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Content ArticleThe six patient safety priorities outlined by Jeremy Hunt are: Develop a credible and comprehensive NHS and social care workforce plan Reform primary care by bringing back individual GP lists Provide a timetable by which the recommendations from the Ockenden Review will be implemented Scrap national NHS targets Join forces with the Treasury and radically reform our litigation and compensation systems Revamp the Learning from Deaths programme so that all Trusts are publishing data on the avoidable deaths that happen in their services
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Content ArticleThe evaluation looks at commitments in the following policy areas: Planning for the workforce Building a skilled workforce Wellbeing at work The Expert Panel found that the overall rating across all the commitments it examined was 'inadequate'. More detail on ratings for specific policy areas can be found in the attached document.
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News Article
Largest private-sector nurses strike in U.S. history begins in Minnesota
Patient Safety Learning posted a news article in News
About 15,000 nurses in Minnesota walked off the job Monday to protest understaffing and overwork — marking the largest strike of private-sector nurses in U.S. history. Slated to last three days, the strike spotlights nationwide nursing shortages exacerbated by the coronavirus pandemic that often result in patients not receiving adequate care. Minnesota nurses charge that some units go without a lead nurse on duty and that nurses fresh out of school are delegated assignments typically held by more experienced nurses, across some 16 hospitals where strikes are expected. The nurses are demanding a role in staffing plans, changes to shift scheduling practices and higher wages. “I can’t give my patients the care they deserve,” said Chris Rubesch, the vice president of the Minnesota Nurses Association and a nurse at Essentia Health in Duluth. “Call lights go unanswered. Patients should only be waiting for a few seconds or minutes if they’ve soiled themselves or their oxygen came unplugged or they need to go to the bathroom, but that can take 10 minutes or more. Those are things that can’t wait.” Read full story (paywalled) Source: Washington Post, 12 September 2022 -
Content Article
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News Article
Watchdog finds 'toxic' culture in Manx hospital A&E
Patient Safety Learning posted a news article in News
There is a "toxic" culture of bullying and blame in the Isle of Man's emergency department at Noble's Hospital, an inspection has found. The Care Quality Commission's report said it was a "significant concern" along with "ineffective" staff training and medicine storage systems. It found a "significant disconnect" between nursing and medical staff had the potential to "cause or contribute to patient harm". During inspectors' four-day visit in June, some staff said the attitude and behaviour of senior medics was "feral". Manx Care's director of nursing Paul Moore said the understaffed department had been "really struggling" at times. He warned efforts to change governance and culture would take time. Mr Moore said on average the emergency department had about 50% of the required staff over a given month, and recruitment was the "number one priority" to help make lasting changes. "The bottom line is I have to put staff in front of patients before other considerations, especially when we're short", he added. Read full story Source: BBC News, 8 September 2022 -
News Article
GPs warn of ‘tsunami of demand’ this winter as patient contacts surge 200%
Patient Safety Learning posted a news article in News
GPs have warned of a ‘tsunami of demand’ this winter as patient contacts surged 200% during the pandemic. One of the largest GP providers in the UK, Modality Partnership, told The Independent it received 4.8 million calls from patients in one year alone with around a quarter going unanswered every day. The provider, which covers 500,000 patients across the country, said its practices were now working above “safe levels” with 50 appointments a day per GP, far higher than the 35 advised by the British Medical Association. Speaking with The Independent, Vincent Sai, chief executive and partner at Modality said the new health secretary Therese Coffey must “not point fingers” and “not find a scapegoat” as “every part of the system is under pressure. Every player in the health system is under the cosh.” Dr Sai said: “We believe patient contacts have increased 200 per cent, over the last few years. The expectation is that GP practices have maybe four to five patient contacts per year, but if you just look at just the number of phone calls alone, it’s showing that it’s much more now. “So something is broken somewhere...there’s more work, there are fewer people. People say I can’t get access to my GP and the hypothesis is they’re just lazy and not working, but it’s not the case.” Read full story Source: The Independent, 7 September 2022 -
News Article
Unfilled consultant posts pose key risk to patient safety - Irish Medical Council
Patient Safety Learning posted a news article in News
Unfilled specialised medical consultant roles and an over-reliance on overworked, internationally trained graduates for non-consultant hospital doctors are among key risks to patient safety identified by the Irish Medical Council. The council, which is the regulatory body for the medical profession, sets out the risks to healthcare for the first time in its workforce intelligence report that breaks down the make-up of the medical register and explains why doctors are leaving the health system. More than a third of all clinically active doctors are on the general register, which is a key risk to patient safety because consultant and specialist roles are not being filled and “a considerable proportion” of non-consultant hospital doctors are required to perform the duties of consultants. The report found that the majority of non-consultant hospital doctors are trained overseas and that the health system overly relied on these doctors who reported being “overworked, undervalued, experiencing discrimination and unable to access specialist training.” “Aside from the individual impact on the doctors, the treatment of international medical graduates has serious implications for patient safety,” the council said. In another risk identified by the regulatory body, more than a quarter of doctors reported working more than 48 hours a week, in breach of the European Working Time Directive. This has further serious implications for patient safety,” the council said. Read full story Source: Irish Times, 1 September 2022 -
News Article
Ministers to make it easier for foreign nurses and dentists to work in NHS
Patient Safety Learning posted a news article in News
Ministers will introduce legislation as soon as parliament returns on Monday to tackle the NHS’s worsening staffing crisis by making it easier for overseas nurses and dentists to work in the UK. The move is part of a drive by the health secretary, Steve Barclay, to increase overseas recruitment to help plug workforce gaps in health and social care. Barclay believes thousands of extra health professionals will come as a result of new rules making it easier for medical regulators to register those who have qualified abroad. If the change proves successful it will help pave the way for more nurses and dentists coming to work in Britain from countries such as India, Sri Lanka, Kenya, the Philippines and Malaysia. However, critics claim the policy is a stop-gap that is no substitute for ramping up the supply of homegrown staff and risks worsening the lack of health workers in other countries that are struggling with shortages of their own. Read full story Source: The Guardian, 5 September 2022 -
Content ArticleJoining David Aaronovitch in The Briefing Room podcast are: Annabelle Collins, Senior Correspondent at Health Service Journal Alison Leary, Professor of Healthcare and Workforce Modelling at London South Bank University Suzie Bailey, Director of Leadership and Organisational Development at The Kings Fund Mark Pearson, Deputy Director of Employment, Labour and Social Affairs at the OECD, Nigel Edwards, Chief Executive of the Nuffield Trust.
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News Article
NHS vacancies in England at ‘staggering’ new high as almost 10% of posts empty
Patient Safety Learning posted a news article in News
The number of posts lying vacant across the NHS in England has reached a “staggering” record high of 132,139 – almost 10% of its planned workforce. The number at the end of June was up sharply from three months earlier when there were 105,855 vacancies, quarterly personnel figures show. NHS leaders said the huge number of empty posts showed why the health service is in a state of deepening crisis, with patients facing long waits for almost every type of care. The previous highest number of vacancies for full-time-equivalent staff was 111,864, recorded at the end of June 2019. The new number represents 9.7% of the NHS’s planned staffing levels – a new high. As recently as March 2021 there were 76,082 vacancies. Danny Mortimer, the chief executive of NHS Employers, said: “These figures paint a bleak picture. A jump in nearly 30,000 staff vacancies – equivalent to the entire staffing of a large NHS hospital – show an alarming trend across the NHS of rising levels of vacancies.” Read full story Source: The Guardian, 1 September 2022 -
News Article
Women wait days for induced labour in troubled maternity service
Patient Safety Learning posted a news article in News
A troubled acute trust has been sent a further warning notice after inspectors found severe shortages of midwives were causing dangerous delays to labour inductions. During one day in June, the Care Quality Commission found eight high-risk women at Blackpool Victoria Hospital had waited prolonged time periods for their labour to be induced. They said one woman had waited five days, while another who was forced to wait more than two days despite her waters having broken on the ward. Delays to labour induction can lead to serious safety risks for mothers and babies. The hospital’s maternity services, previously rated “good” for safety, have now been rated “inadequate” in this domain. The overall rating for maternity has dropped to “requires improvement”. The problems were caused by severe shortages of midwives at the hospital, which had struggled to bring in agency staff due to a lack of availability in the area. However, inspectors also said there was a lack of any discussion or attention to the issues within the trust, despite the Healthcare Safety Investigation Branch previously highlighting concerns. Read full story (paywalled) Source: HSJ, 1 September 2022 -
Content Article
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News Article
Staff shortages force most trusts to suspend NHSE maternity care model
Patient Safety Learning posted a news article in News
More than two-thirds of trusts have been forced to suspend or pause a high-profile service improvement aimed at reducing neonatal and maternal deaths, because of widespread staffing shortages. HSJ research revealed a majority of trusts have been unable to implement the continuity of carer maternity model, after they were told to look again at whether it could be safely implemented. The model intends to give women “dedicated support” from the same midwifery team throughout their pregnancy, with a 2016 review saying it would reduce infant and maternal mortality rates and improve care more generally. It is particularly aimed at improving care for patients from minority ethnic groups and those with other risk factors, and has been championed by Jacqueline Dunkley-Bent, NHS England’s chief midwifery officer. Key targets around the model were included in the 2019 NHS long-term plan. However, there is consensus nationally that it can only be rolled out safely where there are adequate numbers of staff to do so – otherwise the risks outweigh the benefits. Earlier this year, the final Ockenden report into maternity care failings at Shrewsbury and Telford Hospital Trust was critical of the model, and said it should be suspended until trusts have enough staff to meet “safe minimum requirements on all shifts”. Read full story (paywalled) Source: HSJ, 30 August 2022 Read more about the continuity of care maternity model on the hub -
Content ArticleKey findings: Differences in leaving rates between men and women in the same staff group are larger than the differences between those in different job roles of the same gender. Male consultants and nurses and midwives had almost the same leaving rate up to the age of 55, before rising substantially for those over 55. Male HCAs, unlike their female counterparts, also had very high leaving rates in their 20s. There were large differences in leaving rates by nationality, holding all other factors, including age, gender and tenure, constant. For consultants, non-British consultants were substantially more likely to leave the acute sector than their British counterparts. For nurses and midwives, the pattern is more complicated. EU staff were 43% more likely to leave than their British counterparts, while non-EU nurses and midwives were 28% less likely to leave. Previous sickness absences are strongly correlated with future exits from the NHS acute sector for both consultants and nurses and midwives. Regions with higher unemployment rates have lower leaving rates of nurses and midwives and HCAs. Better reported ‘staff engagement’ for nurses and midwives is associated with lower leaving rates.
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Content Article
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Content ArticleThe report proposes twelve actions to help stem the crisis facing the NHS: Focus Leadership 1. Set up a winter-crisis taskforce and settle additional funding early. Minimise Demand 2. Campaign for widespread and early Covid-19 and flu vaccinations across the NHS workforce. 3. Extend public-facing Covid-19 and flu-vaccination strategies to all those aged over 18. 4. Mandate FFP2/3 face-mask wearing for NHS staff in health-care settings. 5. Be prepared to reintroduce the mandating of mask wearing on public transport and in confined spaces. Improve Patient Flow and Efficiency 6. Improve the speed and consistency of access to primary care. 7. Roll out technology to release capacity and manage patient demand. 8. Increase support for social-care services and expedite patient discharges. 9. Identify and enable the flexible use of regional surge capacity. Maximise Capacity 10. Stand up a volunteer and reservist workforce. 11. Expand use of private-sector capacity. 12. Prioritise staff retention.
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Content Article
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News ArticleA study of over 1,000 health and social care workers, conducted by Florence, the tech platform providing health & social care workers access to available shifts, found that almost a third of healthcare workers admit to feeling overwhelmed at least once a week, with 17% feeling burnt-out every day. A staggering 97% believe the cost-of-living crisis has caused further stress or burnout among healthcare professionals. It comes after more than half of healthcare workers (56%) admit to working more than 2-3 times a week over their contracted hours, with 7% working overtime every day. Not having enough staff is causing the most pressure in their role (50%), followed by low pay (39%) and high workload (35%). The study revealed nine in ten NHS and social care workers state chronic staff shortages are affecting the quality of care. Analysing this deeper, three quarters of respondents stated that the quality of care is already being ‘severely’ impacted as high vacancy rates sweep across the industry. Dr Charles Armitage, Former NHS doctor and CEO and Founder of Florence, observed: “If you’ve got fewer people there on-shift to look after people, the quality of care decreases because the people that are there are overstretched, they’re trying to do too many things and are suffering from severe burnout. As a result, mistakes are made as they’re not able to just spend as much time with people and provide that really important patient-centred care.” Read full story Source: Hospital Times, 17 August 2022
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Content Article
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Content ArticleKey points There is unsustainable pressure on health and care services, driven strongly but not exclusively by the severe capacity challenges affecting social care. Like the NHS, the sector faces steep vacancies and is struggling to recruit and retain staff desperately needed to keep people well at home and support them to leave hospital safely. 99 per cent of healthcare leaders responding to our latest survey agreed that there is a social care workforce crisis in their local area. Almost all agreed it is worse than a year ago and expect it to deteriorate into this winter. These pressures are impacting the whole health and care system’s ability to deliver care across community and acute settings. For instance, 85 per cent of those surveyed agreed that the absence of a social care pathway is the primary cause of delayed discharge of medically fit patients. Almost three-quarters (73 per cent) said a lack of adequate social care capacity is having a significant or very significant impact on their ability to tackle the elective care backlog. Over 80 per cent said it is driving urgent care demand. Although health and care are inextricably linked and interdependent, social care is not just about helping to alleviate pressure on the NHS. The care delivered by social care services is critical to the wellbeing of the nation. However, patients will continue to face long delays for treatment unless the government invests in social care to boost capacity. Healthcare leaders stand in support of their colleagues in social care and are calling for urgent government action to tackle this capacity crunch. Healthcare leaders are calling on the government to back social care with a fully funded pay rise to boost recruitment and retention, alongside providing greater overall investment and improved career progression opportunities. This will help to stop the exodus of staff leaving for better paid and less stressful roles in other industries like hospitality. There is no time to waste, and action must be immediate to not only ensure people do not have their health outcomes further threatened, but to also ensure capacity gaps are not worsened. Healthcare leaders are clear that the NHS and social care will sink or swim together. New integrated care systems (ICSs) encompass both health and care and are acutely aware that both need sufficient resourcing if ICSs are to succeed in their essential task of improving health and sustainability. So, what now? Healthcare leaders are asking for a ‘realism reset’ on the state of health and care. This needs to properly acknowledge where the ten years of austerity in the 2010s have left health and care services. It also needs to include an acknowledgement that social care is not ‘fixed’ as the government continues to insist. The priority must be to close the gulf between demand and capacity – particularly in the face of continued COVID-19 spikes, a cost-of-living crisis and what we expect to be another gruelling winter.
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Content ArticleDear Secretary of State, The Patients Association calls on you to act now to prevent a deterioration in NHS services that will inevitably lead to unnecessary deaths. Last autumn, we wrote to your predecessor and asked him to act to protect the NHS. Unfortunately, he did not. The NHS hardly survived through the winter and now the situation is rapidly approaching catastrophe. Your call for hackathons to figure out how ambulance service performance can be improved is a distraction. Your focus should be on the patients and what they need, not a hastily arranged table-top exercise. Patients are waiting for ambulances that are hours late, others are stuck in the back of an ambulance outside A&E for hours, and patients are dying. Please imagine how terrifying that must be for patients and how stressful for staff listening to all the calls coming in of other patients in distress who also need help. It is past time the Government got to grips with the main reasons the NHS is on a cliff edge. Those reasons are: shortages in workforce across all parts of the NHS and social care; and lack of investment in social care, which is preventing hospitals from discharging medically fit people. We back the NHS Confederation’s call for a rescue package for social care. Immediate investment in the sector is urgently needed – in fact, it’s long overdue. As the Confederation says, and we have said previously, Government must take action to make social care a sector that is attractive to work in and where staff is valued and properly paid. But we would add that immediate investment in social care is needed. Extra funding for social care will ensure hospitals can safely discharge medically fit patients into the community, freeing capacity in the NHS. We also repeat calls we made in January for a long-term workforce strategy. We are among many organisations who have been asking for the Government to develop such a strategy. Please do not allow patients, terrified in the back of an ambulance yards away from doctors and nurses, to become the norm. Please do not wait for patients to die because there are not enough doctors and nurses to provide safe levels of care. Please be the Secretary of State who worked in partnership with patients, the NHS, and the professions to develop a robust long-term workforce strategy and invested in social care. Yours sincerely Rachel Power, Chief Executive, the Patients Association
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Content Article
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News ArticleHospital doctors are being sent home from daytime shifts and told to come back and work overnight in the latest stark illustration of the NHS’s crippling staff shortage. Medics are having to change their plans at the last minute because hospitals cannot find any others to plug gaps in the night shift medical rota and need to ensure they have enough doctors on duty. Hospital bosses are forcing last-minute shift changes on junior doctors – trainees below the level of consultant up to the level of senior registrar – because staff sickness and the scarcity of locum medics has left them struggling to ensure patients’ safety is maintained overnight. One trainee doctor in south-west of England told how they started their shift as planned at 8am. However, “by mid-morning the doctor that was meant to be working that night, that I would hand over to, had called in ill”. The doctor stopped working at 11am, drove home – an hour away – and came back to work the night shift at 11pm. “By the time I returned I had already worked for three hours and driven for three hours. That’s an extra six hours on top of a busy night shift of 12.5 hours,” they said. Dr Julia Patterson, the chief executive of EveryDoctor, said: “We are hearing of escalating problems with NHS doctors being forced to work unsafe, unfair hours." “Patient safety is of paramount importance to all doctors, but this situation is simply not sustainable. When mistakes occur, staff are blamed. But staff are working in an unworkable system.” Read full story Source: The Guardian, 11 July 2022
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News Article
CQC criticises outstanding-rated trust for ‘unsafe’ staffing
Patient Safety Learning posted a news article in News
An ‘outstanding’ rated mental health trust has been criticised by the Care Quality Commission (CQC) for ‘unsafe’ levels of staffing and inadequate monitoring of vulnerable patients. The CQC said an inpatient ward for adults with learning disabilities and autism run by Cumbria Northumberland Tyne and Wear Foundation Trust “wasn’t delivering safe care”, and some staff were “feeling unsafe due to continued short staffing”, following an unannounced inspection in February. The inspection into Rose Lodge, a 10-bed unit in South Tyneside, took place after the CQC received concerns about the service. Inspectors highlighted a high use of agency staff, with some shifts “falling below safe staffing levels”, which meant regular monitoring of patients with significant physical health issues “was not always taking place”. They said the trust had “implemented a robust action plan” following the inspection. The CQC did not issue a rating. The trust’s overall rating for wards for people with a learning disability remains as “good”, and its overall rating remains “outstanding”. Read full story (paywalled) Source: HSJ, 8 July 2022 -
Content ArticleThe document summarises the implications of the analysis as follows: Implications for general practice workforce planning Addressing general practice workforce shortages requires comprehensive long-term planning and acknowledgement that improvement will take many years. Top-down targets are unlikely to be effective in addressing workforce supply-demand shortfalls. Policymakers should account for geographic and sector variation in workforce supply and demand. Policies need to be fully costed and funded to be implemented effectively. Joined-up policymaking needs to be underpinned by substantive research on the drivers of workforce supply and demand as well as rigorous projections analysis. Substantial gaps in accessible data about the NHS workforce should be acknowledged and mitigated. Wider implications In all scenarios, the supply of GPs and general practice nurses is projected to fall short of demand through this decade. Under current policy, the NHS faces a shortfall of around 10,700 FTE GPs in 2030/31 (over 1 in 4 projected GP posts) and 6,400 FTE nurses (over 1 in 4 projected posts). In the pessimistic scenario this rises to around 20,400 FTE GPs (around 1 in 2 GP posts) and 10,100 FTE nurses (nearly 1 in 2 posts). This raises serious concerns around future primary care provision in terms of patient safety, the quality of care and equity of access. Sustained policy action targeting improved retention will be key to mitigating the GP and nurse shortfall. Equally, effective integration of other patient care roles in multidisciplinary teams will also be vital. Our optimistic scenario projects a lower GP shortfall of around 3,300 FTE (around 1 in 10 GP posts), assuming that successful integration of newer DPC roles helps lower GP demand by 9% by 2030/31. Policy choices around staff recruitment, retention, training, funding and equity in general practice have a vital role to play in addressing workforce pressures in general practice in the medium term.
