Regulators have failed to properly address patient safety on discharge from hospital in England, leaving the physical wellbeing and dignity of patients continuously at risk at a time when they should be returning safely home, finds new research.
The research, 'Leaving hospital: A step too far for risk-based regulation?' investigates the reasons for the lack of effective regulations from a legal standpoint. It was published in the journal, Medical Law Review* and was funded by the National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre (GM PSTRC) which is a partnership between The University of Manchester and Salford Royal hospital.
Victoria Moore, who led the research, is from the centre's Safer Care Systems and Transitions theme, and said: "Being discharged from hospital can be a dangerous time for patients, but this is an area that regulators haven't recognised as a group and as such haven't paid much attention to. This leaves patients vulnerable. My research investigates why this is the case. The answer lies in the regulatory approach that dominates regulation within the NHS."
Risk-based regulation is the regulatory approach underpinning health and social care regulations in England. To be successful, this approach requires the risk to patient safety to be appropriately identified, fully understood and prioritised by all regulators involved.
Victoria continued: "Within healthcare regulation in England there are a number of regulators, so it is virtually impossible for all of them to have a unified understanding of the risk posed by discharge. This has resulted in a lack of action by any one regulator."
The research identifies that in hospital discharge, there are three main weaknesses in risk-based regulation and these have been created by the sheer number of regulators involved.
The first is when identifying risk, as regulators don't possess a complete overview of all relevant information. This is because of the limited information-sharing mechanisms between the regulators. Therefore, judgements have to be made about what information to share and with which regulator. This is problematic given that successful risk-based regulation is heavily dependent upon the availability of sufficient information to identify risks and inform decision-making.
The number of statutory regulators and the limited nature of information-sharing leads to a second important weakness; it's virtually impossible for all regulators to have a unified understanding of the risks posed by discharge from hospital. Risks will be understood based on the nature of information available, which will vary due to the number of regulators involved.
Finally, the research explains that successful risk-based regulation relies on being able to correctly prioritise risk. This can only happen if regulators have gathered enough information and all understand and agree the regulatory aims.
Victoria concludes: "The combination of the three weaknesses I've identified in my research means the risk posed to the safety of patients on discharge from hospital is neither uniformly recognised by the statutory regulators within the English NHS, nor sufficiently addressed. Professional regulators in particular appear to have a poor awareness of the risk and their role in addressing it. Until regulators can accurately identify this risk, build a unified understanding of its causes and consequences, and prioritise it appropriately, this unacceptable status quo will remain."
The Director of the Greater Manchester PSTRC, Prof Stephen Campbell states that "we know discharge from hospital can be a key patient safety issue and regulation needs reliable and attributable information. This research helps identify key areas for improvement especially the need for a unified understanding of the risk posed by discharge and information-sharing".
Notes for editors:
Greater Manchester Patient Safety and Translational Research Centre
Mary Vingoe - Communications Manager
Phone: 0773 8880152
About the NIHR Greater Manchester Patient Safety Translational Research Centre: The NIHR Greater Manchester Patient Safety Translational Research Centre is a partnership between The University of Manchester and Salford Royal NHS Foundation Trust in collaboration with The University of Nottingham, which aims to make healthcare safer in primary care and transitions of care. It's funded by the National Institute for Health Research (NIHR) for five years from 2017 until 2022 and is one of three PSTRC in England. The Greater Manchester PSTRC conducts research across four themes: Safety Informatics, Medication Safety, Safer Care Systems and Transitions, and Safety in Marginalised Groups.
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About the University of Manchester: The University of Manchester, a member of the prestigious Russell Group, is the UK's largest single-site university with 38,600 students. It has 20 academic schools and hundreds of specialist research groups undertaking pioneering, multi-disciplinary teaching and research of worldwide significance. The University is one of the country's major research institutions, rated fifth in the UK in terms of 'research power' (REF 2014), and has had no fewer than 25 Nobel laureates either work or study there. The University had an annual income of £1 billion in 2014/15. Visit http://www.
About The National Institute for Health Research (NIHR): The NIHR is the nation's largest funder of health and care research. The NIHR:
- Funds, supports and delivers high quality research that benefits the NHS, public health and social care
- Engages and involves patients, carers and the public in order to improve the reach, quality and impact of research
- Attracts, trains and supports the best researchers to tackle the complex health and care challenges of the future
- Invests in world-class infrastructure and a skilled delivery workforce to translate discoveries into improved treatments and services
- Partners with other public funders, charities and industry to maximise the value of research to patients and the economy
The NIHR was established in 2006 to improve the health and wealth of the nation through research, and is funded by the Department of Health and Social Care. In addition to its national role, the NIHR supports applied health research for the direct and primary benefit of people in low- and middle-income countries, using UK aid from the UK government.
This work uses data provided by patients and collected by the NHS as part of their care and support and would not have been possible without access to this data. The NIHR recognises and values the role of patient data, securely accessed and stored, both in underpinning and leading to improvements in research and care. http://www.