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Content ArticlePlans to increase their number in England to plug workforce gaps have been criticised – but their work is valued by hospital colleagues. Sammy Chan is very proud to be a physician associate, despite the controversies. “I find it particularly rewarding because I get to build relationships with patients,” she said. Chan works in respiratory medicine, mainly in outpatients. As well as more routine monitoring of patients and booking scans, she has been trained to perform chest drains and to insert pleural catheters. “While it’s quite emotionally challenging, it’s nice to be a constant presence on their journey,” she said. Chan is one of 40 physician associates employed at the Royal Berkshire foundation trust in Reading. Introduced nearly two decades ago, physician associates have some medical training but are not doctors. They can take medical histories, carry out physical examinations and help develop treatment plans – but cannot prescribe medicine or order X-rays. The NHS aims to increase the number of physician associates working in England from about 4,000 to 10,000 to help plug widespread gaps in the workforce.
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News ArticleOne of Britain’s three high-security hospitals – where notorious people including Ian Huntley and Charles Bronson have been detained – is so understaffed that neither workers nor patients are safe, a damning new report has found. Rampton Hospital in Nottingham faces severe staff shortages, leading workers to restrain patients and lock them away in their rooms and putting patients at risk of self harm, according to the Care Quality Commission. In a report looking into the hospital, inspectors – who rated the hospital as inadequate – said there were around half the staff needed on one ward. In one example of those at the hospital being at risk, a patient self-harmed with glass from their watch, while another was able to harm themselves with a CD while they were confined to their room. One deaf patient was secluded several times on another ward for “being loud”, according to the CQC. “We spoke with people in the learning disabilities services who told us they sometimes get locked in their room from dinner time until the next morning,” the report said. “They told us that they don’t like being locked in their rooms.” Read full story Source: The Independent, 17 January 2024
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News Article
NHS across UK spends a ‘staggering’ £10bn on temporary staff
Patient Safety Learning posted a news article in News
Ministers are facing calls to tackle the NHS’s chronic lack of staff as figures reveal that the bill for hiring temporary frontline workers has soared to more than £10bn a year. Hospitals and GP surgeries across the UK are paying a record £4.6bn for agency personnel and another £5.8bn for doctors and nurses on staff to do extra “bank” shifts to plug gaps in rotas. Widespread short staffing has increasingly forced the service in all four home nations to hand colossal sums to employment agencies to hire stand-in workers. In England alone, the bill for agency staff, particularly nurses and GPs, has risen from £3bn to £3.5bn over the past year – a 16% rise. Wes Streeting, the shadow health secretary, said years of neglect of the growing NHS staffing crisis by Conservative governments had obliged “desperate” hospitals to spend “huge” sums on agency staff, including doctors who can cost more than £5,000 to hire for a single shift. The Royal College of Nursing said the levels of agency spending were “staggering”. It would be cheaper to employ more nurses as staff instead of having tens of thousands of vacancies, the general secretary Pat Cullen said. The NHS in England currently has 42,306 vacant nursing posts. Read full story Source: The Guardian, 16 January 2024 -
News Article
Social care crisis laid bare as quarter of NHS beds occupied by dementia patients
Patient Safety Learning posted a news article in News
The scale of the crisis in social care is laid bare as figures show that dementia patients occupy a quarter of all beds in the NHS. People living with the disease often go into hospital after falls or infections as well as for acute medical or surgical problems. Dementia patients often experience longer hospital stays than the average patient and can be delayed leaving wards due to a shortage of care in the community. At any one time in the NHS, one in four hospital beds are occupied by people living with dementia, according to the National Institute for Health and Care Excellence, which says stays on wards can trigger distress, confusion and delirium for patients. Doctors must carry out a discharge assessment of patients to ensure they are healthy before they can leave hospital. Medics assess a dementia patient’s care needs outside of hospital and discharge can be delayed if these are deemed not adequate. Demand for social care continues to rise as the population grows older but there is a shortage of workers in the sector. Skills for Care estimated that, in 2022/23 an average of 9.9 per cent - or 152,000 - roles in adult social care in England went unfilled. This was the equivalent to 152,000 vacancies - down by 11,000 from the previous year, although vacancies remain high compared to the wider UK economy. Services are so overstretched that people are left struggling without vital support to carry out everyday tasks in their own homes, and lives are being blighted. Read full story Source: The Independent, 14 January 2024 -
News Article
Midwife quit over 'unsafe care' and staffing
Patient Safety Learning posted a news article in News
A former midwife has told the BBC she quit because she could not live with herself if she provided poor care. Hannah Williams says staff shortages meant she kept patients safe, but sometimes only "by the skin of her teeth". BBC Verify analysis shows that the number of full-time equivalent midwife posts in England has gone up by 7% in the last decade. In comparison, the overall NHS workforce has increased by 34%. The country has a shortage of about 2,500 midwives, and maternity units are struggling with safety concerns. BBC research has also found that some trusts have more than one in five midwife jobs unfilled. The Royal College of Midwives says staffing is the "most important issue" and the gap needs to close. Read full story Source: BBC News, 9 January 2024 -
Content ArticleThe Royal College of Nursing (RCN) held its first ever safe staffing summit, bringing together global nursing workforce experts with senior nurses across the UK to agree a vision for the future and how to fight for it. When there are too few nursing staff, they can be stretched dangerously thin. With tens of thousands of vacant nurse posts across the UK right now, this happens too often. The summit heard compelling evidence about the impact of safe nurse-to-patient ratios, set in law in other countries, where there are limits on the number of patients one nurse can safely care for. Nicola Ranger, RCN's Chief Nurse, reflects on the outcome of the RCN’s first ever safe staffing summit.
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Content ArticleFollowing on from the care failures highlighted in the 2021 report, 'No one's listening', the Sickle Cell Society have published a new report taking a deeper look at sickle cell nursing care. The findings show the need for vastly more resources, training and support in this critical area of care. The report highlights that not only is no-one listening, but that lives are still being put at risk.
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Content ArticleUS healthcare organisations continue to grapple with the impacts of the nursing shortage—scaling back of health services, increasing staff burnout and mental-health challenges, and rising labour costs. While several health systems have had some success in rebuilding their nursing workforces in recent months, estimates still suggest a potential shortage of 200,000 to 450,000 nurses in the United States, with acute-care settings likely to be most affected.1 Identifying opportunities to close this gap remains a priority in the healthcare industry. This article highlights research conducted by McKinsey in collaboration with the ANA Enterprise on how nurses are actually spending their time during their shifts and how they would ideally distribute their time if given the chance. The research findings underpin insights that can help organizations identify new approaches to address the nursing shortage and create more sustainable and meaningful careers for nurses.
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News Article
NHS struggling to open extra winter beds and fill staffing gaps
Patient Safety Learning posted a news article in News
Hospital bosses in England are warning a lack of funds means they are having to scale back on plans to open extra beds to cope with winter. The warning, from NHS Providers, which represents managers, came after the Treasury rejected pleas for an extra £1bn to cover the cost of strikes. Recruitment to plug gaps in the workforce was also having to be put on hold, NHS Providers said. But the government said winter planning was on track. It pointed out the goal to open 10,000 "virtual" hospitals beds had been met. This is where doctors remotely monitor patients with conditions such as respiratory and heart problems who would otherwise have to be in hospital. Progress was also being made on opening 5,000 new permanent hospital beds - a 5% increase in numbers, the government said. "We recognise the challenges the NHS faces over the coming months, which is why we started preparing for winter earlier than ever," a Department of Health and Social Care spokesman added. But NHS Providers said the steps being taken may be insufficient. Read full story Source: BBC News, 14 November 2023 -
News ArticleNHS staff are carrying out the equivalent of one 'never-event' every day, figures show. This is despite the Government ordering a crackdown on the mistakes, which cost hospitals an estimated £800million in compensation each year. Experts today demanded further action on 'unacceptable' levels of never-events, blaming inadequate staffing levels and a lack of investment in the NHS. A MailOnline audit of a decade's worth of NHS data found a colossal 4,328 never-events have occurred in England since 2013. This equates to roughly eight a week. Shocking incidents uncovered include women getting parts of their reproductive anatomy cut out instead of an appendix, men getting unwanted circumcisions and laser procedures to the wrong eye. The Royal College of Surgeons said the level of never-events was 'unacceptable' and blamed NHS staffing levels for increasing the risk to patients. "Surgeons will be working hard to do their best for patients, but they do so in difficult circumstances," a spokesperson said. "The NHS is overstretched, with staff shortages, a workforce suffering from burn-out and pressure to get record waiting times down. "This increases the risk of mistakes happening." Read full story Source: MailOnline, 10 October 2023
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News Article
Mouth-cancer deaths fear over NHS dentist shortage
Patient Safety Learning posted a news article in News
Lack of access to dentists is costing lives because mouth cancers are not being spotted or treated early enough, a health charity has told BBC News. The disease killed more than 3,000 people in 2021 - up 46%, from 2,075 a decade ago, latest figures obtained by the Oral Health Foundation show. And last year, a BBC News investigation revealed 90% of UK NHS dental practices were not accepting new adult patients. The government has announced plans to increase dental-training places by 40%. It also said the NHS was treating more people for cancer at an earlier stage than ever before. Oral Health Foundation chief executive Nigel Carter says dental check-ups "are a key place for identifying the early stage of mouth cancer". "With access to NHS dentistry in tatters, we fear that many people with mouth cancer will not receive a timely diagnosis," he adds. Read full story Source: BBC News, 8 November 2023 -
News Article
Patient safety at risk as pharmacists replace GPs, doctors warn
Patient Safety Learning posted a news article in News
Doctors are warning that patient safety is being put at risk as podiatrists and pharmacists replace GPs “on the cheap”. Dozens of family doctors have contacted The Telegraph claiming that talk of a GP shortage is “a big lie” and that they are being replaced by less qualified, cheaper staff, in a “crisis”. Documents seen by The Telegraph show staff including podiatrists, pharmacists and physician associates being used in lieu of GPs to diagnose and treat patients with conditions they are not trained in. In the most extreme cases, poorly children with viral infections, asthma-related issues and concerns about menstruation have been seen and diagnosed by a podiatrist – a healthcare professional trained exclusively to care for feet. It is not clear what happened to any of the patients afterwards, or if their parents were aware they had seen a podiatrist rather than a doctor. One GP said it was “a matter of patient safety” and the notion of “everything being supervised” did not work at a GP practice like it does in hospitals. Read full story (paywalled) Source: The Telegraph, 4 November 2023 -
News Article
Agency profits growing due to ‘acute shortage of staff’
Patient Safety Learning posted a news article in News
Two companies supplying staff to the NHS saw large growth in income and profits last year, annual accounts reveal. Independent Clinical Services, owned by a Canadian private equity firm, saw a growth in turnover of more than 40%, with income growing from £273m to £399m, year on year. A smaller company specialising in recruiting overseas healthcare staff to the UK also saw a bumper year, according to data released last month. Your World Recruitment Ltd’s income increased by nearly a third, going from £50.5m to £66.8m (up 32%), with a similar rise in profits. The company’s strategic report said: “Demand for agency staff and healthcare services in the first half of 2023 has remained strong principally due to staff shortages in the NHS and high waiting lists. “The board expects the challenging market conditions to continue for the remainder of 2023, although demand is expected to remain due to an acute shortage of healthcare workers in the UK and worldwide.” The NHS has been pushing hard for increased overseas recruitment in recent years, to fill domestic gaps." Read full story (paywalled) Source: HSJ, 10 October 2023 -
News Article
NHSE director ‘concerned by 20% nursing gap’ amid push to tackle poor culture
Patient Safety Learning posted a news article in News
NHS England’s national mental health director admitted she was ‘concerned’ that 20% of mental health nurse roles were unfilled and about the impact this could have on a nationwide push to improve safety and tackle closed cultures. Claire Murdoch was speaking to HSJ a year on from a series of high-profile documentaries exposing abuse and poor care at mental health trusts. In their wake, Ms Murdoch urged providers to urgently review safeguarding, while a separate three-year quality programme was also launched to look at closed cultures and improve safety. Now in the middle of that programme, Ms Murdoch stressed that stability in staffing is “vital” to developing safe and therapeutic care, but that many services across the country are struggling with significant nursing vacancies. She said: “The bit that absolutely we need to acknowledge [around changing cultures] is there are some significant workforce and staffing challenges, which I’m concerned about, with a 20%t vacancy of qualified registered mental health nurses nationally. “There are new support roles, psychology assistant roles, physician associates – there are all sorts coming into being in inpatient care, but a lot of services are still struggling with staffing". Read full story (paywalled) Source: HSJ, 21 September 2023 -
Content ArticleThis report provides a comprehensive analysis of the adult social care workforce in England and the characteristics of the 1.52 million people working in it. Topics covered include: recent trends in workforce supply and demand, employment overview, recruitment and retention, demographics, pay, qualification rates, and future workforce projections.
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News Article
NHS can’t prepare for pandemic surge due to lack of staff, NHSE warns
Patient Safety Learning posted a news article in News
The NHS has too few staff to prepare for a pandemic surge, while its ageing buildings and social care’s weak ‘resilience and capacity’ would also undermine its response, NHS England has warned. A new NHSE submission to the Covid-19 public inquiry says funding pressure from 2010 has undermined the health service’s “resilience” and that “resilience and capacity issues in social care are national issues which must be addressed from the centre”. The document was posted unnoticed on the inquiry website last month. No current or former NHSE leaders have so far given evidence to the inquiry. It is the first time NHSE has clearly set out that understaffing and underinvestment compromised the service’s readiness to deal with the pandemic. Referring to the NHS’s ability to create “surge capacity [with] flexible staff and equipment which can be pivoted into different roles”, it goes on: “It is only possible to train staff to work more flexibly into different roles/environments if they can be freed up to attend training and refreshers. “This requires ‘surplus’ staff numbers on rotas, which is not currently possible in relation to many staffing groups across the NHS.” Read full story (paywalled) Source: HSJ, 3 October 2023 -
News Article
NHS only gains one ‘full-time’ GP for every two trainees, report finds
Patient Safety Learning posted a news article in News
The NHS has to train two GPs to produce one full-time family doctor because so many have started to work part-time, new research reveals. The finding helps explain why GP surgeries are still struggling to give patients appointments as quickly as they would like, despite growing numbers of doctors training to become a GP. The disclosure is contained in a report by the Nuffield Trust health thinktank that lays bare the large number of nurses, midwives and doctors who quit during their training or early in their careers. “These high dropout rates are in nobody’s interest,” said Dr Billy Palmer, a senior fellow at the thinktank and co-author of the report. “They’re wasteful for the taxpayer, often distressing for the students and staff who leave, stressful for the staff left behind, and ultimately erode the NHS’s ability to deliver safe and high-quality care.” Read full story Source: The Guardian, 28 September 2023 -
Content ArticleHarold Pedley, known as Derek, attended his GP surgery during the late afternoon on 21.12.22 and after spending most of that day feeling unwell with symptoms including abdominal pain and vomiting. He was appropriately referred to the hospital and travelled there with his friend after his GP had discussed his case with doctors. Due to a lack of available beds in the assessment unit, Derek needed to remain in the emergency department. Following his arrival at 20.07 hours, doctors were not notified of his attendance. He remained in the emergency department waiting area for almost two hours during which time due to significant pressures faced by the department he was not assessed or spoken to by a medical professional. At 21.59 hours a triage nurse called for him. By then, Derek had been unresponsive for some time and had died, his death confirmed at 22.26 hours. A subsequent post mortem examination revealed he died from the effects of non-survivable extensive small bowel ischaemia caused by a significantly narrowed mesenteric artery. His death was contributed to by heart disease.
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News ArticleThousands of women are having induction of labour delayed because of a shortage of staff, raising concerns about the safety of them and their babies, HSJ has found. The issue has been highlighted at seven hospitals in Care Quality Commission reports over the past six months, and HSJ has identified a further three trusts declaring they are concerned about it in their own board papers over the same period. At University Hospitals of Leicester Trust, more than 1,300 “red flags” were raised in a five-month period due to delays in the induction of labour, linked to staffing levels, the CQC said earlier this month. Most were dealys in continuing inductions, and a smaller number were delays between admission and beginning an induction. UHL indicated it had set its own “red flag” bar locally, so all the delays did not represent a national alert. Carolyn Jenkinson, CQC deputy director of secondary and specialist healthcare, told HSJ: “At some maternity services we’ve found women having to wait long periods of time to be induced or for transfer to a labour ward once the induction process has started, and in some cases a lack of effective monitoring during periods of delay. “Where we have found concerns about delayed treatment – including induction of labour – we have made clear to those trusts that effective oversight of the issue is vital and that all action possible should be taken to mitigate any risk and keep people using the service safe.” Read full story (paywalled) Source: HSJ, 27 September 2023
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News Article
Nurses caring ‘for too many patients’ as vacancy rates rise again
Patient Safety Learning posted a news article in News
Around one in ten NHS nursing jobs remain unfilled leaving already stretched service struggling to cope. The number of unfilled NHS nursing jobs in England has risen again after falling slightly earlier this year. Between March and June of this year, the number of vacant nursing positions across the NHS in England increased by 3,243 taking the total to a staggering 43,339. With the number of applications to study nursing also falling by a massive 13,380 in just two years, experts admit they are concerned about how the NHS is going to cope. In real terms, the figures mean around one in ten NHS nursing jobs remain unfilled. The Royal College of Nursing (RCN) has warned the high vacancy rate will leave the health service “underprepared” for winter. Read full story Source: Nursing Notes, 25 August 2023 -
News Article
NHS whistleblowers warn of 'unsafe' A&E staff shortages
Patient Safety Learning posted a news article in News
A group of senior doctors has accused NHS Grampian of ignoring their safety concerns about emergency departments. They told BBC Scotland News they were speaking out because they feel they cannot deliver a safe level of care. The medics said staff shortages meant Grampian's two A&Es have no senior registrars on shift to make key decisions about patients for the majority of weekend night shifts. Documents seen by the BBC News show medics have been raising concerns since 2021, both with NHS Grampian and the Scottish government, and in July this year submitted a formal whistleblowing complaint about the situation. One doctor said: "The staff are in an impossible situation. "We are witnessing ongoing harm with unacceptable delays to the assessment and treatment of patients. "There have been avoidable deaths and at other times there are too long delays getting to patients who may be suffering from a serious condition like stroke or sepsis." Read full story Source: BBC News, 23 August 2023 -
News Article
Criminal acts of violence at UK GP surgeries almost double in five years
Patient Safety Learning posted a news article in News
Criminal acts of violence at GP surgeries across the UK have almost doubled in five years, new figures reveal, as doctors’ leaders warn of a perfect storm of soaring demand and staff shortages. Police are now recording an average of three violent incidents at general practices every day. Staff are facing unprecedented assaults, abuse and aggression by patients, with surgeries struggling to cope with “unmanageable levels of demand” after years of failure to recruit or retain sufficient numbers of family doctors. Security measures such as CCTV, panic buttons and screens at reception are now increasingly being rolled out across GP surgeries, the Guardian has learned, with senior medics claiming ministers perpetuate a myth that services are “closed”. Last night, Britain’s two most senior doctors condemned the wave of violence and called for urgent action to finally resolve the workforce crisis. “It is unacceptable that GPs and their staff are afraid and at risk of being verbally or physically abused, when they are working amid exceptional pressures and striving to do their best for patients,” said Dr Chaand Nagpaul, chair of the British Medical Association. “GP practices are facing unmanageable levels of demand with 2,000 fewer GPs than in 2015.” He added it was “no surprise” that patients were struggling to get appointments because of the national “lack of capacity” and “lack of historic investment in general practice”. Read full story Source: The Guardian, 31 May 2022 -
News Article
Hospitals urged to use retired staff to cut backlog
Patient Safety Learning posted a news article in News
NHS bosses in England are urging hospitals to offer staff more overtime and tempt retired employees back, to help tackle waiting lists. A letter sent by NHS England said tackling the backlog that had grown during the pandemic would require a "number of high impact actions". And many hospitals were already taking innovative approaches to the issue. More than six million people are on waiting lists for treatment such as knee and hip surgery. According to the General Medical Council, 21,000 doctors are due to retire in September. And part of the plan would be to tempt some of those back by offering part-time opportunities to: train students run virtual consultations help with follow-up check-ups. Other measures recommended by NHS England are: removing caps on consultant hours - in some places senior doctors are limited to 40 hours a week - to offer extra shifts where safe offering more bank shifts - overtime opportunities for trust rather than agency staff increasing the use of NHS reservists - members of the public who have signed up to work for the NHS for at least 30 days a year - to help run wards, feed patients and provide support for the Covid-vaccination programme exploring taking simple procedures, such as cataract surgery, out of operating theatres and into other parts of the hospital. Read full story Source: BBC News, 5 May 2022 -
News Article
GPs won’t see us unless it’s ‘life or death’, complain pensioners
Patient Safety Learning posted a news article in News
A 94-year-old man has said his GP refuses to see him “unless it’s life or death”. Dennis Baker, from North Hampshire, said he felt “put off” by his doctor's surgery, which is a three-minute walk from his house. The pensioner, who lives with his wife who has advanced dementia and is bed-bound, said he found it “quite difficult to carry on a conversation with a doctor” and cannot get one to visit him at home. “The chances are [the receptionist] will say… ‘you're not dying, a doctor will phone you at some stage today’, that’s the usual response,” he told BBC Radio 4’s World at One. It comes as the president of the Royal College of GPs (RCGP) said family doctors should start “saying no” to extra work to tackle the crisis in primary care. Speaking at Pulse Live last week, Professor Dame Clare Gerada said the workload crisis was not the fault of GPs and they “cannot innovate [their] way out”. “When you’re in debates and people are saying to you 'you’ve got to work harder and smarter' - no, the rest of the system has to adapt,” she told the conference. “You have to start saying no.” Read full story (paywalled) Source: The Telegraph, 3 May 2022 -
News Article
Nurses reveal shocking abuse from patients as backlog rises
Patient Safety Learning posted a news article in News
Nurses have spoken of the shocking abuse they face from patients as the NHS struggles to cope with a rise in demand for care. Both patients and staff are becoming increasingly frustrated with the situation the NHS is in, with staff shortages and a patient backlog of six million people causing already stretched services extra strain. "As we are the faces that the public see we do get the brunt of a lot of their anger as they are becoming increasingly frustrated with the situation that the NHS is in," one nurse wrote on Nursing Standard’s Facebook page. "Staff are equally frustrated with the whole situation and knackered from working long hours and covering for the many staff still absent." Nurses given the task of conveying ‘unwelcome messages about the limitations of resources’ Another said: "Working in an ED abuse occurs on a daily basis… it is not acceptable but even when you Datix these incidents nothing gets done, staff are reduced to tears and frightened to walk into patient waiting areas, it is not acceptable." It comes as former chief inspector of social services Lord Herbert Laming accused health service managers of putting nursing staff in the public firing line during a House of Lords debate on reducing abuse of nurses in the NHS. Read full story Source: 12 April 2022, Nursing Standard
