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Issue 6: 2 August 2012








Welcome to the new style Quality and Safety e-Bulletin

The e-Bulletin brings you the latest news from key national agencies and initiatives across the UK, arranged under themed headings.

The Bulletin will be taking a short break over the summer period. The next issue will be on 30 August 2012.

 Your feedback on the e-Bulletin is welcome. Please contact us at qualityandsafety@rcn.org.uk.

Ross Scrivener, Claire Constable and Deborah Fisher

RCN Quality, Standards and Innovation Unit



RCN highlights

RCN works with doctors to improve patient safety. The Royal College of Nursing has joined forces with the Royal College of Physicians (RCP) to launch a new universal patient safety system. The National Early Warning Score (NEWS) consists of a standardised bedside chart and uses universally recognised terminology to make it easier for clinical staff to recognise and respond to a patient whose condition is deteriorating. The system can be used in both acute and community care settings. The RCN led on the development of a key part of the work, an e-learning portal, for use by all staff groups, from health care assistants to hospital consultants. A film about NEWS is also available.
National Early Warning Score (NEWS) online training resource
Royal College of Physicians: National Early Warning Score (NEWS): Standardising the assessment of acute-illness severity in the NHS.

‘This is nursing’ film. The film supports the RCN’s This is Nursing work and offers an insight into the critical role nursing staff play in restoring the health and wellbeing of their patients. It reflects the challenges and huge rewards that a career in nursing can bring and shows nurses and health care assistants offering care and support in various clinical areas and in both acute and community settings. More on the This is nursing initiative will be unveiled in the coming weeks.

New Policy Briefings from the RCN Policy and International Department:



  • Policy briefing 16/12 Personal health records and information management (PDF 303.KB). This briefing summarises the RCN vision for personal health information management, how ICT can support this vision and what needs to be done to overcome barriers to achieve the changes required. It is intended to inform all aspects of records development, record standards development and nursing educational programmes.

  • Policy briefing 17/12 NHS failure regime (PDF 422.1KB). The RCN is deeply concerned that some organisations in the NHS could fail. Failure could be where: patients cannot be treated safely; an organization is no longer financially sustainable; both of these.  This briefing provides an overview of the current and future approaches to an NHS failure regime.

  • Policy briefing 18/12 New Monitor in England. (PDF 177KB). This briefing note sets out how the role of Monitor is changing under the Health and Social Care Act 2012. Although much is still unknown about how Monitor will implement the changes set out in law, this briefing provides an overview of what we know and raises some issues for nurses.

  • Policy briefing 19/12 Clinical Commissioning Groups: an overview of the authorisation process (PDF 97.6KB). The Health and Social Care Act 2012 includes radical reform of the way that health care is commissioned in England. This RCN factual briefing is intended as a user-friendly summary of the authorisation process for CCGs, focusing in particular on the nursing role in the new commissioning landscape. 

  • Policy briefing 20/12 Social Care Reform (PDF 3481.KB). This briefing examines the detail of the white paper, draft bill and funding progress report and reflects on the positives and negatives in relation to the RCN’s positions and how changes will impact on service users and patients, their families and carers, and care and support staff.

Lightbulb innovations: Easing the pain of hip fractures. In Poole, nurse Mandy Layzell and her team developed a service to reduce pain for patients who have fractured their hip, by providing a nurse-led femoral block service, delivered by injection. As soon as possible after a patient arrives in A&E, the team makes an assessment, obtains consent and performs the block.

President and deputy president re-elected. RCN President Andrea Spyropoulos and Deputy President Cecilia Anim have been elected unopposed for their second two-year terms of office.

New Chair of RCN Governance Support Committee. Kevin Bell, RCN Council Member for Northern Ireland, has been elected as the new Chair of the RCN Governance Support Committee. This committee has responsibility for ensuring the governance of the RCN is fit for purpose, and supports effective, timely decision making informed by RCN members’ views.

RCN members shine in Olympic ceremony. In a performance celebrating the role of the NHS in British society, RCN members joined other health care staff in a dance routine, thrilling the crowd in the Olympic stadium and a global television audience of millions.

Catch up with the RCN Bulletin. The August issue of the RCN Bulletin is now available to read online. It includes an article on the National Early Warning Score developments.

NICE consultation gateway 

The NICE consultation gateway pages have been updated and include all the details about current consultations and how to get involved that previously appeared as a separate section within this bulletin. We will highlight these pages in every bulletin. You can find out about the NICE consultations the RCN is involved in at Current consultations.



NICE seeks nurses for diabetes group. NICE is looking for community diabetes specialist nurses and nurse practitioners who work in primary care to apply for places on the guideline development group for type 2 diabetes. The group will meet every six to ten weeks for approximately 18 months from October. Travel and subsistence costs will be reimbursed. Interested practitioners will be required to provide a copy of their CV, a completed equalities form and a declaration of interest form. NICE seeks members for its independent advisory committee on the use of medical technologies.

NICE seeks nurses for technologies group. NICE is recruiting members for its independent advisory committee on the use of medical technologies. Applications are particularly welcome from nurses with experience of technologies aiming to promote more independent living and/or out-of-hospital treatment. Experience of research and of interpretation of complex data from work in an academic setting would be an advantage. The application deadline is 24th August 2012. Further details at NICE is recruiting members to join its Medical Technologies Advisory Committee (MTAC).

RCN events

The RCN organises an annual programme of events and conferences, including RCN Congress, to support all health care professionals with their personal and professional development. See: 



  • RCN national events

  • England regions and branches

  • Northern Ireland

  • Scotland

  • Wales

RCN Scotland: Supporting Better Care September to October 2012. RCN Scotland is hosting a development programme for all Health Care Support Workers/Care Assistants to enhance their knowledge and practice and therefore extend their competence and confidence in direct care. This programme is free of charge to HCSW RCN members and an Independent Learning Allowance (ILA) is available for the programme. For further information on the programme please contact Susan Watt by email at susan.watt@rcn.org.uk  or sbc@rcn.org.uk   or by telephone on 0131 662 6152.

See also RCN accredited events and conferences.


For further information about accreditation and endorsement processes see RCN accreditation

Quality and safety news

News highlights are:



BBC Health: Hinchingbrooke Hospital's bosses claim improved care. The first private company to run an NHS hospital claims it has cut waiting times, improved care and delivered savings in its first six months. 

DH: Structure of Public Health England. This factsheet sets out the proposed structure for when Public Health England comes into being in April 2013. 

DH: Consultation on joint strategic needs assessment and joint health and wellbeing strategy guidance. Proposals for the duties of health and wellbeing boards have been published. The draft guidance, on which views are being sought, provides a framework for NHS and local government to work together to undertake joint strategic needs assessments(JSNA) and joint health and wellbeing strategies (JHWS). The consultation closes on 28 September 2012.  

Guardian: Labour puts pressure on Lansley over nurses cleaning wards. Labour has put pressure on health secretary Andrew Lansley to investigate after it emerged that nurses at a cash-strapped hospital are being forced to clean wards. 
Nurses wash wards as cover for cleaners at cash-strapped hospital. Nursing staff at Mid Yorkshire Hospitals Trust forced to clean wards despite warnings it would divert them from patient care.

Health in Wales: Chief Medical Officer Dr Tony Jewell retires. Dr Jewell has spent six years in the role, providing independent professional advice and guidance to the First Minister and the Welsh Government on health and healthcare matters. 

NHS Commissioning Board: Strategic clinical networks. The NHS Commissioning Board Authority has set out its plan for a small number of national networks to improve health services for specific patient groups or conditions. Called strategic clinical networks, these organisations will build on the success of network activity in the NHS which, over the last 10 years, has led to significant improvements in the delivery of patient care.

NHS Improvement: Cardiovascular diseases outcomes strategy survey. The strategy will set out what needs to be done to deliver improved outcomes for CVD – from prevention, through to diagnosis and treatment, long-term support and end-of-life care and will need to take into account demographic changes such as an aging population and increasing obesity. The survey closes on 28 September 2012.

Nursing and Midwifery Council (NMC): Appointment of Mark Addison as Chair of NMC.  Mark Addison who is a non-executive Director at the National Archives and has previously held several senior positions in the Civil Service, will take up his post in the autumn and the appointment will be for 18 months initially.
RCN: RCN seek meeting with new NMC Chair. The Royal College of Nursing is to seek a meeting with the newly-appointed Chair of the Nursing and Midwifery Council (NMC) as a matter of urgency.

Welsh Government: NHS Wales Chief Executive’s annual report 2011/12. NHS Wales has made “significant advances over the past 12 months in improving access to treatment and delivering improved quality of care”, according to the annual report from Chief Executive, David Sissling. 
Health in Wales: NHS reducing hospital admissions for chronic conditions. Figures from the annual report show emergency admissions for heart disease, respiratory conditions and diabetes fell by almost 12 per cent overall in 2011/12 compared to the previous year.

Welsh Government: Health Minister proposes a new relationship between the Government, the NHS and the public. Health Minister Lesley Griffiths has launched a conversation around how the NHS, the public and the Government in Wales can work better together on improving health and health services. The consultation is asking people to offer their views to help drive improvements faster. How can services be improved?  How can the NHS improve the way it works with communities and offers advice to individuals?  Can people be better helped to manage their own health and health problems? The consultation closes on 24 October 2012.

Quality improvement

Audit, reviews, legislation

Diabetes UK: Over 80 hospitals lack specialist footcare teams.  Based on data from the National Diabetes Inpatient Audit, there are over 80 hospitals in England and Wales that do not have the specialist diabetes footcare teams that are widely recognised as being important for preventing diabetes-related amputations.
BBC Health: Diabetic foot care 'appalling’.

DH: Guides to monitoring quality during transition. A series of “How to” guides to assist current NHS organisations, and their supervisory and regulatory bodies, to respond to quality risks and failures within a simple and single framework during this transition year has been produced. Two earlier guides are also signposted. The three published in July by the National Quality Board are:

  • How to: organise and run a rapid responsive review (PDF 758.2)

  • How to: quality impact assess provider cost improvement plans (PDF 3.4MB)

  • How to: organise and run a risk summit: 2012/13 (PDF 295.2KB).

DH: New NHS internal audit standards published. The issue of these standards ensures that those responsible for establishing, delivering and reviewing internal audit across the NHS continue to do so within a consistent framework.

Guardian: Cancer care varies widely depending on postcode, says survey. Data from the National Cancer Intelligence Network (NCIN) has shown the rate of urgent GP referrals to hospital for patients with suspected cancer ranges from under 830 to more than 2,550 in every 100,000 patients a year.
NCIN press release: Wide variation in number of patients GP refer with suspected cancer (PDF 87KB).

Healthcare Inspectorate Wales: Nursing & Midwifery Council Report on the HIW's Local Supervising Authority 2012. The purpose of the review was to examine the function of the Healthcare Inspectorate Wales (HIW) Local Supervising Authority (LSA). The Nursing Midwifery Council (NMC) has a responsibility to assess that all the requirements regarding supervision of midwives are in place and monitored by the LSA. 

Healthcare Quality Improvement Partnership (HQIP): Child diabetes multi-site audit releases parent leaflet. The project team for the multi-site audit has released an information leaflet aimed at parents of children with the condition, What care to expect when your child is admitted into hospital. The publication follows the report from the HQIP-commissioned multi-site audit, released in February this year.
See also the audit report at Inpatient Audit of Children with Diabetes (PDF 221KB).

HQIP: DH asks local clinical audit staff for data burden feedback. In an effort to try and reduce future data request burdens, the DH is asking relevant clinical audit staff to complete cancer audit-specific short surveys in order to feedback on the time and input required to complete national audits locally. The surveys, created by the Information Centre for Health and Social Care which is coimmissioned by HQIP to carry out the audits, relate to the national Bowel, Head and Neck, Lung and Oesophago-gastric cancer audits.  If successful, similar surveys may be carried out for all NCAPOP audits.

HQIP: HQIP Stakeholder Survey 2012. From 27 February to the 2 April 2012, HQIP ran its second survey about their work, asking for feedback on what was done well and where improvements could be made and received 255 responses. The vast majority of respondents – 77 per cent – were clinical audit staff. 

King's Fund: Preparing for the Francis report: how to assure quality in the NHS. It is widely expected that regulators will come in for further criticism in the autumn when the Public Inquiry into the serious failures of care at Mid Staffordshire NHS Foundation Trust reports. The Francis Inquiry’s Chair, Robert Francis QC, is likely to propose far-reaching changes at all levels of the system, including to the external organisations that regulate quality. In this paper the authors set out their views on how the system of quality assurance, including regulation, needs to evolve, the principles on which it should be built and how it should operate.

National Audit Office (NAO): Health and social care memorandum: Progress in implementing the 2010 adult autism strategy. This memorandum outlines the considerable progress that has been made in the two years since the Strategy was published - 24 of the 56 commitments in the Strategy have been implemented, and work has begun on most of the remaining commitments. However, less progress has been made in some areas, such as improving access to social care assessments, personal budgets and diagnostic services.

RCN Policy and International Department: Policy briefing 18/12 New Monitor in England (PDF 177KB). This briefing note sets out how the role of Monitor is changing under the Health and Social Care Act 2012. Although much is still unknown about how Monitor will implement the changes set out in law, this briefing provides an overview of what we know and raises some issues for nurses.

Scottish Intercollegiate Guidelines Network (SIGN): SIGN audit tools. SIGN has published audit tools for Guideline 112 - ADHD and Guideline 117 - sore throat.

Guidance, innovation, tools

Department of Health, Social Services, and Public Safety (DHSSPS): Minimum standards for childminding and day care for children under age 12 . The standards have been developed for Northern Ireland. The draft standards set out the requirements for registration and inspection of providers by HSC Trusts to ensure consistency of approach across Northern Ireland and ensure that all children, parents and providers have a clear understanding of the minimum standard of care they can expect to receive and provide.

DH: No health without mental health: implementation framework. The government has published the mental health implementation framework, which sets out what organisations can do to make the six high-level objectives of the mental health strategy No Health without Mental Health a reality.
NHS Confederation: No Health Without Mental Health: implementation framework. In February 2011 the Government published No Health Without Mental Health, its cross-government, all-age strategy for mental health in England. This Briefing provides an overview of the implementation framework, focusing on those areas that are most relevant to providers of NHS mental health services.

DH: Commissioning toolkit for respiratory services published.  The chronic obstructive pulmonary disease (COPD) commissioning toolkit is published for NHS commissioners and chief executives. It aims to make it easier to commission better outcomes for people with COPD by bringing together the clinical, financial and commercial aspects of commissioning in one place.

DH: Family Nurse Partnership (FNP) programme information leaflet. The Family Nurse Partnership (FNP) programme information leaflet has been revised and updated. It covers the main features of the programme, as well as information for commissioners. 

National End of Life Care Programme: The route to success in end of life care – achieving quality for social work. This guide has been produced with support from The College of Social Work. It follows the nationally-recognised six-step end of life care pathway, and includes key issues and actions for social workers and their managers, top tips, reflective questions, examples of good practice and anonymised case studies.

National Institute for Health and Clinical Excellence (NICE): Public health briefings for local government. From April 2013, councils in England will be taking on the role of improving the public health of their communities. NICE has developed these briefings for local authorities and their partner organisations in the health and voluntary sectors, in particular those involved with health and wellbeing boards. The first three topics are: tobacco; workplace health; physical activity.

NICE: First Commissioning Outcomes Framework indicators revealed. Care for those recovering from stroke, tackling diabetes, and improving maternal health are among topics covered in the first set of Commissioning Outcomes Framework (COF) indicators published by NICE.T he COF has been developed by the NHS Commissioning Board, with support from NICE and groups of patients and experts, to improve the quality of healthcare provided at a local level. 

NICE: Rheumatoid arthritis in QOF 2013/14 menu. Rheumatoid arthritis could be added to the Quality and Outcomes Framework (QOF) for the first time, as NICE unveils potential indicators for 2013/14. Introduced in 2004 as part of the General Medical Services Contract, the QOF is an incentive scheme for GP practices in the UK, rewarding them for how well they care for patients.

NICE: Tough decisions issue 8. As part of the transition of the National Prescribing Centre (NPC) to become the National Institute for Health and Clinical Excellence (NICE) Medicines and Prescribing Centre (MPC), Tough Decisions will soon be published in a new and improved format. A survey is provided for readers to influence this future format.

Nef (new economics foundation): Measuring well-being: a guide for practitioners. This short handbook on measuring well-being is produced by the Centre for Well-being at nef. It is designed primarily for voluntary organisations and community groups delivering projects and services, to help them kick-start the process of measuring well-being outcomes.

NHS Commissioning Board: CCG authorisation: Key facts. Proposals for key elements of the authorisation governance process for CCGs, including the decision-making, moderation, conditions and support processes within the NHS Commissioning Board (NHS CB) have been agreed by the NHS Commissioning Board Authority.

NHS Diabetes: A guide to diabetes management during Ramadan. This online guide is aimed at commissioners and providers of diabetes care. It brings together guidance and links to support health care professionals understand how to support their service users living with diabetes, who wish to fast during the holy month of Ramadan. These pages also provide examples and supportive materials showcasing how the treatment of diabetes can be managed during this time.

NHS Diabetes: new end of life diabetes care strategy. Patients with diabetes who are at the end of life have a unique set of care needs relating to health and social care. Commissioned by Diabetes UK, End of Life Diabetes Care aims to summarise a consistent but high-quality approach towards end of life care for people with diabetes by providing a series of clinical care recommendations.

NHS Improvement: Stroke rehabilitation in the community: commissioning for improvement (PDF 831KB). This is a comprehensive guide to the development of effective community rehabilitation services. Together with detailed examples of good practice and information about early supported discharge (ESD) service models implemented in England, it explores factors which influence local commissioning, and identifies tools to assist with commissioning and funding rehabilitation. This new publication is particularly relevant to the emerging commissioning landscape, the development of a new outcomes framework, and the positioning of stroke within long term conditions.

National Obesity Observatory (NOO): Adult and child weight factsheets. The National Obesity Observatory have updated their factsheets on adult weight and child weight. The factsheets (previously known as Key Data Briefings) compile up-to-date key information and data about obesity and its determinants. They are intended for use by policy makers, practitioners and anyone with an interest in obesity. 

RCN Policy and International Department:Policy briefing 16/12 Personal health records and information management (PDF 303.KB). This briefing summarises the RCN vision for personal health information management, how ICT can support this vision and what needs to be done to overcome barriers to achieve the changes required. It is intended to inform all aspects of records development, record standards development and nursing educational programmes.

RCN Policy and International Department: Policy briefing 17/12 NHS failure regime (PDF 422.1KB). The RCN is deeply concerned that some organisations in the NHS could fail. Failure could be where: patients cannot be treated safely; an organization is no longer financially sustainable; both of these.  This briefing provides an overview of the current and future approaches to an NHS failure regime.

Royal College of Midwives (RCM): Innovation and Improvement in Midwifery Services. This study on innovations and improvements in maternity services shows midwives are leading on improving services and generating savings. The study looks at examples of innovative practice from across England. The report emphasises the important role that clinical leadership plays in enabling innovation and improvement to take place. 
RCM News: New report backs innovation for midwives.

Royal Pharmaceutical Society (RPS): Professional standards for hospital pharmacy services: optimising patient outcomes from medicines. The standards have been developed by a wide range of stakeholders across GB and covers pharmacy services delivered by acute, mental health, private and community service providers. The 10 overarching standards underpin patient experience and the safe, effective management of medicines within and across organisations. Supporting resources are also available.
RPS news: New professional standards for hospital pharmacy services.

Scottish Government: Scottish Government's Armed Forces Veterans Guide For Healthcare Providers. The leaflet focuses on what questions to ask patients to establish veteran status, the condition and illnesses that veterans typically contract following service and points to the privileges that veterans can access from the NHS in Scotland.


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