Placement of nasogastric tubes

Summary: We welcome HSIB’s investigation report into placement of nasogastric tubes, and its many helpful recommendations directed at royal colleges and other national bodies.

Patient safety research is an important part of safety improvement, including for areas where the safety and effectiveness of new technology or new interventions needs to be tested. There are already processes for how the NHS’s research needs, including patient safety needs, are identified and commissioned, and the complementary responsibilities of DHSC, NIHR, and NHS England and NHS Improvement have been set out. This reply summarises the process by which NHS can identify and commission necessary research to support improvements in patient safety and explains how the DHSC, NIHR, and NHS England and NHS Improvement work together to achieve this. Because of this, we do not believe a new action plan to deliver this safety recommendation is needed.

The overall research commissioning system is complex, and the DHSC, NIHR, and NHS England and NHS Improvement have systems and support that means research needs can be navigated to the right part of the system. We will undertake to jointly produce a brief guide to help HSIB direct any future research-related recommendations to the body best placed to take them forward. We expect to be able to provide this to HSIB by 31 May 2021.

We are confident these systems will work for future nasogastric tube research needs. As we know HSIB appreciates through the summaries provided for its investigation, there has been substantial research investment in new methods of nasogastric tube placement confirmation, and companies have also conducted their own clinical trials. When current early stage trials are published it will be clearer whether these are or are not likely to have a lower error rate than current testing methods, and therefore whether we have a research need for larger scale safety and efficacy trials.

Full response: We welcome HSIB’s investigation, and its many helpful recommendations directed at royal colleges and other national bodies.

Patient safety research is an important part of safety improvement, including for areas where the safety and effectiveness of new technology or new interventions needs to be tested. There are already processes for how the NHS’s research needs, including patient safety needs, are identified and commissioned, and the complementary responsibilities of DHSC, NIHR, and NHS England and NHS Improvement are already set out. These responsibilities in summary are:

DHSC via NIHR works in partnership with NHS England & NHS Improvement to systematically support the identification, prioritisation and exploration of opportunities for commissioning research to address the NHS’s research needs. This also includes the funding and commissioning research infrastructure and research delivery, such as the NIHR collaboration with the Academic Health Science Networks.

NHS England and NHS Improvement supports and engages in these processes, and has specific responsibilities to improve NHS commissioner input into identifying research needs in the NHS, and to identify the strategic research needs of its own national programmes, including the NHS Long Term Plan.

Patient safety research needs are best met as an integral part of these systems rather than separated, as aspects of quality are frequently intertwined; for example, many areas of research whose primary focus is patient experience or clinical effectiveness also demonstrate safety benefits.

Some of the ways DHSC, NIHR, and NHS England and NHS Improvement work together to ensure patient safety research needs are met include:

• DHSC’s policy research funding stream, which is a vital and valued route for NHS England & NHS Improvement to propose major new research to influence patient safety policy.
• Jointly hosting national workshops to bring all potential players in the patient safety research landscape together to streamline the patient safety research journey.
• DHSC and NIHR seeking NHS England & NHS Improvement advice and input when recommissioning major patient safety research streams, such as the Patient Safety Translational Research Centres.

These are just some of many examples in an overall operational relationship that is very positive, supportive and productive for patient safety research.

Because of these existing strategic and operational processes, we do not believe a new action plan to deliver this safety recommendation is needed.

We acknowledge the overall research commissioning system is complex, and the DHSC, NIHR, and NHS England and NHS Improvement have systems and support that means colleagues with research needs do not need to understand the complexity, but can be navigated to the right part of the system. We will undertake to jointly produce a brief guide to help HSIB direct any future research-related recommendations to the body best placed to take them forward. We expect to be able to provide this to HSIB by 31 May 2021.

We are confident these systems will work for future nasogastric tube research needs. As we know HSIB appreciates through the summaries DHSC and NIHR provided for its investigation, there has been substantial research investment in new methods of nasogastric tube placement confirmation, and companies have also conducted their own clinical trials. We appreciate the key research need is to identify a testing methodology less likely to fail to detect lung misplacement than current methods of x-ray and pH checks, where ‘never events’ are occurring in around one in 30,000 placements. When early stage trials are published it will be clearer whether any new technologies are, or are not, likely to have a lower error rate than current testing methods, and therefore whether we have a research need for larger scale safety and efficacy trials. Any future potential research needs can be taken forward through the systems described above.

Response received on 15 March 2021.