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Safety and protection from avoidable harm

Summary :: Our health and well-being :: Safety and protection from avoidable harm

Vulnerable adults

A vulnerable adult is defined as follows by the Department of Health in No Secrets: [1] “An adult (a person aged 18 years or more) who is or may be in need of community care services by reason of mental or other disability, age or illness and who is or may be unable to take care of him or herself or unable to protect him or herself against significant harm or exploitation.”

No Secrets [1] gave local authorities the lead responsibility for developing and implementing multi-agency processes to coordinate systems, policies and procedures to protect vulnerable adults from abuse. The work of the Kent and Medway Safeguarding Adults Executive Board is to coordinate agencies to safeguard these adults who are at risk of being abused. The Kent and Medway Safeguarding Vulnerable Adults Board takes a strategic lead on safeguarding matters and is co-chaired by the Assistant Director of Social Care in Medway.

Safeguarding Vulnerable Adults work is concerned with the multi-agency approach to responding to and preventing the abuse of 'vulnerable adults'. Across Kent & Medway, there are multiagency policy, protocols and guidelines in place, which are updated twice a year.

It is thought that there is considerable under reporting of adult abuse. Work has been done to increase public awareness, but this now needs to extend to BME and LGBTQ groups in Medway.

For more information, see: Adults ➜ Safeguarding

Patient safety incidents

During the period 1st October 2016 to 31st March 2017, 4,375 incidents were reported to the National Reporting and Learning System (NRLS) as happening at Medway Foundation Trust (MFT). [2] Of the 136 Acute (non-specialist) organisations, MFT's reporting rate (46.74 incidents per 1,000 bed days) lies within the highest 25% of reporters. This has insreased over time, from 14.77 incidents per 1,000 admissions for the reporting period 1st October 2015 to 31st March 2016. Organisations that report more incidents usually have a better and more effective safety culture, so this an improvement for MFT. [2]

Figure 1: Top 10 incident types, October 2016 to March 2017
Figure 1: Top 10 incident types, October 2016 to March 2017 [3]

50% of all incidents were submitted to the NRLS more than 24 days after the incident occurred. At MFT, 50% of all incidents were reported to NRLS more than 30 days after the incident. If serious incidents are not reported promptly, steps cannot be taken to prevent harm to others. [2]

Figure 2: Incidents reported by degree of harm for medium acute organisations
Figure 2: Incidents reported by degree of harm for medium acute organisations, October 2016 to March 2017 [2]
  Count
None 3,419
Low 840
Moderate 84
Severe 17
Death 15
Table 1: The number of incidents reported by degree of harm, Medway Foundation Trust [2]

Health protection

Air pollution

Air pollution can have a negative impact on health. Estimates suggest that it reduces life expectancy within the UK by an average of six months. The main pollutants in the UK include particulate matter (PM), nitrogen oxides and ozone. Road transport is a key source of air pollution, which tends to be worse in more deprived areas. In terms of health effects, the most important air pollutant is PM. This consists of small particles which may be emitted from vehicle exhausts or chimneys, or they may form in the air as a result of reactions between other pollutants. Nitrogen Dioxide at high concentrations can also exacerbate lung conditions such as asthma. Ozone is formed as a result of the reaction between sunlight and other pollutants and can also cause breathing difficulties. [4]

Air pollution may also have an effect on children's lung function in the long term. As lung development is generally complete by the age of 18, this is unlikely to recover. The Health Protection Agency estimates that up to 57 children aged 0–15 per 1,000 in England and Wales may have reduced long–term lung function as a result of air pollution. In 2016, there were 56,669 children aged 0–15 living in Medway.[5] This could mean as many as 3,231 children living in Medway have reduced lung function as a result of air pollution. [4]

Children, in particular those with asthma, will benefit from a reduction in levels of air pollution. It has been estimated that 30% of acute exacerbations of asthma may be related to environmental factors. In the UK, 36 children and 30 adults per 1,000 population may have asthma which is attributable to chemical pollution. This means that as many as 1,858 children (aged 0–15) and 6,156 adults (aged 16 and over), living in Medway could have asthma attributable to chemical pollution. [4]

As well as the association with respiratory disease, a relationship has also been shown between the number of particles in the air and admissions to hospital with cardiovascular disease. A report from the HPA suggests that a reduction in PM10 (particulate matter less than 10 micrometers in diameter) might be associated with a 0.8% reduction in all age, all cause cardiovascular hospital admissions. In Medway, in 2010/11, there were 2,001 emergency cardiovascular admissions, which would mean 16 fewer admissions a year if PM10 levels were reduced. [4]

Please see the Kent Air website for pollution readings around Kent and Medway

Chlamydia diagnoses (15–24 year olds)

Chlamydia is the most commonly diagnosed sexually transmitted infection in England, with the highest rates being seen in those under the age of 25. Many infections cause no symptoms and thus remain undiagnosed. Untreated, it can lead to pelvic inflammatory disease in women, which can result in infertility or ectopic pregnancy. [4]

Figure 3: Rate of 15--24 year olds screened through the National Chlamydia Screening Programme and percentage of positive tests
Figure 3: Rate of 15–24 year olds screened through the National Chlamydia Screening Programme and percentage of positive tests, January to December 2016 [6]

The National Chlamydia Screening Programme was established in England in 2003. It aims to provide early detection of chlamydia, allowing treatment of asymptomatic infections, reducing the risk of complications and further spread of the disease. It is targeted at sexually active young people under the age of 25. [4]

Public Health England recommends that local authorities should be working towards achieving a detection rate for chlamydia among 15 to 24 year olds of at least 2,300 per 100,000 population. [4] In Medway in 2016, there were 7,662 tests carried out, equating to 20.5% of the 15–24 year old population. Of these, 8.6% (656) tested positive for chlamydia. This equates to a detection rate in Medway of 1,754 per 100,000. Although this does not quite meet the PHE recommendations, this value lies above the rates per 100,000 achieved for the South East and England overall (1,665 and 1,978 respectively). [6]

Population vaccination coverage

Immunisation is the most important public health intervention, other than clean water, for saving lives and improving health. The complete list of complete routine immunisation schedule is available at GOV.UK's website

Vaccination generally provides a similar degree of immunity to that provided by natural infection, but without the risk of complications of the disease. Vaccinations work by producing immunological memory, so that when the immune system is subsequently exposed to natural infection it is able to recognise and respond to it, thus preventing or modifying the disease. In some cases more than one dose of the vaccine may be required to produce this response and/or booster doses to maintain it. While the main aim of vaccination is to protect the individual who receives it, high levels of immunity in a population mean those who cannot be vaccinated because, for example, they are too young, are also at reduced risk of being exposed to a disease. This is known as herd immunity. [4]

When vaccine coverage is high enough, a disease may be eliminated from a community. However if high coverage is not maintained, the disease may return. Vaccine coverage is evaluated against World Health Organization (WHO) targets of 95% coverage annually for each vaccine (except Meningitis C) at the national level, with at least 90% in each Strategic Health Authority (SHA). [4]

The schedule for routine vaccinations in childhood is defined by the Department of Health on the advice of the Joint Committee on Vaccination and Immunisation (JCVI) and has changed over time as new vaccines have become available. [4]

People presenting with HIV at a late stage of infection

In 2015, 39% (1,920) of adults were diagnosed at a late stage of infection in the UK (with a CD4 cell count <350 cells/mm3 within three months of diagnosis) including 21% (1,030) who were severely immunocompromised (CD4 cell count <200 cells/mm3) at diagnosis. [7]

HIV attacks CD4, or T-cells, and uses them to make more copies of HIV. In doing so, HIV weakens the immune system, making it unable to protect the body from illness and infection. [8] It is recommended that patients should begin anti-retroviral therapy when CD4 cells counts drop <350 cells/ mm3. [9]

The routine offer of HIV testing has been recommended to all sexual health clinic and antenatal care attendees over the past decade. Over this period, the proportion of people diagnosed late has declined significantly overall, from 59% in 2001 to 39% in 2015 [7], and across all exposure groups. [10]

  Number with cell
count <350mm3
Percentage of
all diagnoses
Medway 17 39.5
Medway
Kent 84 56.8
Kent
South East region 613 43.4
South East region
England 5,136 40.1
England
Table 3: Percentage of late diagnosis of HIV, 2014 - 16 [11]

Delayed HIV diagnosis is associated with an increased risk of AIDS and death. Reports of AIDS-defining diseases declined rapidly following the advent of antiretroviral therapy in the mid-1990s. They have, nevertheless, continued over the past decade, with 372 AIDS at HIV diagnosis reported in 2015. The majority of AIDS diagnoses are made in people who were diagnosed late. Late diagnosis also means that a person has remained unaware of their HIV status for many years, increasing the risk of onward transmission.[7]

Prevalence of diagnosed HIV in Medway is not significantly different to England.

Accidents

Unintentional injury is a leading cause of death and hospital admission among children aged 0–14. In 2016, 134 children aged under 15 years died from unintentional injury in England and Wales, of which 52 were due to land transport accidents.[12]

Most injuries result from accidents in the home and there are inequalities between groups in the likelihood of these occurring. Many fall accidents are caused by pushing, shoving and wrestling. Children have also died or have been seriously injured by heavy objects such as furniture and televisions being pushed or pulled onto them.[4]

Unintentional injury rates in under 16 year olds are higher in lower socio-economic groups. Inequalities also exist in relation to sex, age, ethnicity and geographical region. Home safety schemes are not universally available and are often confined to more deprived neighbourhoods. Inequalities may be exacerbated by this approach because there will be people from less deprived groups living in deprived areas who receive help that they may not need. Of greater concern is that there may be people not getting help they need from projects like Surestart because, while they live in a less deprived area, they are themselves from a more deprived group.[4]

In 2016/17, 93 under 5s in Medway were taken to A&E for 'other accidents' (which excludes road traffic accidents); 51 boys and 42 girls. The most common primary diagnosis was head injury, with 32 children attending for this, followed by laceration and Contusion/abrasion (both 13).[13]

Within the national curriculum, there is a requirement to teach children about hazards, risks and controls, as well as road safety. SureStart also offers a range of services, including low cost home safety equipment and conducting home safety outreach interventions.

The majority of accidents involving older people are falls, with almost three-quarters of falls in people 65 years and over resulting in injuries to arms, legs and shoulders. One in every five falls in women aged 55 and over results in a fracture. The most serious accidents involving older people often occur on stairs or in the kitchen whilst the most common places for all accidents are the bedroom and living room.

In 2016/17, there were 2,930 admissions of Medway residents to Medway Foundation Trust in relation to an accident. The number of unique residents was 2,625. This means that 305 were admitted more than once within these 12 months.[13]

Road traffic accidents

The number of casualties from collisions on Medway's roads has reduced, from 1,253 in 1998 to 856 in 2015, of which 77 people were either killed or seriously injured.\cit{RTA2015} Serious injury includes fractures, severe lacerations, paralysis and extended stay in hospital. Slight injury includes whiplash, sprain and minor lacerations.

Medway council works closely with Kent Police to gain information on any collisions which occur in Medway. As a picture is built up over time, sites with multiple crashes (cluster sites) are investigated by road safety engineers who look at the factors leading up to a collision, visit the site and gain insight from residents and the local community. This informs road improvement initiatives such as speed limit reduction, changes to road markings or restructuring junctions.[4]

Work-related accidents

In 2016/17, 1.3 million people suffered from work-related illness[14], 137 people were killed at work and 70,116 injuries were reported under 'Report Injuries, Diseases and Dangerous Occurrences' (RIDDOR) in Great Britain.[15]

In 2016/17 (provisional), there were 0 fatalities, 75 specified injuries and 162 injuries where symptoms lasted over seven days in Medway. There has been a slight decrease over the last five years for the total number of reported non-fatal injuries. Specified injuries have remained fairly constant but there has been a decrease in the number of 'over seven day' injuries. Medway had no fatalities in this period.[15]


References

[1]   Department of Health. No secrets: guidance on developing and implementing multi-agency policies and procedures to protect vulnerable adults from abuse 2000; Department of Health. http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4008486 .
[2]   National Reporting and Learning System, National Patient Safety Agency. Organisation Patient Safety Incident Report: Medway NHS Foundation Trust, 1 October 2016 to 31 March 2017 September, 2017; National Reporting and Learning System and National Patient Safety Agency. https://report.nrls.nhs.uk/explorerTool/PdfReport.aspx .
[3]   National Reporting and Learning System, National Patient Safety Agency. Organisation Patient Safety Incident Report: Medway NHS Foundation Trust, 1 April 2011 to 30 September 2011 2012; National Reporting and Learning System and National Patient Safety Agency. http://www.nrls.npsa.nhs.uk/EasySiteWeb/getresource.axd?AssetID=133125&type=full&servicetype=Attachment .
[4]   NHS Medway. Annual Public Health Report 2011/12 2012; NHS Medway.
[5]   Office for National Statistics. Mid-2016 population estimate
[6]   National Chlamydia Screening Programme. Chlamydia testing data for 15-24 year olds in EnglandPublic Health England. https://hivstiwebportal.phe.org.uk/login.aspx .
[7]   Public Health England. HIV in the UK 2016 report 2016; Public Health England. https://www.gov.uk/government/publications/hiv-in-the-united-kingdom .
[8]   Cichocki M. What is a CD4 Count and Why is it Important? 2012;
[9]   Association of Public Health Observatories. Sexual Health Balanced Scorecard: Percentage HIV diagnoses with CD4 cell count <350mm3 at time of diagnosis, 2009 technical report 2010; Association of Public Health Observatories. http://www.apho.org.uk/resource/view.aspx?RID=74115 .
[10]   Health Protection Agency. HIV in the United Kingdom: 2011 Report 2011; Health Protection Agency. http://www.hpa.org.uk/hivuk2011 .
[11]   Public Health England. 3.04 - HIV late diagnosis 2014 to 2016;
[12]   Office for National Statistics. Death registrations in England and Wales, summary tables: 2016 2017;
[13]   Medway Public Health Intelligence team. Secondary Uses Service Hospital activity analysis
[14]   Health and Safety Executive. Reported road casualties in Great Britain 2017;
[15]   Health and Safety Executive. Reported road casualties in Great Britain 2017;