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Keep up to date with the latest news, research and activity in patient safety.

Trust that banned corridor care ‘reluctantly’ brings it back

An acute trust has announced the ‘reluctant’ return of ‘corridor care’ – having previously eradicated the unsafe practice – due to extreme ambulance handover delays and other emergency pressures.
Last year, University Hospitals North Midlands Trust chief executive Tracy Bullock said the trust had been “resisting” placing patients in corridors as it “brought significant patient safety and staff wellbeing issues”. This was despite the trust having large numbers of handover delays, being singled out for criticism by the ambulance service, and ‘corridor care’ being commonplace in many other acute hospitals amid severe bed pressures. 
The trust had successfully eliminated the practice several years earlier, because of these issues.
However, at its board meeting today, the trust confirmed the practice was formally introduced at its Royal Stoke site on the day of the ambulance staff strike (21 December) because it was “holding more ambulances than we deem acceptable”.
Read full story (paywalled)
Source: HSJ, 4 January 2023
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Council providing three-minute care visits to vulnerable, finds ombudsman

Care workers are taking as little as three minutes to help vulnerable people in their own homes, the social care ombudsman has found, after discovering a council was allocating extremely short visits to hundreds of people.
Amid chronic staff shortages and rising unmet care needs nationwide, a homecare worker commissioned by Warrington borough council sometimes stayed for just three minutes, despite the family paying for the full visit. The council was found to have allocated 15-minute care calls to more than 300 people in the region, despite national guidance stressing these were “not usually appropriate”.
The Homecare Association, which represents care providers, said the number of short calls being commissioned was increasing more widely and said “15-minute visits are inappropriately short”, result in inadequate care and are stressful for workers placed under “unfair pressure”.
The case that triggered the investigation involved a woman with dementia who was paying the full costs of her care under a plan devised by the council. In 15 minutes two agency care workers were expected to wake her, prepare a meal and a drink, ensure she ate and drank, administer her medication, change her incontinence pad, administer any personal care and tidy the kitchen. Electronic monitoring showed they regularly stayed less than 15 minutes and the ombudsman said it was probable her care needs were not met and her care was not dignified.
Read full story
Source: The Guardian, 5 January 2023
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Inquiry into deaths after Northern Ireland ambulance delays

The Northern Ireland Ambulance Service (NIAS) is investigating whether a delayed response contributed to the deaths of eight people in recent weeks.
All eight deaths occurred between 12 December and the start of January.
The NIAS is treating four of the deaths as serious adverse incidents, which is defined as an incident that led to unintended or unexpected harm.
The remaining four deaths are being investigated to see whether they meet that criteria.
The patients' identities have not been disclosed, but it is understood one of the eight people was a man who waited more than nine hours for an ambulance in mid-December.
The man's condition deteriorated and he died before paramedics arrived.
The delays are a cause of "great concern," but there is "no end in sight to the pressures we are facing," according to the ambulance service's medical director Nigel Ruddell.
He said the ambulance service conducts an internal review whenever "there is a delayed response to the call and a poor outcome from the call" to see whether delays contributed to a death.
"That process involves liaising with the family and being open and clear with them about what happened on the day - whether it was because of pressures and demand on the day or whether there was something that, potentially, we could have done better."
Read full story
Source: BBC News, 4 January 2022
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NHS whistleblower wins £500,000 for unfair dismissal

A “commended” NHS nurse has been awarded nearly £500,000 for being wrongly sacked after she claimed that high workloads led to a patient’s death.
Linda Fairhall, 62, a 44-year veteran of the health service, said she made 13 separate pleas to bosses warning that her colleagues were overburdened, but she was ignored each time.
Fairhal told officials at the University Hospital of North Tees and Hartlepool that she was worried about a recently imposed policy that obliged nurses to monitor patients who took prescribed medicines and maintained that it led to nurses having to conduct 1,000 extra patient visits a month without extra resources.
She said nurses were overwhelmed by the additional responsibility, which resulted in rising “anxiety” among staff and higher rates of absence. However, Fairhall told the tribunal in Teesside that nothing was done in response to her concerns, and ultimately a patient died.
The tribunal heard that the nurse raised her last warning with officials just before she went on annual leave. On her return she was suspended and investigated for “bullying and harassment”, then sacked for gross misconduct.
A tribunal has now ruled that the decision to dismiss Fairhall was “materially influenced” by her complaints regarding patient safety, with the panel adding that it could not “genuinely believe” that she was guilty of misconduct.
Read full story (paywalled)
Source: The Times, 4 January 2023
Read the full tribunal decision: Ms L Fairhall v University Hospital of North Tees and Hartlepool Foundation Trust
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NHS Wales: Patients can be sent home without care package

Senior NHS staff have been advised by the Welsh government to discharge people who are well enough to leave, even without a package of care.
But one GP called the announcement "terrifying" and warned that patients could deteriorate and end up back in hospital.
The seven health boards in Wales have nearly 1,800 patients medically well enough to leave hospital.
The Welsh government has called the NHS situation "unprecedented".
The message comes after one health leader said the NHS was on a "knife-edge" in terms of its ability to cope.
The letter from the chief nursing officer and the deputy chief medical officer to the health boards offered "support and advice to ensure patients are kept as safe as possible, and services are kept as effective as possible over the next period".
Read full story
Source; BBC News, 4 January 2023
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Trusts told to appoint board director with responsibility for reducing racism

Mental health trusts will be expected to appoint a board member responsible for improving racial equality and to develop individual plans to eliminate systemic racism, according to new draft NHS England guidance seen by HSJ.
The draft guidance says all providers will be required to draw up their own Patient and Carer Race Equality Framework by March 2024. These blueprints will outline how trusts plan to improve access, experience and outcomes for racialised communities, covering all services from talking therapies through to secure inpatient services.
PCREFs were a key recommendation in the 2018 Mental Health Act review which identified disproportionate applications of the act in racialised groups and are part of NHSE’s wider mental health equalities strategy.
Black people are 10 times more likely to receive a community treatment order after being an inpatient and their rate of detention under the act is four times as high as the rate for white people.
The guidance follows HSJ last month revealing the “staggering” rise in restraints of black people in NHS care.
Read full story (paywalled)
Source: HSJ, 5 January 2023
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NHS fury as patient turns up to A&E complaining of ear wax

A man turned up to an accident and emergency department in the Midlands complaining about ear wax on the day a hospital declared a critical incident, a nurse who works there has said.
Lesley Meaney, a sister at University Hospitals of North Midlands (UNHM), said the patient presented to A&E with “no pain, no discomfort, just eat war wax!”
Earlier on 30 December officials at the trust declared a critical incident, citing “extremely high demand for all of our services.”
The disclosure by Ms Meaney underlines the scale of the challenge facing the NHS and staff working in hospitals across the country.
Writing on Twitter, Ms Meaney added: “Seriously what is up with the general population? A major incident declared, ambulances queuing, and you decide to come to the emergency department on New Year’s Eve with ear wax.”
Dr Matthew Lewis, medical director at UNHM, said: “The accident & emergency departments at UHNM are some of the busiest in the country so we would urge the public to only come to our Emergency Departments if it’s for serious, life-threatening conditions that need immediate medical attention, such as persistent severe chest pain, loss of consciousness, acute confusion, severe blood loss, serious burns, broken bones, suspected stroke.
Read full story
Source: The Independent, 4 January 2023
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Children’s oral health is “national disgrace,” says head of royal college

The poor state of children’s teeth is a damning indictment of widening inequalities in child health in England, the president of the Royal College of Paediatrics and Child Health has said.
In an interview with The BMJ Camilla Kingdon said that paediatricians were seeing the effects of longstanding health inequalities widening as the cost of living crisis affects the types of ill health that children are presenting with. She further told The BMJ, “There are lots of examples. One that we often forget about is oral health and the state of children’s teeth, which is actually a national disgrace. The commonest reason for a child having a general anaesthetic in this country is dental clearance. That’s a terrible admission of failure.”
In her interview with The BMJ, Kingdon identified asthma and nutrition as other major areas of child health where the UK was failing. She said that these trends were partly being driven by social factors and expressed concern at the lack of focus in policy on fixing them.
She warned, “Our worry, with the health disparities white paper being kicked into the long grass, is that without that intention, without a clear signal from the government that this is a priority, all these ideas [for tackling child health inequalities] just won’t be prioritised and we will miss an opportunity to really intervene.”
Read full story
Source: BMJ, 4 January 2023
Patient Safety Learning

NHS hospitals moving patients into hotel to free up beds

NHS hospitals are discharging patients into a hotel in a bid to ease demand for beds.
Bristol, North Somerset and South Gloucestershire trusts are using the hotel for patients who no longer need urgent treatment but need social care.
The Integrated Care Board (ICB) for the three trusts has booked the "hotel care facility" for up to 30 patients.
A spokesperson for the ICB said care services were "under significant pressure".
"This temporary care facility delivered at a local hotel will help us to improve the flow of patients through our hospitals by ensuring more people can be discharged as soon as they are medically fit to leave hospital," they said.
The hotel care facility was introduced in late November 2022 and will run until the end of March. It is being provided by CQC-registered homecare company Abicare.
The service is being delivered by live-in care workers on a 24/7 basis with visiting clinical teams providing rehabilitation and primary care support, the ICB said.
Nadra Ahmed OBE, chair of the National Care Association (NCA), told BBC Radio 4 Today she is concerned about the quality of care in a hotel setting.
"This is a short-term solution- what we really need is a robust, sustainable and well-invested social care sector," she said.
Read full story
Source: BBC News, 5 January 2022
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Patients ‘warehoused’ and ‘lost in the system’ amid rush to discharge

More and more older people are being “warehoused” in inappropriate care beds, condemned unnecessarily to long-term care, and “lost” to health and care services, due to the rush to discharge from full hospitals and a lack of community rehab services, leaders have warned.
Several senior figures in community and social care have raised the issue with HSJ, warning it has been a growing concern over the past 18 months of severe system pressure following on from acute covid peaks.
The Health and Safety Investigation Branch has also raised the issue, telling HSJ inappropriate care placements are leading to harm and readmissions, while a major accountability gap remained over the safety of discharges.
The average length of hospital stay has increased compared to pre-Covid, with a big jump in those staying more than three weeks. Many in the NHS put this down to a lack of social care capacity meaning more medically fit people are stuck in hospital. 
Senior staff in community health and social care services told HSJ hospitals were increasingly demanding rapid discharges, often as part of “surge” measures when they are very full and under pressure to reduce ambulance queues. Homecare cannot be organised, and with suitable step-down and care beds also full, trusts are instead “spot purchasing” space in unsuitable homes which may be a long journey from the person’s home area, and in a different council area.
Read full story (paywalled)
Source: HSJ, 5 January 2023
Further reading
HSIB interim bulletin - Harm caused by delays in transferring patients to the right place of care
Patient Safety Learning

Excess deaths in UK hit highest level in two years amid NHS crisis

Excess deaths in the week before Christmas were the highest in two years amid a crisis in NHS care, new figures show.
Approximately 2,500 more people died than usual in the week ending 23 December in England and Wales, numbers from the Office for National Statistics reveal.
The total death toll of 14,530 is 21% higher than would be expected for this period, compared with averages from the last five years.
The new figures represent the highest excess and overall deaths recorded since February 2021. At that time, the UK recorded 15,943 deaths from Covid as transmission rates remained high. But only 429 of the most recent deaths have been linked to the virus.
Read full story
Source: The Independent, 5 January 2023
Patient Safety Learning

Junior doctors threaten three-day strike with no A&E cover

Junior doctors have threatened to stage a “full walkout” for three consecutive days in March in which they would not treat A&E patients.
The British Medical Association told the government this morning that junior doctors would strike for 72 hours if it is supported in a ballot that opens next week. The association said that “doctors will not provide emergency care during the strike”, which is likely to worsen deadly accident and emergency delays.
Hospital bosses said they were “deeply worried” by the BMA’s announcement, urging the government to start negotiating rather than “sitting back and letting more strikes happen”. NHS bosses fear that the BMA will co-ordinate strike action with the nursing and ambulance unions if the dispute is allowed to rumble on. Nurses will strike on January 18 and 19, and ambulance workers are due to walk out on January 11 and 23.
Read full story (paywalled)
Source: The Times, 6 January 2023
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NHS must improve efficiency before asking for more money, claims ICS chief executive

An ICS chief has said the NHS workforce crisis is not the result of a ‘funding issue’ but caused by an inefficient use of resources.
Patricia Miller, chief executive of Dorset Integrated Care Board, told a board meeting on Thursday that “constantly talking about the NHS needing more money” was undermining leaders’ case to government.
She said: “We have got a workforce issue in the NHS, there is no doubt about that. I don’t actually believe we have got a funding issue. We just don’t use our resources very efficiently and I don’t think we do our case any positive favour with government when we’re constantly talking about the NHS needing more money when we can’t demonstrate that what we do is efficient.
“So I don’t actually accept we’ve got a funding issue unless we start to work at the optimum and then we can absolutely demonstrate that.
“I think what this comes down to is that our systems are too complicated and that starts at the centre, where every initiative we have is not about redesigning service models end-to-end but about layering on different solutions to different ends of the pathway and it just makes it more complicated.
“I’ve no doubt that we’ve probably got 50-plus entrance and exit points to our urgent emergency care service, it’s ridiculous. I can’t navigate my way around 50 or 60, so there’s no way a patient can do it.”
Read full story (paywalled)
Source: HSJ, 6 January 2023
Patient Safety Learning

Discharge guidance could see patients die

Patients discharged from hospital without social care packages could die at home, doctors have warned.
They said Welsh government advice to do this showed a system at breaking point.
The British Medical Association (BMA) said it rejects the guidance to "change the risk threshold" for releasing people from hospital.
The Welsh government said discharging patients could help them get better "by reducing the risk of infection and muscle wastage".
Royal College of General Practitioners Wales chairwoman, Rowena Christmas, said the NHS was "unbelievably stretched".
"A frail, elderly person coming home, who can't really safely get from their bed or their chair to the bathroom without risk of falling over, they're not going to be able to survive at home," Dr Christmas said.
"I completely understand we need more beds, but that feels like a bad move."
Read full story
Source: BBC News, 6 January 2023
Patient Safety Learning

Gridlock as record number of ambulances queue at A&E in England

The extent of the gridlock in hospitals over Christmas has been revealed, with data in England showing record numbers of ambulances delayed dropping off patients at A&E.
More than 40% of crews were forced to wait at least half an hour to hand over patients in the week up to 1 January.
That is the highest level since records began a decade ago.
But there is hope pressures could soon start easing, with flu and Covid admissions dropping last week.
But the UK Health Security Agency is warning it is too early to say whether the flu season - the worst in a decade - has peaked, because reporting lags over the festive period may have affected the data.
And Matthew Taylor, of the NHS Confederation, which represents hospitals, said wards were still incredibly full, which was creating delays in A&E and for ambulances.
He said hospitals were facing "crisis conditions" that were presenting a risk to patients.
Read full story
Source: BBC News, 5 January 2023
Patient Safety Learning

Ambulances ‘lose’ 55,000 hours in one week during handover delays

Hours lost to ambulance handover delays, and the numbers of ambulances waiting more than an hour outside hospitals hit new highs in the week after Christmas.
Data published this morning by NHS England revealed nearly 55,000 hours were lost to delays between 26 December and 1 January and 18,720 ambulances had to wait more than an hour to handover patients as emergency departments struggled, with many trusts declaring critical incidents.
The number of hour-plus delays followed previous years’ trend of a slight dip in the week leading up to Christmas followed by an acceleration afterwards. However, levels this year were more than twice those seen in 2021 and three times those of the previous two years.
Read full story (paywalled)
Source: HSJ, 6 January 2023
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