in 10 percent of those drownings, the adult will actually watch the child do it, having no idea it is happening.’ Must read
Every year I retweet this piece on how to spot drowning. Last year someone replied saying they’d read my RT the previous year and later rescued a kid. TL;DR: drowning kids usually don’t scream or splash about.
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On the day that the government will be considering whether to introduce restrictions, I thought this might be relevant…
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‘RN staffing and seniority levels were associated with patient mortality. The lack of association for HCSWs and agency nurses indicates they are not effective substitutes for RNs who regularly work on the ward.’
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@NHS_HealthEdEng
When HEE commissioned the Academy of Medical Royal Colleges to write the patient safety syllabus. And their leading authors wouldn’t accept my (HEE invited and encouraged) review comments that patient engagement in patient safety might be a useful thing to know about.
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‘I’m 2 years post menopausal and have no children. I had an hysteroscopy this morning. Put it this way, one of the staff said afterwards that if the doctors actually told patients in advance how painful if can be, nobody would ever do it.’
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@RoryStewartUK
@RestIsPolitics
Happy Birthday Rory 🥳🥂. In a very grim year,
@RestIsPolitics
has been a beacon of information, insight and appropriate outrage (ie rightly strong but never rude…most British!). You’ve been intellectual and emotional lifesavers & I have recommended you to everyone I know! 👏👏
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@ShaunLintern
@10DowningStreet
At what point do we the public/patients say ‘no more?’ And demand safe and accessible healthcare, where we’re not worried that our friends and family won’t suffer avoidable harm and death as this crisis deepens?
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“The system is broken, utterly and completely broken, and the public needs to be made aware of this.”
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‘Work as imagined vs work as done is often used within patient safety but it's not always an easy concept to explain. I recently tried a new tactic to bring the realities of this concept to life, & show why it is so important to address these issues’
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‘The presence of fear in an organisation is the first sign of weak leadership.’ Psychological safety is a condition in which you feel 1 included 2 safe to learn 3 safe to contribute 4 safe to challenge the status quo
@ptsafetylearn
#patientsafety
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“Elevate the voice of patients!”, WHO is calling on all stakeholders to take necessary action to ensure that patients are involved in policy formulation, represented in governance structures & engaged in co-designing safety strategies, and are active partners in their own care.
The
@WHO
has announced that the theme of World Patient Safety Day 2023 will be "Engaging patients for patient safety", in recognition of the crucial role patients, families and caregivers play in the safety of health care. Read more below⬇️
#patientsafety
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‘If it’s not safe, it’s not care’ Dr Tedros at the Global Summit on Patient Safety
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Statistics obtained through a FoI request to NHSE, only released the data after the ICO intervened. ‘It should have released the figures after a month, but took five to do so.’ What’s the point of a national system if it doesn’t report transparently?
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@PippaCrerar
@meropemills
There is strong evidence from research & personal testimony that listening to patients & families is not only courteous but absolutely essential in delivering safe care. Insights from patients & families are different from those of staff and invaluable in seeing the ‘big picture’
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Why patient information leaflets need be designed by experts and coproduced with patients 🤣🤣🤣
@ptsafetylearn
@PiFonline
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Fantastic to join
@hsib_org
and colleagues at the
#nhsstafffatigue
at this important
#patientsafety
and
#staffsafety
event. Lots of resources on fatigue at the hub
@ptsafetylearn
and will add more from today
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@kateferguson4
@PippaCrerar
I’m one of those. But we have to find the refugee through friends, charities, businesses etc. There isn’t a system where we’re being matched with those that need accommodation. This isn’t good enough in my view. I’m coordinating with a friend in Poland. Any contacts anyone?
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‘We need a national effort; all healthcare organisations to have fatigue on the risk register, to demonstrate how they are mitigating the impact of long hours & nightshift work. Why
#staffsafety
is a
#patientsafety
@ptsafetylearn
@hsib_org
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UK IPC guidance needs to be updated urgently: a respirator (FFP2, FFP3, NIOSH-approved N95, or equivalent)… should be worn by health workers along with other personal protective equipment (PPE) before entering a room where there is a patient with suspected or confirmed COVID-19.
Available now via the
#pslhub
-
@WHO
recommendations on mask use by health workers, in light of the Omicron variant of concern
#Covid19
#PPE
#patientsafety
#staffsafety
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@NMacdonaldBHT
@markhughes1878
I got one last week, wanting to buy Patient Safety Learning 🙄. Said that as a charity, no thanks. Don’t want to buy from whoever is providing him with a database either 😂
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@ScribblerPen
It’s a long running concern that the voices of those living with long covid are not being listened to inform the design and delivery of services and support
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@trishgreenhalgh
We all have huge debt and gratitude to you. Speaking truth to power can be a lonely and risky business. You’re an absolutely hero
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@trishgreenhalgh
And the irony is that Semelweis was not believed for decades for the very same reason, a failure to accept and respond to new evidence
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‘The trust's chief executive apologised to those who felt let down.’ When will healthcare leaders realise this isn’t and doesn’t sound like an apology? If nothing wrong, defend yourself, if care is inadequate, apologise, sincerely
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‘There’s a lot of talk in healthcare about learning from errors, but you can’t prevent the same thing happening again if you don’t recognise that you got something wrong.’ Also the resistance to patients & families’ critical role in safe care & investigation if things go wrong
🗨️Had my concerns been taken seriously by medical staff, Lewis might still be alive today🗨️
New on the
#pslhub
today, Simon Chilcott (
@hardlife1970
) tells his son Lewis’s story⬇️
#patientsafety
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So many of us struggle to know what to do or say to help someone who is grieving. Please share. Thank you 🧡
#Griefkid
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@WelshGasDoc
I got in trouble for answering a phone in an office I worked in. When I passed the customer’s message on, I was shouted at and told only X is allowed to answer that phone. Several years later X was prosecuted for fraud, running an alternative business using NHS resources.
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Delighted that a global leader approached me at the Global Ministerial Summit on Patient Safety & thanked me for the hub, our free learning platform for patient safety. She said it’s invaluable for accessing resources & insights for implementation
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@chrischirp
I agree. Incredibly complacent article, ill informed and distainful of the long term impact of covid
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An excellent piece of government advice, recently, unaccountably, removed from the govt web-site. I think we really ought to share it as much as possible. All over Twitter in fact. Please pass on
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‘We’re churning patients out faster & faster, older, frailer & more complex, but given no time to rehab or improve them, knowing that they will likely get readmitted again in a few days; disheartening when there is so much we could do.’
@theRCOT
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Can someone explain how both these statements can be true? ‘Substantial issues around culture, behaviour, leadership and governance that will need to be addressed ‘Not found any “fundamental safety issues” at the trust.’
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If you need to better understand what nursing is all about, read this
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‘We are looking for women of all ages (minimum of 16 years old) that have had a coil/IUD procedure (insertion or removal) that they found distressing.’
Coil procedures: Exploring negative experiences through qualitative research (an interview with Sabrina Pilav)
#WomensHealth
#IUD
#PatientEngagement
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Well done the 32 trusts that are prioritising patient and staff safety 👏👏👏 An inspiration to others?!
@HSJAnnabelle
@DRTomlinsonEP
@alisonleary1
@ptsafetylearn
#patientsafety
#staffsafety
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"I do not want to be a whistleblower, none of us do. We want to raise concerns, have them acted on and keep our patients safe." Read an anonymous view of why clinicians don’t speak up, reflecting on the Francis report recommendations
@peter__duffy
@NHSwhistleblowr
@sarasiobhan
We all want a culture of speaking up, don’t we? So, why isn’t it happening?
A new blog on the
#pslhub
today:
#patientsafety
#justculture
#speakingup
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Delighted to be joining
@NeelamDhingra1
and global colleagues at
@WHO
‘Implementing the Global Patient Safety Action Plan 2021-2030: Pandemic and Beyond’
@ptsafetylearn
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◦Failing to listen to patients.
◦Still not learning from investigations.
◦Poor behaviour and a corrosive blame culture.
◦Lack of effective leadership for patient safety.
◦Absence of an effective regulatory framework.
An analysis from a broad patient safety perspective, focusing on five key themes consistent with many other serious patient safety inquiries & reports. It highlights the need for a transformation in approach to patient safety if similar scandals are to be prevented in the future.
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‘There is no framework to assess the effectiveness of patient safety inquiry recommendations. Once inquiries have concluded, there is no central repository or responsibility across government for tracking whether recommendations have been implemented & have an impact’
🗨️... we often lack the tools to easily check if recommendations have been implemented or ascertain whether their implementation has resulted in meaningful change🗨️
Public inquiries, patient safety and the implementation gap
#patientsafety
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‘Patients want to improve things for themselves and other patients, they want to support staff and they want the culture to be more open to feedback and less defensive.’
🗨️Patients are internally asking questions about the healthcare professionals they engage with, firstly “Do they care about me?” and secondly “Are they taking me seriously?”🗨️
New on the hub today, an interview with James Munro from Care Opinion⬇️
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@ShaunLintern
Without a robust and deliverable workforce plan we will have unsafe care provided by exhausted and often untrained or inexperienced staff. And what did parliament do? Agree not even to have a published plan. Scrabbling to reallocate staff like this is desperate and hugely risky
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The iceberg of ignorance. Hadn’t come across this before but speaks volumes. Thx for sharing
@Hughhbw
and great talking with you
@ptsafetylearn
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Chris Frek, chair of
@ClinicalHF
adapting James Reason’s model to reflect the reality of health care and all too often its approach to responding to hazards
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With
@siesta0652
@AnnieHunn
@cflashman
at the
@NHSConfed
@AHSNNetwork
Innovation Awards as finalists in the
#patientsafety
award for the hub
@ptsafetylearn
. Fabulous to be here. Missing you
@safetynurse999
and so many more. Could have invited thousands of our members ❤️
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Might be the lever for healthcare changing shift patterns so staff aren’t driving tired after long hours working?
#fatigue
@hsib_org
@ptsafetylearn
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@ShaunLintern
@thesundaytimes
I’m anticipating it with interest but also a degree of dread; there’s really some ghastly safety issues happening at the moment. Just relieved you’re on the case
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Finance directors have a key role in exposing the hidden costs of avoidable harm & championing the business case for patient safety improvement.
@hfmaorg
@ptsafetylearn
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WHO says
#LongCovid
‘can affect a person’s ability to perform daily activities such as work or household chores.’ EHRC’s assertion that longcovid is not a disability is ill-informed, inaccurate in law and contradicts the definition of disability under the Equality Act 2010.
A coalition of
#pwLC
inc LCS are sending📩to
@EHRC
Their recent puzzling statement contradicts previous advice re
#LongCovidWork
our employment advocates co-produced w/ partner orgs inc
@somceo
@CIPDpolicy
We are always available for ongoing involvement
#NothingAboutUsWithoutUs
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Hierarchy of intervention effectiveness. Where does our patient safety effort go?
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So many people to thank for their content contributions. I don’t want to miss anyone from the list of amazing people who have shared their knowledge, insight and experience. A few I’d like to mention personally. Others are unattributed because of confidentiality. Thank you all 👏
🥳We are delighted that our platform for patient safety, the hub, has won the Patient Safety award at the
#LHAwards
!
Would you like to be part of a global, online community, working to improve patient safety? Sign up to the hub today:
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‘Patient Safety is not seen as an investment, it’s seen as an expense.’ We need to make the case for patient safety
@ptsafetylearn
#patientsafety
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Much could be learned from listening to people living with long covid and their communities. They’ve been willing to partner and engage but too often haven’t been listened to
@ptsafetylearn
@LongCovidKids
@long_covid
@LongCovidScot
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Hugely important ‘Responding to patient feedback thermometer’ by
@PSCommissioner
at todays ‘Safety for All’ conference
@RCPhysicians
@ptsafetylearn
@_SHBN_
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WHO Patient for Patient Safety champions
@sue_e_sheridan
@hhask
❤️ @ Working today with colleagues to create a global action plan for patient engagement and empowerment for safer care
#patientsafety
@ptsafetylearn
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#staffsafety
is a
#patientsafety
issue. Many staff who have
#longcovid
will have caught the virus from being at work. A disability equality issue that needs addressing urgently
@ehrc
@long_covid
@LongCOVIDPhysio
@LCNMUK
@LongCovidWales
@LongCovidScot
@_SHBN_
@journo_kituno
Patient safety is at risk from the change in sick leave policy for healthcare workers affected by
#LongCovid
, which should be a cause for concern for all of us.
@helenh49
@ShaunLintern
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We need transparent information. Do the clinics for
#longcovid
patients exist or not? Great if they do - just tell us where.
@trishgreenhalgh
@keyeri
@jakesuett
We wrote to the NHS on 11 Sept asking for the list of post-COVID support clinics to be published along with details on how they can be accessed by
#LongCOVID
patients.
We have still yet to receive a response or any further information about these clinics
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I periodically retweet this. Still too true
So many share with us
@ptsafetylearn
that this is their experience of raising patient safety concerns. This must change
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We’ll add these examples to the hub, our free learning platform for patient safety. Let’s raise awareness and call for action for
#patientsafety
See more here
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It’s World Patient Safety Day! The
@ptsafetylearn
team have authored a blog that highlights key patient safety issues and collates great resources to address medication harm, this year’s
#WPSD2022
focus.
Today is
#WorldPatientSafetyDay
!
In a new blog on the
#pslhub
we set out the need for a transformation in our approach to patient safety and consider this year's theme, medication safety
#WPSD2022
#WorldPatientSafetyDay2022
#WPSD
#patientsafety
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@MeshCampaign
@KathSansom
@BBCBreakfast
@theresa_may
@PSCommissioner
Why are the
@bbc
promoting a treatment that was put under scrutiny for 2 1/2 years by the government, resulting in the scathing report
#firstdonoharm
by Baroness Cumberlege
#immds
?
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@LG_NHS
That’s reassuring to hear. But clearly some internal leaders didn’t understand the legal & moral implications & felt confident enough to make a written direction that was illegal, offensive & bullying. What are the lessons from this that you need to address?
@parthaskar
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‘Munchetty and Pattison agreed that the NHS is failing girls & women. They said GPs, specialists & doctors lack the specialism and training required to recognise & treat gynaecological issues that are devastating the lives of women and girls across the UK’
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Sooo excited to be travelling to meet up with
@AnnMarieRiley10
and colleagues for their Patient Safety Conference and how
@ptsafetylearn
’s patient safety standards can help them deliver their ambitious new strategy
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Our award arrived ❤️. Thank you
@leading1health
, the amazing contributors to the hub and wonderful team
@ptsafetylearn
Do visit and register for this free learning platform for patient safety. Over 400k visits since we launched 18 months ago! www.pslhub.org@
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@NHSPbank
@SaskiaDutton
Seriously? I can understand how challenging it can be to organise staffing but people do become unwell at short notice. Not malingers, but genuinely committed people. ‘Pending a HR appeal of course’ - is that supposed to sound reasonable and empathetic? Doesn’t cut it with me
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This award is a tremendous achievement for Patient Safety Learning. Many thanks to HIMMS for the award and providing us the opportunity to support our ambition for the hub, our learning platform for patient safety, and for it to become a global resource for safer care.
We are delighted to announce that
@ptsafetylearn
's Chief Executive
@helenh49
has been recognised by
@himss
in the
#HIMSSFuture50
as a Patient Leader in digital healthcare, alongside
@Birgitpower
,
@tiffmckever
and
@cvonraesfeld
:
#patientsafety
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This is an absolutely vital point. Without family persistence, these issues would not have been exposed. Trusts, regulators and politicians need to listen and respond to patient concerns with high quality & independent investigations. We are destined to repeat tragedies if not
With just 5 days until Kirkup, I am reminded of the CQC's response to us after 10 months of investigating "After an extensive review, we do not believe there has been a breach in regulation." Only our pushing, led to the biggest criminal prosecution ever carried out by the CQC.
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Public facing request to report unsafe situations at
@HeathrowAirport
When will healthcare be ready to support patients and families to do this?
#patientsafety
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Mismanagement of deterioration is the single biggest cause of avoidable harm
@ptsafetylearn
#patientsafety
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The new
@PSCommissioner
’s aims. Everything is a safety matter, we need to put safety into everything we do - a culture shift in healthcare
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Heartbreaking. A mother told not to be anxious as her daughter’s sepsis wasn’t recognised or treated until too late
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Don’t often travel through Penge West station but delighted by their floral display. Glorious, so I thought I’d share
@Se_Railway
@londonOverRBLX
@thepengetourist
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Getting excited about tomorrow’s Patient Safety Learning Conference
#patientsafety
#patientsafefuture
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‘Excessive form filling is the scourge of hospital care. It slows doctors and nurses down, adds little value, and occasionally even undermines or compromises the care we offer.’
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In light of ‘First Do No Harm’ report by
@JuliaCumberlege
, more patients are still having to ‘join the dots’ for patient safety. This must change
New on the hub, as part of our 2020 overview series, we reflect on the work we’ve been doing to highlight serious
#patientsafety
concerns relating to hysteroscopy procedures in the NHS and how we’ve been making the case for change -
#pslhub
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