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Content ArticleIn a television studio in Stoke-on-Trent last month, Liz Truss and Rishi Sunak traded blows over everything from credit card economics to Channel migrants to the accessories chain Claire’s. The list of issues the pair clashed over was dizzyingly long. There was one glaring omission, however. In the hour-long debate there was not a single mention of the NHS – despite being engulfed in its biggest ever crisis. The NHS now shares the same traits as many of those relying upon it to keep them alive and well: it is elderly, has multiple comorbidities, and is in dire need of emergency care. Summer has left it on its knees. Worse is expected this winter. “The new prime minister will inherit an NHS in its worst state in living memory,” says Matthew Taylor, the chief executive of the NHS Confederation, which represents the healthcare system in England, Wales and Northern Ireland. “There is no escaping that the NHS is in a state of crisis.”
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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 ArticleThe NHS often appears to be in a state of permanent crisis. Recently, there've been headlines about long waiting times for ambulances and the huge backlog for routine surgery. Before that, the NHS faced a two-year pandemic which may rear its head again this winter. But the NHS also has a big underlying problem that it has tens of thousands of vacancies for doctors, nurses and other medical workers – and that makes all the other pressures on the NHS even harder to handle. So why does the NHS have a staffing problem? And what can be done to fix it?
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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“The National Health Service and the adult social care sector are facing the greatest workforce crisis in their history”, said Parliament’s Health and Social Care Select Committee in July. The aspirations to rebuild services post-Covid, and tackle rising waiting times and other access challenges, are limited by the same challenge: there are simply not enough staff, writes Richard Murray in this article for the Independent.
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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 ArticleThis report by the Institute for Fiscal Studies (IFS) looks at which staff are more likely to leave the NHS acute sector. There is still little analysis available on the reasons why staff leave the NHS, but increasing our understanding of the complex factors that cause people to leave the health service would allow the NHS to develop more effective retention strategies. The report uses the Electronic Staff Record, the monthly payroll of directly employed NHS staff, to analyse the leaving rates of consultants, nurses and midwives, and health-care assistants (HCAs) between 2012 and 2021. The authors highlight that many other factors that influence retention remain unknown, and much more research is needed in this area.
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Content ArticleThis article in The Guardian aims to explain the major pressures the NHS will face in Autumn 2022. It identifies and explores the following threats: Covid Influenza Cost of living crisis Workforce shortages Pay
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Content ArticleThis report by The Tony Blair Institute for Global Change sets out an action plan to save the NHS this winter. It highlights the pressures the health service faces, worsened by the Covid-19 pandemic, including a resurgent flu epidemic, the effect of the cost-of-living crisis, the unprecedented elective-care backlog and a depleted and exhausted workforce. The authors call for the Government to immediately: focus leadership minimise demand on the service improve patient flow and efficiency maximise capacity.
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Content ArticleIn this blog for The King's Fund, Richard Murray examines the issues that are pushing the NHS into crisis and causing the lowest levels of public satisfaction since the 1990s. The primary cause of this emergency is the workforce crisis, an existing trend that has been accelerated by the Covid-19 pandemic. He examines the approaches that have been taken to similar crises in the past, and highlights the importance of the workforce plan that is due to be released by NHS England and Health Education England towards the end of the year.
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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 ArticleThe importance of nurse staffing to the delivery of high-quality patient care was a principal finding in the landmark report of the Institute of Medicine’s (IOM) Committee on the Adequacy of Nurse Staffing in Hospitals and Nursing Homes: “Nursing is a critical factor in determining the quality of care in hospitals and the nature of patient outcomes”. Nurse staffing is a crucial health policy issue on which there is a great deal of consensus on an abstract level (that nurses are an important component of the health care delivery system and that nurse staffing has impacts on safety), much less agreement on exactly what research data have and have not established, and active disagreement about the appropriate policy directions to protect public safety. Researchers have generally found that lower staffing levels are associated with heightened risks of poor patient outcomes. Staffing levels, particularly those related to nurse workload, also appear related to occupational health issues (like back injuries and needlestick injuries) and psychological states and experiences (like burnout) that may represent precursors for nurse turnover from specific jobs as well as the profession. This chapter from the Patient Safety and Quality: An Evidence-based Handbook for Nurses summarises and discusses the state of the science examining the impact of nurse staffing in hospitals and other health care organisations on patient care quality, as well as safety-focused outcomes. To address some of the inconsistencies and limitations in existing studies, design issues and limitations of current methods and measures will be presented. The chapter concludes with a discussion of implications for future research, the management of patient care and public policy.
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Content ArticleLack of capacity in social care is having a severe effect on NHS services as hospitals are unable to discharge patients without appropriate care arrangements in place. This is causing delays right across the healthcare system. In this report, NHS Confederation highlights the risks to patient safety caused by the workforce crisis affecting social care in England. In the Confederation's latest survey, 99% of healthcare leaders agreed that there is a social care workforce crisis in their local area, and almost all agreed that it is worse than a year ago and expect it to deteriorate into this winter. The report recommends the government focus on the following key priorities to deal with the crisis: Increase pay in the social care sector, starting by immediately implementing a national care worker minimum wage Publish a long-term, properly funded plan to develop the care workforce and offer career progression opportunities Commit to increasing overall investment to increase access to care to those who need it, meet future demand and pay more for care
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Content ArticleIn this letter to the Secretary of State for Health and Social Care, Rachel Power, Chief Executive of the Patients Association, calls on Steve Barclay to ask the Government to develop a long-term workforce strategy for the NHS. She also requests that the government urgently fund social care and calls on Steve Barclay to take action to remedy the threat to patient safety caused by staff shortages.
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Content ArticleThis video examines the crisis facing NHS ambulance services in the UK and looks at the impact of delays and lack of capacity on patient safety. Paul Brand, UK Editor at ITV News, speaks to ambulance crews, patients and a recently bereaved family about their experiences, and highlights the increased stress levels ambulance staff are reporting. Note: The video contains footage of a 999 call that some viewers might find distressing.
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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 ArticleThis document summarises the findings of The Health Foundation's analysis on workforce supply and demand in general practice in England up to 2030/31. It focuses on patient care staff including GPs and general practice nurses. The Health Foundation developed three scenarios of potential workforce supply through a mix of in-house modelling and publicly available data: a scenario based on current policy, a more optimistic scenario and a pessimistic scenario. The analysis demonstrates that in all three scenarios, the supply of GPs and general practice nurses is projected to fall short of demand. Under current policy, the NHS faces a shortfall of over 1 in 4 GP and general practice nurse posts by 2030/31. In the pessimistic scenario this increases to around 1 in 2 GP and nurse posts, raising concerns about patient safety, quality of care and equity of access. In the optimistic scenario, the GP shortfall can be substantially mitigated by 2030/31, but this would require sustained and concerted policy action to boost GP retention and integrate newer roles within multidisciplinary practice teams.
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Content ArticleSince the Covid-19 pandemic, staff shortages have worsened in health systems around the world, with an increasing number of healthcare workers leaving the workforce coinciding with increased patient demand. In this blog, Jens Hooiveld, International Marketing Manager at the Patient Safety Company, examines the patient safety issues caused by staffing shortages. He highlights tools that can help nurses manage patient safety in this pressured climate by decreasing the burden of admin associated with reporting adverse incidents.
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News Article
Patients unwashed ‘for three days’ at trust under ‘extreme pressure’
Patient Safety Learning posted a news article in News
The Care Quality Commission (CQC) has issued a trust with a warning notice following an inspection that found wards did not have enough staff to care for patients. Staff at York hospital told inspectors they were not able to interact with individual patients and cater to their needs, with one saying: “We have to choose, do we turn, check, and make sure all patients are not soiled, or do we fully wash ten? Some of these patients haven’t been washed for two to three days.” York and Scarborough Teaching Hospitals CEO Simon Morritt said: “Many of the issues raised by the CQC were known to us, and reflect the extreme pressures facing the trust, the demands of covid and associated staff absence, and the well-documented recruitment challenges. The report demonstrates that, when faced with these pressures, it is not always possible to give the standard of care we would want for all of our patients all of the time.” The CQC said there were “significant safety concerns about fundamental standards of patient care” at the hospital. “The service didn’t have enough nursing staff with the right skills, training and experience to keep patients safe and to provide the right care and treatment,” said Sarah Dronsfield, the CQC’s head of hospital inspection. “It was disappointing that managers didn’t regularly review the situation and change the staffing arrangements to accommodate this.” Read full story (paywalled) Source: HSJ, 9 June 2022 -
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
