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Content ArticleThe NHS and social care system in the UK are under immense strain, and this is increasingly causing harm to patients. This is seen in the current crisis in urgent and emergency care, but is present throughout the system. This BMJ article looks at a collaborative document produced by the Royal College of Physicians (RCP), Royal College of Emergency Medicine (RCEM), Royal College of General Practitioners (RCGP), Royal College of Psychiatrists (RCPsych) and the Society for Acute Medicine (SAM). The document highlights key actions and priorities that may help mitigate part of the crisis facing the NHS. As part of these recommendations, the authors call on the UK governments to increase and prioritise investment in primary care, social care, mental health and ambulance services.
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Content ArticleWith the NHS under relentless pressure this winter and as records keep getting broken for all the wrong reasons, Helen Buckingham takes a closer look at why hospitals are so full, and emphasises the importance of supporting and helping the health service’s staff.
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Content ArticleIn this article, HSJ's Annabelle Collins reflects on the increasing number of NHS staff quitting their jobs and the risk to patient safety of 'corridor care'.
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Content ArticleThe NHS saved William Fear's life and inspired him to change career. But when William started as a healthcare assistant on a hospital ward for older patients, it was clear how bad things had got. This is his story, told to the Guardian, of a typical shift
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Content ArticleHospitals are crammed full of patients, the staffing crisis in adult social care continues to escalate, and alarming numbers of junior doctors report that they are planning to quit their NHS posts to work abroad. The multiple problems confronting the UK’s health and care system are interconnected and have been years in the making. While the pandemic exacerbated many of them, hugely increasing pressures on staff, political failures and, above all, a lack of investment are making it impossible for the service to stand still this winter – let alone recover. This Guardian Editorial gives its view on the current state of the NHS.
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Content ArticleIn the face of record high waiting times for elective care, The King's Fund undertook research to understand the strategies that have been used to reduce waiting times in England and elsewhere in the past 20 years. Elective care waiting lists and waiting times are a product of the fluctuations in and disparities between the demand for and available supply of healthcare. Understanding the root causes of these disparities and taking corrective action to restore balance between demand and supply and optimising the conditions within the health care system is therefore considered key to any strategy to reduce waiting times and sustain them at that level.
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Content ArticleThe brief focuses on the nursing workforce at a time when a global pandemic is raging across the world. The year just ended—2021— has seen unprecedented damage inflicted on health systems and on the nursing workforce. The year just begun—2022— marks no change in the continuing relentless pressure of the pandemic on individual nurses, and on the global nursing workforce. This brief was commissioned by the International Centre for Nurse Migration (ICNM). It provides a global snapshot assessment of how the COVID-19 pandemic is impacting on the nursing workforce, with a specific focus on how changing patterns of nurse supply and mobility will challenge the sustainability of the global nursing workforce. It also sets out the urgent action agenda and global workforce plan for 2022 and beyond which is required to support nurse workforce sustainability, and therefore improve health system responsiveness and resilience in the face of COVID-19.
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Content ArticleThis report from the International Council of Nurses is intended to give an overview of the continuing challenges faced by nurses, highlight the potential medium- to long-term impacts on the nursing workforce, and inform policy responses that need to be taken to retain and strengthen the nursing workforce.
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Content ArticleA survey conducted by the Commonwealth Fund has found that a majority of primary care doctors in the US and other high-income countries say they are burned out and stressed, and many feel the pandemic has negatively impacted the quality of care they provide. This article presents the survey results in the form of graphs with a commentary, and you can also download data from the survey.
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Content ArticleThis article for Vogue explores the experience of a midwife working in an overstretched maternity unit in England. Melissa Newman, who has been a midwife for nearly six years, highlights the impact of staff shortages on midwives—she describes how she does not have time to eat, avoids drinking because she will not have time to go to the toilet, and sometimes works fifteen hours without any break. She calls on the Government for more funding to fix the crisis facing NHS maternity services, and the NHS more widely.
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Content ArticleThis letter from Dr Robert Farley, President of the Institute of Physics and Engineering in Medicine (IPEM) to Karen Reid, the Chief Executive Officer of NHS Education for Scotland (NES) highlights that lack of funding for Clinical Scientist training places is putting patient safety in Scotland at risk. Dr Farley says, "We understand NHS Education for Scotland are proposing funding that equates to less than a single training post in medical physics and clinical engineering in 2023. ‘This is despite the Scottish Government's Chief Healthcare Science Officer’s public acknowledgement of the importance of training. "Scotland currently has a 10 per cent Clinical Scientist vacancy rate across the medical physics specialisms. This equates to seven vacancies in radiotherapy, three in nuclear medicine, four in diagnostic radiology and radiation protection. These posts are critical to supporting diagnostics and cancer treatments."
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News Article
‘It feels very unsafe’: the NHS staff bracing for winter as cuts loom
Patient Safety Learning posted a news article in News
Further funding cuts to the NHS will unavoidably endanger patient safety, an NHS leader warned last week after the chancellor’s promise of spending cuts of “eye-watering difficulty”. Matthew Taylor, the chief executive of the NHS Confederation, said his members were issuing the “starkest warning” about “the huge and growing gulf between what the NHS is being asked to deliver and the funding and capacity it has available”. The warning came as figures showed that paramedics in England had been unavailable to attend almost one in six incidents in September due to being stuck outside hospitals with patients. Service leaders say wait times for A&E and other care are being exacerbated by an acute lack of nurses, with a record 46,828 nursing roles – more than one in 10 – unfilled across the NHS. "Patients are presenting more unwell," says a GP from South Wales, "Wait times in A&E have become unmanageable, so we’re seeing patients who have waited so long to be seen they’re bouncing back to us. Things we can’t deal with, like injuries and chest pain. We tell them they have to go back to A&E. "Abuse of surgery reception and admin staff began last year and it’s just scaled up from there. We’ve had staff members who have been verbally and physically threatened and we’re struggling to recruit and retain staff – people are hired and quit in a couple days. A lot of people are going off sick with stress." Five healthcare workers describe the pressures they are facing, including ambulance stacking, rising A&E wait times and difficulties discharging patients. Read full story Source: The Guardian, 1 November 2022 -
News Article
Record number of trainee doctors for ‘under pressure’ NHS
Patient Safety Learning posted a news article in News
The largest expansion of medical training posts has been announced the day after Scotland’s health secretary warned that the NHS was facing up to its most challenging winter. Humza Yousaf yesterday confirmed that 152 more places for trainee doctors would be created next year. He hailed it as the “most significant increase in medical training places to date” and an increase on the 139 places created last year. The announcement comes after ministers were urged to fund the creation of additional training places in key specialities including general practice, core psychiatry, oncology, emergency medicine, intensive care medicine and anaesthetics. “These additional training places highlight the Scottish government’s continued commitment to ensure that our health service is resilient and can continue delivering high quality care to those who need it,” Yousaf said. “This record expansion will support a wide range of medical specialties, many of which are under increased pressure as a result of growing demand. “We will continue to monitor the number of available training places in collaboration with NHS Education for Scotland to help make sure the NHS is equipped to meet the country’s current and future needs.” Read full story (paywalled) Source: The Times, 1 November 2022 -
News Article
NHS Scotland in a perilous situation, says doctors' union
Patient Safety Learning posted a news article in News
Scotland's NHS is in "a perilous situation" amid a staffing and funding crisis, according to the chairman of the doctors' union. Dr Iain Kennedy said urgent action was needed to tackle workload pressures ahead of a potentially "terrifying" winter period. It comes after Scotland's health secretary Humza Yousaf admitted NHS Scotland was not performing well. Mr Yousaf told BBC Scotland it would take at least five years to fix. Dr Kennedy, who is chairman of the industry body BMA Scotland, said it was good to hear Mr Yousaf being honest about the scale of the problems, but added that "frankly we cannot wait five years" for things to improve. He told BBC Radio's Good Morning Scotland programme: "The NHS in Scotland is in a perilous situation and we have a particular crisis around the workforce - we simply do not have enough doctors in general practice and in hospitals. "We need more urgent action because the pressures and the workload have really shot up." Dr Kennedy has called on the government to publish a "heat map" showing where NHS vacancies are unfilled across Scotland. He said: "The public need to see transparency on where the vacancies are. We think that there are probably 15% vacancies across hospital consultant posts across Scotland. "Even the government admits to 7% and that we are at least 800 GPs short in Scotland - and I, and others, suspect we are probably well over that figure now." Read full story Source: BBC News, 31 October 2022 -
News Article
Eighteen deaths following Tees health trusts' safety lapses
Patient Safety Learning posted a news article in News
Eighteen people died at two Teesside hospital trusts following patient safety lapses over a 12-month period. Sixteen such deaths were recorded at the South Tees Hospitals NHS Foundation Trust, with two at the North Tees and Hartlepool NHS Foundation Trust. Examples of patient safety lapses include a failure to provide or monitor care, a breakdown in communication, an out-of-control infection in a hospital, insufficient staffing or a missed diagnosis. NHS England figures show that, between April 2021 and March this year, there were 16,557 incidents at the South Tees Trust, which operates James Cook University Hospital in Middlesbrough, and Northallerton's Friarage Hospital. Thirty-four resulted in "severe" harm. Middlesbrough MP Andy McDonald told the Local Democracy Reporting Service the figures were a concern and that he planned to take them up with the South Tees Trust's chief executive. He said NHS staff worked under "the most demanding of conditions" but added: "Every person going into hospital rightly expects to receive the best treatment. Patient safety is paramount and no family wants to see a loved one suffer." Dr Mike Stewart, the trust's chief medical officer, said: "We encourage an open and transparent culture and promote the reporting of all patient safety incidents, even when there is uncertainty over a direct link between any problems in care and incidents of severe harm or death. "In the last year there were no deaths graded as definitely preventable due to a problem in the care delivered by the trust. "While our reporting has increased consistently over the last three years, the number of serious incidents has not risen, which is strong evidence of a positive safety culture." Read full story Source: BBC News, 30 October 2022 -
News Article
Nurses are working the equivalent of one day a week for nothing, research says
Patient Safety Learning posted a news article in News
Nurses are working the equivalent of one day a week for nothing, according to a study. Researchers from London Economics were commissioned by the Royal College of Nursing (RCN) to look at pay in England, Wales, Scotland and Northern Ireland since 2010. They found that the salary of an experienced nurse had fallen by 20% in real terms, based on a five-day week. Experienced nurses in England, Wales, and Northern Ireland would need a nominal pay rise of 45% by 2024-25 just to return their salaries to levels seen in 2010-11 in real terms, the research said. And such a pay rise would actually help the NHS save money in the long term, as it would be cheaper than hiring staff from overseas, according to the study. Dr Gavan Conlon, who oversaw the research, said that bringing staff in from overseas costs approximately £16,900 more annually than retaining a nurse, while using agency workers costs around £21,300 more per year. He said that about 32,000 nurses leave the NHS every year, many due to the failure of their pay to keep up with the rising cost of living. The RCN is balloting its 300,000 members for strike action, calling for higher pay and an effort by government to fill the hundreds of thousands of nursing vacancies across the country. Read full story Source: Sky News, 28 October 2022 -
News ArticleThe NHS is launching an effort to recruit tens of thousands of nurses to help fill the record number of vacancies that low pay, Covid and heavy workloads have created across the service. A multimedia blitz will try to raise nursing’s profile as a worthwhile career by featuring patients who benefited from nurses’ skills and dedication. NHS England’s “We are the NHS” campaign will use radio, social media and cinema advertisements to portray nursing as a varied and fulfilling role that can change people’s lives. It comes soon after NHS figures showed that the number of empty posts in nursing across hospitals, mental health, community care and other services had reached 46,828 – the largest number ever. That means that more than one in 10 nursing roles (11.8%) are unfilled across the service overall. While the NHS is short of almost every type of staff, service chiefs say the acute lack of nurses is a key reason why so many patients are waiting so long for A&E, cancer treatment and other care. Read full story Source: The Guardian, 24 October 2022
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News Article
End rules stopping thousands of doctors working in GP surgeries, says GMC chief
Patient Safety Learning posted a news article in News
Thousands of doctors are being prevented from working in overstretched GP surgeries across the UK because of unnecessary “red tape”, leaving NHS patients experiencing “unprecedented” waits for care, the head of the doctors’ regulator in the UK has said. Charlie Massey, the chief executive of the General Medical Council, said barriers that stopped medics from being deployed to meet areas of high demand, such as in primary care, must be removed urgently if the NHS workforce crisis was to be resolved and access to care improved. “Red tape is stopping the UK from making the most of many of its skilled and experienced doctors,” he said. “Without action, patients will suffer.” The regulator will on Tuesday call for a relaxation of rules so the fastest-growing part of the medical workforce – skilled doctors in non-training roles – can undertake a wider range of work beyond hospitals, such as in GP surgeries. “There are no easy answers to the challenges facing the NHS. There is no army of new doctors coming over the horizon, so part of the solution must be to make sure that we have more doctors in the places that patients need them,” Massey said. “The government should make a start immediately by changing the performers list criteria so more doctors are allowed to work alongside GPs. That needs to be done urgently. “But beyond technical changes there is also a need for fresh thinking in the way our health services are structured and in how teams of health professionals work together. We can’t keep doing things the same way they have always been done, or nothing will change." Read full story Source: BBC News, 18 October 2022 -
News Article
Social care ‘on its knees’ as vacancies hit record high
Patient Safety Learning posted a news article in News
Social care services face an “absolute crisis” over record vacancies as unfilled jobs have risen by more than 50% in a year, a new analysis reveals. New data on social care workers shows at least 165,000 vacancies across adult social care providers at the end of 2021-22. This is the highest on record according to the charity Skills for Care, which has collected the data since 2012. Leading think tanks have warned the figures to point to the “absolute crisis” facing social care with the “system on its knees”. At the same time the demand for care has risen, highlighting that social care is facing a complex challenge with recruitment and retention which will be impacting on the lives of people who need social care. The annual report by Skills for Care predicts social care services will need an extra 480,000 workers by 2035 to meet the demand but could be set to lose 430,000 staff to retirement over the next decade. Simon Bottery, senior fellow at The King’s Fund, said the report was evidence “of the absolute crisis social care faces when trying to recruit staff, a crisis that has profound consequences for people needing care”. He added: “A key reason for that is pay, which continues to lag behind other sectors including retail and hospitality, as well as similar roles in the NHS. Our recent analysis found that nearly 400,000 care workers would be better paid to work in most supermarkets." Read full story Source: The Independent, 11 October 2022 -
News Article
Four of UK’s top countries for nurse recruitment on WHO ‘red list’
Patient Safety Learning posted a news article in News
Three of the top seven countries from which the UK recruits overseas nurses are on the World Health Organization’s (WHO) ‘red list’ where active recruitment should not be used. Nigeria, Ghana and Nepal are the third, fifth and seventh highest respectively in the list of countries that provided the largest number of overseas staff joining the Nursing and Midwifery Council (NMC) register between April 2021 and March 2022. All three were on the red list during this period, which is derived by the WHO and identifies countries facing the most pressing health workforce shortages, meaning they should not be targeted for systematic recruitment by international employers. Nepal has since moved off the red list following of a government-to-government agreement between the Department of Health and Social Care (DHSC) and the Government of Nepal in the summer. But the agreement has raised concerns among health leaders, including those reported in The Observer which suggested Nepali recruitment agencies carried out abusive practices, such as charging illegal fees. Royal College of Nursing general secretary and chief executive Pat Cullen said the “overreliance” on international recruitment showed that the government had “no grip on the nursing workforce crisis”. “It’s deeply concerning that four ‘red list’ countries appear amongst the top 20 most recruited from countries,” she said. “This approach is unsustainable. Ministers must invest in growing the domestic nursing workforce. “They need to give nursing staff the pay rise they deserve to retain experienced nurses and attract new people to the profession.” Read full story Source: Nursing Times, 4 October 2022 -
News ArticleNurses will start voting on Thursday on whether to strike over pay amid warnings that record numbers are leaving the profession. Around 300,000 members of the Royal College of Nursing (RCN) are being asked if they want to mount a campaign of industrial action in the union’s first UK-wide ballot. The RCN said new analysis by London Economics to coincide with the ballot launch showed that pay for nurses has declined at twice the rate of the private sector in the last decade. It is the first time in its 106-year history that the RCN has balloted members across the UK on strike action and it is urging them to vote in favour. RCN general secretary Pat Cullen said in a message to those being balloted: “This is a once-in-a-generation chance to improve your pay and combat the staff shortages that put patients at risk. “Governments have repeatedly neglected the NHS and the value of nursing. We can change this if together we say ‘enough is enough’. “Record numbers are feeling no alternative but to quit and patients pay a heavy price. We are doing this for them too." Read full story Source: The Independent, 6 October 2022
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News Article
‘Perilous’ shortage of homecare workers leaves patients trapped in hospitals
Patient Safety Learning posted a news article in News
A “perilous” shortage of homecare workers is the biggest reason thousands of people are languishing longer in hospital than needed, driving up waiting lists and making people sicker, figures reveal. Almost one in four people unable to be discharged – sometimes for weeks – were trapped in hospital because they were waiting for home care, as agencies hand back contracts because staff are quitting owing to low pay, leaving 15% of jobs vacant. A fifth of people unable to be discharged were also waiting for short-term rehabilitation and 15% were waiting for a bed in a care home, according to analysis of data obtained using freedom of information requests and public records by Nuffield Trust and the Health Foundation. It estimated that in April this year, one in six patients were in hospital because of delayed discharge, and the discharge of patients with a hospital stay of more than three weeks was delayed by 14 days on average. “People are ending up in hospital for malnutrition and dehydration, problems which, even if you supported people a little bit at home, would stop,” said Jane Townson, the director of the Homecare Association. “More providers are having to turn down work than usual and some are having to hand back people because they can’t do it.” Read full story Source: The Guardian, 3 October 2022 -
News Article
Record number of nurses quitting the NHS
Patient Safety Learning posted a news article in News
Record numbers of nurses are quitting the NHS in England, figures show. More than 40,000 have walked away from the NHS in the past year - one in nine of the workforce, an analysis by the Nuffield Trust think tank for the BBC revealed. It said many of these were often highly skilled and knowledgeable nurses with years more of work left to give. And the high number of leavers is nearly cancelling out the rise in new joiners that has been seen. There were just 4,000 more joiners than leavers in the year to the end of June. But a Department of Health and Social Care spokesman said progress was being made and the government was already halfway to meeting its target to increase the numbers of nurses working in the NHS in England during this Parliament by 50,000. He said a workforce strategy would be published soon, setting out how the NHS will continue to recruit and retain nurses in the coming years. Read full story Source: BBC News, 30 September 2022 -
News Article
Coffey accused of leaving NHS 'in limbo' on A&E target
Patient Safety Learning posted a news article in News
The four-hour emergency care target is “not the right answer” long term, but services have been left “in limbo” by Therese Coffey’s promise that it will no longer be scrapped, the president of the Royal College of Emergency Medicine has said. Katherine Henderson said RCEM was “delighted” there could be more focus on the four-hour target in the short term following the health and social care secretary’s surprise comment last week, as emergency care has been “in a performance policy vacuum since before the pandemic”. But Dr Henderson said that in the long term there should be performance metrics that account for the “journey” of the most acutely unwell patients, and should be a further review of NHS England’s clinical review of standards – which proposed a suite of new measures to replace the totemic four-hour target. She added that more than a dozen A&Es which are involved in trialling the new measures have been “left in limbo”. Dr Henderson, whose term as RCEM president ends in October, said plans to use virtual wards and urgent community response teams to improve patient flow and prevent emergency admissions would have limited impact this winter due to a lack of staff. Read full story (paywalled) Source: HSJ, 26 September 2022 -
News Article
NHS staff shortages are ‘biggest’ sepsis risk this winter, charity warns
Patient Safety Learning posted a news article in News
The looming NHS staffing crisis could lead to more patients dying from sepsis, a major UK charity has warned. Doctors have told the UK Sepsis Trust that staff shortages and high numbers of patients to treat are two of the most common factors preventing them from following national sepsis guidance. The chief executive of the UK Sepsis Trust, Dr Ron Daniels, warned that the NHS was in a “fragile” state and said workforce shortages were some of the “biggest potential causes of harm” in the context of diagnosing the condition. In a report by the trust, shared with The Independent, 65 out of 100 doctors in the UK warned that they had missed cases of sepsis. The most common reason for this was staff shortages alongside “high patient caseloads”, they said. Dr Daniels warned that staff might find it increasingly difficult to spot sepsis in the coming months as the staffing crisis intensifies. He told The Independent: “The NHS is in a fragile state after the pandemic... and staff absence is a fact of life within the NHS at the moment. That’s partly because staff have left, it is partly because we have high caseloads, but it is also because staff are still off sick". “It is my view that staff shortages are one of the biggest potential causes of harm that our public face in the context of developing sepsis, and we need to urgently address it.” Read full story Source: The Independent, 26 September 2022
