Speech by the Minister for Health, Simon Harris TD at the National Patient Safety Office Conference – 25th October 2017
**Check Against Delivery**
Good morning and a warm welcome to all of you attending this National Patient Safety Conference. Patient safety is the fundamental cornerstone of our health service and this event is an excellent opportunity to reflect on progress, consider challenges and plan together how we can deliver safe, effective care where good quality patient outcomes are our primary focus.
I took up the role of Minister for Health around 18 months ago now. In that relatively short time, we have already seen an increasing emphasis on patient safety issues across many areas of the health service, education bodies and our regulatory bodies. Indeed, I launched the National Patient Safety Office a short 10 months ago in this same venue with the intention that the Department becomes an active player in promoting patient safety. Based on a Government decision, this Office means that patient safety has a central role for the Minister of Health of the day.
So I am now going to take time today to outline my priorities for patient safety. At the outset it is important to recall what we mean when we talk about patient safety. For me, it is about taking a particular approach to the delivery of healthcare, in some ways reflective of that oldest approach in medicine – “first, do no harm”. While we have, of course, established a National Patient Safety Office, and while there are experts in quality, risk and patient safety working throughout the health service, it is vital that we do not allow the perception that patient safety is somehow external to the delivery of healthcare, or an optional extra, to gain ground. I would imagine that many of us here this morning are familiar with some of the more stark statistics in relation to patient safety as a global health problem, where 1 in 10 patients develop a healthcare acquired condition, and where patient harm is estimated to be the 14th leading cause of the global disease burden.
Some estimates indicate that up to 15% of hospital budgets can be absorbed by such events. Professor Niek Klazinga will speak to this very issue later this morning when he examines the Economics of Patient Safety.
Given this, it is the responsibility of everyone working in the health service – clinicians, managers, and support staff – to ensure that they take account of the patient safety aspects of their role. Services need to be designed and delivered in such a way as to minimise the risk of patient safety incidents occurring. And we need to ensure that the care experienced by our patients is high quality and effective, as well as safe.
In viewing the conference programme with its presentations, workshops and poster walk rounds as demonstrations as to what is happening in our health system around patient safety, it is evident to me that many of our clinicians and managers are making significant strides in relation to patient safety and quality; and although there is still much to do, I commend you for those efforts and your commitment and leadership. I also welcome the focus on patients and the public, who are the reason why we all get up to work each day. I have already met a number of patient representatives attending here this morning.
It takes more than the effort of any one individual to bring about change though. That is why the theme of this year’s conference appears most apt, as it looks at teamwork for patient safety. Teamwork takes on many forms; it happens not just in formal clinical practice, but also across our formal and informal networks working in policy, regulation, management, education and research.
For example, I would like to highlight that across the Department of Health, patient safety concepts are now being considered across all new policy developments. In July, a far reaching National Cancer Strategy for the next 10 years was published. In setting out our ambitious plans for cancer care a chapter is dedicated to the importance of patient safety and quality, stressing the need for evidence based practice, appropriate surveillance of activities, inclusion of patients in service design and the management of adverse events when they arise. The Major Trauma Audit, the first NCEC National Clinical Audit, was recently used to inform the work of the Trauma Steering Group in developing ‘A Trauma Policy for Ireland’. And a set of NCEC clinical guidelines are in development to support the Maternity Strategy Implementation Plan, which I was pleased to launch last Thursday.
The Department of Health is, of course, working closely with the HSE in this area too, so that the profile of patient safety is raised and that it becomes the core of health service delivery. I fully support the 3-year Patient Safety Programme being led by the HSE to drive this agenda across all areas of the health service. The new programme aims to co-ordinate and support existing patient safety work to promote upscaling and sustainability of fundamental patient safety requirements. It emphasises the need to optimise efforts, build on successful initiatives and create a coherent organisation-wide strategy for patient safety which sets out key improvement priorities. The national emphasis on this agenda will help to refocus patient safety as a priority in its own right as both a practice and a goal.
Similarly, the vital role which the service regulators, HIQA and the Mental Health Commission, play in relation to patient safety cannot be overstated. This work complements the important tasks undertaken by the professional regulators such as the Medical Council, the NMBI and CORU. All of you as regulators have individually demonstrated your commitment to re-emphasise the importance of safety and quality as core components of regulatory practice. An example of health regulators working together to improve patient safety is the Medical Council and PSI who recently launched joint guidance, entitled ‘Safe Prescribing and Dispensing of Controlled Drugs’, for doctors and pharmacists, which is a collaborative practical resource to safer prescribing and dispensing of controlled drugs, encouraging and supporting best practice for enhancing patient safety.
Aligning levers of policy, regulation and implementation transforms the approach to patient safety. It accelerates development and becomes a powerful movement for progressive change.
National Patient Safety Office
Over the past ten months, the National Patient Safety Office has been building its capacity to deliver on its ambitious programme of policy change. All three strands of the office are now coming into operation, that is, patient safety surveillance, patient safety policy and advocacy and an enhanced clinical effectiveness agenda.
Although early days, I would like to share with you some of the initiatives being progressed.
With this Office, the Department of Health has, for the first time, an in-house patient safety surveillance function. This new National Patient Safety Surveillance System, which will be fully established over the next year will enable the construction of patient safety profiles, bringing together data from a wide variety of sources to inform patient safety priorities across service delivery, regulation and education.
It is also important that we gain an understanding of how those who use our health services perceive the care they are receiving. That is why, in May of this year, we saw Ireland’s first ever National Patient Experience Survey take place. I am sure that many of you are not only familiar with the Survey, but were closely involved in promoting it among your own patients. For that, I would like to sincerely thank you. This annual survey is a joint undertaking between my Department, the HSE and HIQA. I know that later on this morning you will be updated on the current situation with regard to the Survey and we expect a full report in December. We will build on the reach of this Survey and in line with Maternity Strategy, maternity services will be our next target audience.
Building our information capability is an integral part of service design and delivery. As a health system we are now seeing solid data sources for patient safety emerging including audits from NOCA, the Royal College of Physicians, maternity and hospital patient safety statements and the Irish Maternity Indicator Report. This is constructing a culture that is more open and transparent with its information; a key value that underpins patient safety.
Earlier this year, the Department published the third report of the National Healthcare Quality Reporting System. This initiative allows health providers to look at their outcomes from a comparative perspective, in relation to a selected series of indicators including cancer, stroke and heart attack survival rates, as well as broader issues such as immunisation rates and antibiotic consumption.
Antimicrobial resistance (AMR)
The mention of antibiotics brings me to one of the most significant emerging challenges for the delivery of healthcare in the 21st century. Healthcare Associated Infections and the rise of antimicrobial resistance, or AMR, are global challenges and I want to mention both in the context of patient safety.
In relation to HCAIs, while we have seen recent successes in relation to tackling some bugs, they continue to pose a serious threat. Most urgently, we now face a rising threat from CPE, which in some cases results in bacteria that are resistant to all conventionally used antibiotics – hence the name superbugs. AMR threatens to undo many of the lifesaving advances in human health care that have been made over the last 100 years. While we have been taking actions it is clear to me these need to be scaled up significantly. To this end, I will launch later today with my colleague Minister Creed iNAP. iNAP is Ireland’s 3-year National Action Plan on AMR. It focuses on surveillance and prudent antibiotic prescribing.
Antibiotics are of course critical to the timely treatment of sepsis, which if left unrecognised and untreated, can have devastating consequences for patients. Here is an example of where clinical effectiveness meets patient safety surveillance and this joined up approach is how I expect the National Patient Safety Office and the health system operate going forward.
I recently attended the 4th annual HSE Sepsis Summit and was delighted to hear of the progress that the National Programme on Sepsis is making on reducing mortality. In 2015, there were almost 9,000 cases of sepsis in adult inpatients in Ireland, mirroring the international experience. It is estimated that compliance with the national Sepsis programme will result in an additional 500 lives saved per year, as well as a reduction in length of stay in hospital. The second National Sepsis Outcomes Report, which I launched in September, showed that Ireland’s sepsis-associated hospital mortality rate is now less than 20%. This benchmarks very well internationally and represents a 20% decrease in mortality since 2014. There has also been a 67% increase in the number of cases diagnosed, which is a direct result of the efforts of the sepsis committees in all the acute hospitals and the willingness of clinicians to engage with this important initiative.
It should be recalled that the National Clinical Guideline on sepsis was published in 2014. Given that it is now three years old, it is currently being updated to ensure we base our health services on the most up-to-date evidence possible. I was very proud earlier this year when a resolution on preventing, diagnosing and managing sepsis, developed by Ireland in partnership with other member states, was agreed at the 70th World Health Assembly in Geneva. The WHO resolution recommends training in sepsis recognition and management, promotion of hand hygiene, infection control, public awareness and the use of evidence based guidelines. We were in a strong position to contribute to the development of this international resolution, due to the comprehensive and systematic implementation of our own national sepsis programme in Ireland, led by Dr Vida Hamilton.
National Clinical Effectiveness Committee (NCEC)
I appointed Dr Karen Ryan as NCEC Chair earlier this year. She is bringing a strong implementation focus to the clinical effectiveness agenda. This approach combined with a dedicated source of evidence for guidelines through a 5-year HRB programme called HRB-CICER is raising the bar for our shared goal of clinical practice based on robust evidence. HRB-CICER is being delivered through a collaboration between HIQA’s HTA team and the RCSI’s HRB Centre for Primary Care Research. My Department is committed to expanding this approach to synthesising evidence for practice to other policy areas.
The NCEC in partnership with clinicians and the clinical programmes is leading an ambitious work programme. This year saw the publication of the Hepatitis C Screening guideline and a Lung Cancer Guideline will be launched early November. Nine other guidelines are in development, notably in relation to Tobacco addiction, Under-nutrition in Hospital and Diabetes Type 1. A second National Clinical Audit – the Royal College of Physician’s Radiology QI programme – is progressing through the NCEC Quality Assurance process and it is planned that the NCEC’s National Clinical Audit function will soon be open for other applications.
This work can’t progress without the commitment and leadership of clinicians, researchers and educators. I thank all those who contribute time and expertise on NCEC appraisal teams and subgroups. In particular I acknowledge Professor Declane Devane, Mr Ian Callanan and Prof Dermot Malone who chair these subgroups.
The NCEC has also commenced a capacity building programme for evidence based practice and implementation science, and is creating linkages with partners such as the Centre for Effective Services and the Naji Foundation. We are building an ‘NPSO Learning Zone’, as an online learning resource hosted on the Department’s website. This will be freely accessible to healthcare professionals, patients and the public. A sample of one eLearning module is on display here today at the back of the conference hall.
I want to focus again on patients. Both I and my Department are committed to patients being at the core of what we are about and I have been heartened to see the increasing priority being placed by the HSE, regulators and educators on including the patient and public voice. I mentioned earlier that you will hear more later on the National Patient Experience Survey. Tomorrow you can attend a workshop dedicated to NCEC’s work to finalise a Public Involvement Framework to strengthen public participation in healthcare decision-making and bring public knowledge and experience to clinical effectiveness processes. I am delighted too that the HSE work to update ‘Your Service Your Say’ is complete and will be launched shortly.
Launch of National Standards on the Conduct of Reviews for Patient Safety Incidents
I am however very conscious of the important work you do in an increasingly complex healthcare environment where while much of what happens goes well at times things do go wrong. When this happens a primary concern is always to understand what has occurred, and then to take the learning from the incident so that we can make the service safer for the next patient, and the patient after that.
Recognising these challenges, my Department commissioned HIQA and the Mental Health Commission to develop a set of national standards on the conduct of reviews of patient safety incidents. I am really pleased to be able to officially launch these standards today.
Many of you, including patients, have been part of the development of these standards. They will set out a new approach to the way health providers respond to, review and investigate incidents in order to determine as quickly as possible what may have transpired, and why, so as to ensure that we can immediately implement any improvements necessary to prevent a re-occurrence. I would in particular like to thank Patricia Gilheany and Phelim Quinn for their leadership in this regard.
Of course, standards such as these need an implementation plan and I am happy to report that, in parallel with their development, the HSE is currently finalising the review of its Safety Incident Management Policy. The resulting Incident Management Framework places particular emphasis on the provision of support to service users and staff in the immediate aftermath of an incident occurring. It acknowledges that the maintenance of trust is critically dependant on on-going open and supportive communication, and looks to adopt a proportionate approach to reviewing incidents which is robust, responsive and based on best international practice. I thank the patients and staff for their commitment to this work and acknowledge the on-going commitment of Patients for Patient Safety.
We will continue to support all of this good work through policy and legislation. My Department is developing a new Patient Safety Complaints and Advocacy Policy and provisions to support Open Disclosure are included in the Civil Liability (Amendment) Bill, which is currently progressing through the Oireachtas. The Health Information and Patient Safety Bill will create a mandate for reporting of serious events. In addition, this Bill provides for the extension of HIQA’s remit to private hospitals laying the foundation for hospital licensing.
I will also shortly be bringing forward the general scheme of a new Patient Safety Licensing Bill, which will for the first time introduce a regulatory system through licensing for all hospitals in Ireland, as well as certain designated high risk activities that take place outside a hospital setting. This new licensing system, where HIQA will be the licensing authority, will promote the development of robust clinical governance frameworks throughout the health service and serve to aid in the effort to ensure a safe, responsive and accountable approach to the delivery of health care.
As we build and nurture our patient safety initiatives I would like to focus for a minute on the coming months which see us heading into the winter period. Earlier this week I attended the HSE’s annual ‘Winter Ready’ meeting in Mullingar. There I met with colleagues across primary, acute and social care services, as well as HSE management, who were all finalising their integrated winter plans, ready for the coming months. That meeting provided an opportunity to share best practice as we are all responsible for doing our bit to meet the increased demand for health services this winter. That may include: getting the flu vaccine; working with older people in our communities to enable them to stay well; taking steps to improve patient flow in our hospitals to alleviate pressure at peak times in our EDs; implementing infection prevention and control measures; working with nursing homes; supporting GP out-of-hours services to name but a few. We all have something to contribute to this health service to keep people well this winter and for those patients that need care, to better meet their needs in a safe and effective way.
Finally, I would also like to assure you that the patient safety agenda will be very much to the fore as we move towards implementation of the Sláintecare report, which as you know sets out a 10 year vision for transforming the health service. Two weeks ago I announced that 3 key steps were in train: an independent group to examine the impact of separating private practice from the public hospital system; a public consultation on the future alignment of hospital groups and community health organisations; and legislation and the establishment of a board to strengthen the oversight and performance of the HSE.
The successful implementation of the Sláintecare report depends on ensuring we emphasise the safety and quality of the care we provide. As Slaintecare outlines, the corner stones of a safe, quality service includes team working – this year’s conference theme – and clinical governance – the focus of day two of the conference. A new Board for the HSE, will give the opportunity to apply the learning of the last few years and I hope will encompass much of the good strategies and practices you will be hearing about over the next 2 days.
Thank you very much for your kind attention, and I hope that you all have a productive and enjoyable time here at Dublin Castle.