Bolton NHS Foundation Trust

All NHS Trusts are obliged to report any occurrence of a Patient Safety Incident, which are defined as “any unintended or unexpected incident that could have or did lead to harm for one or more patients receiving NHS-funded healthcare” (Guidance notes on NRLS official statistics publications – September 2017).

These encompass a wide range of types of incident including medication or prescription errors, pressure ulcers, medical device or equipment failures and surgical errors, among many others. All Patient Safety Incidents are recorded against the level of harm that occurred as a result, ranging from no harm through to death. The defined levels of harm are:
No harm – Where no harm or damage was caused to the patient
Low harm – Extra observation or treatment was required as a result of the incident
Moderate harm – Requiring extra treatment including extra surgical intervention, cancelling treatment, transfer to another area and short-term harm as a result of the incident
Severe harm – Permanent or long-term harm as a result of the incident
Death – Where death has occurred as a result of the incident

Patient Safety Incident data is published twice a year and can be found on the NHS England website at: https://www.england.nhs.uk/patient-safety/national-patient-safety-incident-reports/. This data is public sector information licensed to Blackwater Law under the Open Government Licence v3.0: http://www.nationalarchives.gov.uk/doc/open-government-licence/version/3/.

Within England 95% of patients who attend A&E or make an emergency admission should be admitted, transferred or discharged within 4 hours of arrival. This means that depending on the severity of their condition, patients need to be admitted into the hospital for further treatment or observations, transferred into another NHS organisation or separate care (such as social services) or discharged home.

This data includes those who make an unplanned attendance at either a 24-hour A&E department, a single speciality A&E department or a walk-in/urgent care centre. An A&E department must see, on average, more than 200 separate patients each month before it is obliged to provide this data.

A&E attendances and emergency admission data is published monthly and can be found on the NHS England website at: https://www.england.nhs.uk/statistics/statistical-work-areas/ae-waiting-times-and-activity/. This data is public sector information licensed to Blackwater Law under the Open Government Licence v3.0: http://www.nationalarchives.gov.uk/doc/open-government-licence/version/3/.

The NHS report on bed occupancy rates as an indicator as to what capacity each individual trust is running at.

The figures presented here relate to the overall percentage of beds that are occupied overnight during the reporting period.

It is thought by some commentators that bed occupancy levels greater than 85% can lead to compromised patient safety and higher hospital acquired infection rates (Bagust A et al , British Medical Journal, Vol 319).

Bed occupancy data is available quarterly and can be found on the NHS England website at: https://www.england.nhs.uk/statistics/statistical-work-areas/bed-availability-and-occupancy/. This data is public sector information licensed to Blackwater Law under the Open Government Licence v3.0: http://www.nationalarchives.gov.uk/doc/open-government-licence/version/3/.

The Summary Hospital-level Mortality Indicator (SHMI) compares the actual number of patients who die following hospitalisation against the number of patients who would be expected to die on the basis of average for trusts across England, given the characteristics of the patients treated at that Trust. The SHMI includes deaths that have occurred in hospital or within 30 days of discharge from hospital.

A SHMI number of 1 indicates the observed number of deaths was higher than expected A SHMI of 2 indicates the observed number of deaths was as expected and a SHMI of 3 indicates the observed number of deaths was lower than expected, when compared to the national baseline .

SHMI data is published half yearly by NHS Improvement. The data is calculated using Hospital Episode Statistics (HES) data linked to Office for National Statistics (ONS) death registrations data and is published quarterly using a 12 month reporting period.

With any given number of expected deaths, a range of observed deaths is considered “as expected” however if the number falls outside this range, the Trust is then deemed to have a higher or lower SHMI than expected. A higher than expected SHMI should trigger an investigation by the Trust but cannot immediately be attributed to poor performance.

SHMI source data can be found on the NHS Improvement website at: https://digital.nhs.uk/data-and-information/publications/clinical-indicators/shmi. This data is public sector information licensed to Blackwater Law under the Open Government Licence v3.0: http://www.nationalarchives.gov.uk/doc/open-government-licence/version/3/.

All NHS Trusts must report when an elective operation has been cancelled at the lastminute for non-clinical reasons. For the purposes of reporting, a last-minute cancellation is deemed to have occurred after the patient has arrived at the hospital, or on the day of the operation or surgery. The operation must have been cancelled for non-clinical reasons for it to be reported.

Examples of a non-clinical reason for cancelling an operation include: ward beds being unavailable, equipment failures, administrative errors and emergency cases needing the theatre. This includes all planned and elective operations, including day cases. However, in accordance with the Cancelled Operations Guidance available on the NHS England website, any operation that is rescheduled to a time that is within 24 hours of the original operation time and date is classed as a postponement rather than a cancellation, as long as this only occurs once (any further postponements are then classed as a cancellation).

Cancelled elective operations data is available quarterly and can be found on the NHS England website at: https://www.england.nhs.uk/statistics/statistical-work-areas/cancelled-elective-operations/. This data is public sector information licensed to Blackwater Law under the Open Government Licence v3.0: http://www.nationalarchives.gov.uk/doc/open-government-licence/version/3/.

In order to provide a medical diagnosis, it is often necessary to perform a diagnostic test or procedure to identify a disease or condition. As a result, the NHS report on a number of items relating to diagnostics. The figures presented here relate to the percentage of patients who had to wait 6 weeks or more from the moment the request for the diagnostic test or procedure is made, through to when the test or procedure has been completed.

“Early diagnosis is important to patients and central to improving outcomes. For example early diagnosis of cancer improves survival rates. Bottlenecks in diagnostic services can significantly lengthen patient waiting times to start treatment.” (NHS England)

Diagnostics waiting time data is available monthly and can be found on the NHS England website at: https://www.england.nhs.uk/statistics/statistical-work-areas/diagnostics-waiting-times-and-activity/monthly-diagnostics-waiting-times-and-activity/. This data is public sector information licensed to Blackwater Law under the Open Government Licence v3.0: http://www.nationalarchives.gov.uk/doc/open-government-licence/version/3/.

All NHS Trusts have been expected to eliminate all instances of mixed-sex accommodation, unless it is in the best interest of the patient, for instance where there is a need for urgent or critical care. In such cases, mixing may be justified and therefore will not be a breach and will not be counted in these statistics.

Any reported occurrence of shared mixed sex accommodation shown here is classed as an unjustifiable breach and therefore should not be occurring under the NHS guidelines. The Department for Health states:
“There is no justification for placing a patient in mixed-sex accommodation where this is not in the best interests of the patient and better management, better facilities or the removal of organisational constraints could have averted the situation.” Department for Health (2010) Eliminating Mixed Sex Accommodation.

Data is gathered and published monthly to report on any unjustified breaches of NHS sleeping accommodation guidelines. This includes any areas where patients are admitted and cared for on beds or trolleys, even if they do not stay overnight and includes day surgery units as well as clinical decision units; but excludes any areas where patients have not yet been admitted – such as accident and emergency cubicles.

Mixed sex accommodation breach source data can be found on the NHS Improvement website at: https://www.england.nhs.uk/statistics/statistical-work-areas/mixed-sex-accommodation/msa-data/. This data is public sector information licensed to Blackwater Law under the Open Government Licence v3.0: http://www.nationalarchives.gov.uk/doc/open-government-licence/version/3/.