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Found 84 results
  1. News Article
    An NHS hospital has been so overwhelmed that it told senior doctors to make “the least unsafe decision” when treating patients. Medical groups have voiced concern that Norfolk and Norwich hospital trust’s instruction to its consultants this week showed it was struggling so much to cope with the number of people needing care that patient safety was being put at risk. At the time the hospital had no spare beds, a full accident and emergency department, 35 patients waiting on trolleys to be admitted, and had declared a major internal incident. In its message, seen by the Guardian, it said: “We would like you to know that the trust will support you in making difficult decisions that may be the least unsafe decision, and we would appreciate your cooperation over the coming days with this.” The circular from the Norwich hospital added: “We are facing our most challenging situation with our trust today,” because it was so overcrowded and unable to find a bed for the 35 patients doctors had decided needed to be admitted as emergencies. Read full story Source: The Guardian, 20 December 2019
  2. News Article
    A lot has been written about the workforce crisis in health and social care. 43,000 registered nurse vacancies, a 48% drop in district nurses in eight years and not enough GPs to meet demand. When we talk about workforce, the focus is always on numbers. There are campaigns for safe staffing ratios and government ministers like to tell us how many more nurses we have. But safety is not just about numbers. Recent workforce policy decisions have promoted a more-hands-for-less-money approach to staffing in healthcare. More lower-paid workers mean something in the equation has to give. In this case, it’s skill and expertise. In this article in The Independent, Patient Safety Learning's Trustee Alison Leary discusses how healthcare has failed to keep frontline expertise in clinical areas due to archaic attitudes to the value of the experienced workforce. Read full story Source: The Independent, 15 December 2019
  3. News Article
    The NHS is relying on less qualified staff to plug workforce gaps because of a huge shortage of nurses, according to a new report. Support staff, such as healthcare assistants and nursing associates, have been used to shore up staffing numbers, said the Health Foundation charity. The NHS has relied upon overseas recruitment, but a lack of EU nurses because of Brexit means it is now taking more nurses from countries such as India and the Philippines. At present, there are almost 44,000 nursing vacancies across the NHS (12% of the nursing workforce), but this could hit 100,000 in a decade, the report said. The report said most changes to the skill mix – meaning the ratio of fully qualified to less qualified staff – are implemented well and led by evidence, but added: “It is important that quality and safety are at the forefront of any skill mix change.” Read full story Source: The Guardian, 28 November 2019
  4. News Article
    Hospitals are so short of doctors and nurses that patients’ safety and quality of care are under threat, senior NHS leaders have warned in a dramatic intervention in the general election campaign Nine out of 10 hospital bosses in England fear understaffing across the service has become so severe that patients’ health could be damaged. In addition, almost six in 10 (58%) believe this winter will be the toughest yet for the service. The 131 chief executives, chairs and directors of NHS trusts in England expressed their serious concern about the deteriorating state of the service in a survey conducted by the NHS Confederation. The findings came days after the latest official figures showed that hospitals’ performance against key waiting times for A&E care, cancer treatment and planned operations had fallen to its worst ever level. However, many service chiefs told the confederation that delays will get even longer when the cold weather creates extra demand for care. “There is real concern among NHS leaders as winter approaches and this year looks particularly challenging,” said Niall Dickson, the chief executive of the confederation, which represents most NHS bodies, including hospital trusts, in England." “Health leaders are deeply concerned about its ability to cope with demand, despite frontline staff treating more patients than ever." Read full story Source: 19 November 2019
  5. Content Article
    Safety culture has been shown to be a key predictor of safety performance in several industries. It is the difference between a safe organisation and an accident waiting to happen. Thinking and talking about our safety culture is essential for us to understand what we do well, and where we need to improve. These cards from Eurocontrol are designed to help us to do this.
  6. Content Article
    It can be difficult to turn down requests to cover rota gaps. However, you must balance your own needs against those of the service discusses Emmeline Lagunes-Cordoba, Partha Kar and Tharusha Gunawardena in this BMJ article.
  7. Content Article
    While the NHS delivered a remarkable amount of elective treatment during the pandemic, the pressure of caring for large numbers of patients seriously unwell with COVID-19 has led to the waiting list for elective care reaching the highest level since current records began. This analysis from The Health Foundation looks in detail at the impact of the pandemic on the waiting list for elective care in England. It highlights that: 6 million fewer people completed elective care pathways between January 2020 and July 2021 than would have been expected based on pre-pandemic numbers the backlog of elective care is not evenly distributed across England patients living in socioeconomically deprived areas faced more disruption and delays than those in England’s least deprived areas. It also looks at the difficulty in predicting how long the backlog will take to clear and how much it will cost. One unknown factor that complicates this task is 'missing' patients - those who did not or could not seek care during the pandemic. These patients may present at a healthcare setting requiring more urgent, intensive treatment as a result of missing out on earlier intervention.
  8. Content Article
    The Emergency Department Safer Nursing Care Tool is now available to use in NHS emergency departments in England. Developed by the Shelford Group chief nurses, licenced by Imperial College London and supported by the NHS England Chief Nursing Officer, the Emergency Department Safer Nursing Care Tool (ED SNCT) calculates nurse staffing requirements for emergency departments based on patients’ needs (acuity and dependency). Together with professional judgement, the tool supports emergency department managers and chief nurses in their safe staffing decisions. The Safer Nursing Care Tools (SNCT), including the Mental Health Optimal Staffing Tool (MHOST), are free to use by NHS trusts in England.
  9. Content Article
    Substantial evidence indicates that patient outcomes are more favourable in hospitals with better nurse staffing. One policy designed to achieve better staffing is minimum nurse-to-patient ratio mandates, but such policies have rarely been implemented or evaluated. In 2016, Queensland (Australia) implemented minimum nurse-to-patient ratios in selected hospitals. In a study published in the Lancet, McHugh et al. aimed to assess the effects of this policy on staffing levels and patient outcomes and whether both were associated.
  10. Content Article
    Amiri et al. analysed the role of nurse staffing in improving patient safety due to reducing surgical complications in member countries of Organization for Economic Co-operation and Development (OECD). They found that a higher proportion of nurses is associated with higher patient safety resulting from lower surgical complications and adverse clinical outcomes in OECD countries.
  11. Content Article
    Achieving safe district and community nurse caseloads, staffing levels and skill mix in order to deliver the increasing demand for care close to or in the home are a key challenge for primary and community care organisations in the UK. However there is a national crisis in relation to robust workforce evidence due to a lack of tools available to capture the complexity of care being delivered in different geographical locations to meet rural and urban patient population need. This paper presents a case study to illustrate the potential benefits of implementing Cassandra, a community workload analysis tool in one community provider organisation in the south of England. The Cassandra tool provides potential to: i) model the multidimensional complexity of care in different contexts and populations; ii) develop a potential blueprint for robust monitoring of decisions related to safe caseloads, staffing levels and skill mix; iii) when triangulated with other metrics, provides additional value to organisations as it enables an accurate picture to be created to monitor safe caseload, staffing levels, skill mix and competence and impacts on quality of patient care and commissioning of services in different geographies. As a place based demand tool this offers real opportunity to improve the evidence base of workforce planning and development driven by the needs of community populations.
  12. Content Article
    An article* from Ehi Iden, hub topic leader, discussing the Nigerian healthcare workforce crisis.
  13. Content Article
    When many people think about NHS services they often think about clinical staff, such as doctors or nurses, and how they deliver care and interact with patients and families. However, in the context of patient safety, there is often more to see ‘behind-the-scenes’ in non-patient facing services. These services may be less visible, but they play a vital part in ensuring patient safety. Understanding the importance of these services, and how they are crucial to the ability of the NHS to operate effectively, is often underestimated. In this blog for the Healthcare Safety Investigation Branch (HSIB), National Investigators Russ Evans and Craig Hadley highlight how 'behind-the-scenes' services are crucial to help the NHS operate effectively and safely.
  14. News Article
    NHS dentistry is "hanging by a thread" with some patients facing two-year waits for check-ups, the British Dental Association has said. Department of Health data analysed by the BBC shows almost 1,000 dentists working in 2,500 roles across England and Wales left the NHS last year. One woman told how she had been in pain for more than a year while waiting to have root canal surgery. NHS England said patients who most needed care should be prioritised. Pamela Carr, 58, from Carlisle, has been looking for an NHS dentist to fix her root canal since November 2020. "I've become used to the pain," she said. "I can't afford the private care, and I've tried every practice within 30 miles. I phoned NHS England too." "They said there's nothing they can do because there are no NHS dentists. That was the end of the conversation." Clinical Commissioning Group North Cumbria, which covers the area, lost 4% of its dentists in the last year. The worst-affected area was NHS Portsmouth CCG, which lost 26% of its NHS dentists over 12 months. At least 10% of NHS dentists were lost in 28 other English CCGs. Read full story Source: BBC News, 19 January 2022
  15. News Article
    The number of Covid patients in hospitals in England and Scotland has continued to rise this week, as NHS England reached a deal with private hospitals to free up beds amid the outbreak of Omicron cases. Meanwhile, Covid staff absences in England rose to their highest level since the introduction of the vaccine. The number of NHS workers in England off sick because of Covid was up by 41% in the week to 2 January, according to the latest figures. Five health workers describe some of the challenges they are facing, including understaffing, waiting times and bed-blocking. Read full story Source: The Guardian, 14 January 2022
  16. News Article
    “Protect the NHS” sounds like the team name for an illegal Downing Street quiz, but it won’t be winning any prizes for patient safety, writes Dr Phil Hammond in The Times. The fact is, the NHS, as was the case long before the pandemic, is woefully understaffed. Even more billions have been thrown at the system, but, as ever, so little of it finds its way to the frontline carers we all clapped for. The NHS is always fighting a losing battle. When the government first asked us to protect the NHS, it may as well have said: “Stay at home, die alone, protect the NHS.” Thousands of people have done just that since the pandemic started, for reasons not fully understood. They may have had Covid or non-Covid diseases, or both. They didn’t ask for, or couldn’t find, help when they were seriously ill. They followed their “stay at home” orders. Many died. "The NHS does some amazing things but the truth is it has never had the staff nor capacity — and sometimes not the culture — to provide safe, effective and timely care to all its citizens," says Hammond. "We also have appalling levels of public health inequality. The rich live a decade longer than the poor, and the poor suffer 20 more years of chronic disease and NHS dependency. No health service can cope with such high demands, many of them avoidable." Today, many people can’t even access care, never mind the quality of it. But we don’t need to dismantle the NHS, we need to staff it safely. We need to start with a proper, costed workforce plan for now and the future. If we put even more money into healthcare, we need to prove it’s being spent on frontline care that is proven to work. Just as we didn’t plan properly for Covid, we have never had a proper workforce plan for the NHS to estimate what staff increases we need to cope with an ageing, anxious and increasingly isolated population chock full of chronic diseases. How did we get in this mess? There is good evidence that safe staffing levels deliver better care, and that continuity of care and a long-standing relationship with your GP or nurse is hugely beneficial to your health. It’s much more rewarding for health professionals too. Alas, they don’t grow on trees and there’s a global shortage. There’s a limit to how many we can steal from countries who may need them more. No matter how much money we throw at the NHS in a pandemic panic, this tanker won’t be turned around quickly. Read full story (paywalled) Source: The Times, 18 December 2021
  17. News Article
    Former health secretary Jeremy Hunt has warned extra funding for the NHS “will unravel quickly” without the extra doctors and nurses needed. The health committee chair said today that the lack of any mention of workforce training budgets in the Chancellor’s speech on Wednesday was “the big gap” in news for the NHS. Before the budget, Mr Hunt, who served as health secretary for six years and who has accepted he did not do enough to increase staffing levels in the NHS, said a workforce plan for the NHS was needed. In the budget documents, released after the Chancellor Rishi Sunak had finished speaking, the Treasury confirmed only that it would continue to fund workforce training and repeated existing promises around 50,000 extra nurses. But many experts including the Health Foundation and think tanks as well as NHS leaders have said what is needed is a properly costed long term workforce plan so that the NHS can train enough staff to meet future patient demand. Read full story Source: The Independent, 28 October 2021
  18. News Article
    The trust at the centre of a maternity scandal does not have enough midwifery staff to keep women and babies safe, a Care Quality Commission (CQC)inspection has revealed. East Kent Hospitals University Foundation Trust relied on community midwives to fill slots at its acute unit, with some of them working 20-hour days after being called in to help cover and feeling outside of their competence. The trust had suspended a midwife-led unit and diverted women in labour to other hospitals – and when the CQC raised the understaffing issue at its inspection in July, it suspended its home birth service. But the CQC found that the number of midwives and maternity workers on duty rarely matched planned numbers and managers rarely calculated staffing numbers accurately, with some elements of the workload not being factored in. Lack of staff meant there was a risk to the safe assessment and monitoring of women and babies at the trust’s William Harvey Hospital in Ashford. Unqualified staff were having to deal with telephone queries from women who needed advice and support. Read full story (paywalled) Source: HSJ, 15 October 2021
  19. News Article
    Twenty-three hospital trusts had more than a third of their core bedbase occupied by COVID-19 patients on Tuesday, and occupancy is still rising at all but one. Three trusts (North Middlesex in north London, as well as Medway and Dartford and Gravesham in Kent) had more than half of general and acute beds occupied by patients who had the virus, and others were not far behind. Several trusts saw their covid occupancy share up by more than 10 percentage points in a week — a rate of growth which would soon see them entirely filled by covid patients, a situation with radical consequences for emergency hospital care in those areas. London as a whole had a third of these beds occupied by patients with COVID-19. HSJ has analysed data published for the first time by NHS England last night. The data concerns the status of adult general and acute beds, which make up the large majority of the acute bedbase. They do not include intensive care, which is also now under huge pressure in London, the south east and the east of England. Most hospitals in these areas are stretching IC capacity above normal levels. Such high covid occupancy in both intensive care and the core bedbase is putting severe strain on hospitals’ ability to treat other patients. Most or all of the trusts under the greatest pressure have now cancelled routine planned surgery, and many are struggling with crowding, delays getting patients into and out of emergency departments due to the space available, and a lack of staff. Read full story (paywalled) Source: HSJ, 1 January 2021
  20. News Article
    Frontline doctors have testified to deteriorating conditions in hospitals in London and the south east as the NHS deals with a surge in COVID-19 cases. Speaking to the Independent SAGE group of experts on 30 December, Jess Potter, a respiratory doctor in east London, told how she and colleagues were afraid of resources running out. “My greatest fear is having a patient that I cannot provide lifesaving treatment to,” she said. “We had one of our largest medical intakes yesterday, the vast majority with coronavirus. What do we do when we run out of resources, and who is going to provide that guidance? It will harm our patients and our staff, because we have a set of values by which we practise, and we will have to reduce the level of care we deliver.” She added, “Back in April I never saw a case where we didn’t provide a bed to a patient who needed it in intensive care, and decisions were taken as if in normal times. Now I hear from medics across the country that things are very bad, and the situation is the same as in April, if not worse. We are afraid of what will happen if we don’t act now.” Sonia Adesara, a doctor in London, spoke to Independent SAGE after a set of night shifts at her trust and told of a chronic shortage of continuous positive airway pressure (CPAP) capacity. “In the past few days, despite my hospital significantly increasing intensive and critical care capacity, our intensive care unit has been full, and there is no spare CPAP capacity. Medics are spending shifts trying to closely monitor all of our patients who are on the highest level of oxygen that we can give with a normal mask, assessing who is most unwell and unstable—and then frequently checking on patients who are on CPAP and then swapping people [around]." Read full story Source: BMJ, 31 December 2020
  21. News Article
    The flagship Nightingale hospital is being dismantled as medics warn that there are not enough staff to run the facilities despite the NHS being at risk of being overwhelmed by coronavirus. Amid surging virus case numbers, elective surgery is being cancelled as the number of patients in hospitals in England passes the peak of the first wave in April. Although the NHS is "struggling" to cope, the majority of the seven Nightingale hospitals, created at a cost of £220 million, have yet to start treating COVID-19 patients during the second wave. The Exeter Nightingale has been treating Covid patients since mid-November. The facility at London's Excel centre has been stripped of its beds and ventilators. The NHS has told trusts to start preparing to use the overflow facilities in the coming weeks, but bosses have failed to explain how they will be staffed. Read full story (paywalled) Source: The Telegraph, 28 December 2020
  22. News Article
    More than three-quarters of midwives think staffing levels in their NHS trust or board are unsafe, according to a survey by the Royal College of Midwives (RCM). The RCM said services were at breaking point, with 42% of midwives reporting that shifts were understaffed and a third saying there were “very significant gaps” in most shifts. Midwives were under enormous pressure and had been “pushed to the edge” by the failure of successive governments to invest in maternity services, said Gill Walton, the chief executive of the RCM. “Maternity staff are exhausted, they’re demoralised and some of them are looking for the door. For the safety of every pregnant woman and every baby, this cannot be allowed to continue,” she said. “Midwives and maternity support workers come into the profession to provide safe, high-quality care. The legacy of underfunding and underinvestment is robbing them of that – and worse still, it’s putting those women and families at risk.” RCM press release Read full story Source: The Guardian, 16 November 2020
  23. News Article
    NHS England has told hospitals in the Midlands to further dilute their staffing ratios so critical care capacity can be doubled, HSJ has learned. In a letter sent on 9 January to the boards of all trusts in the region, national leaders said they needed to “dilute nursing ratios beyond the current ask of 1:2” to achieve the significant increase in capacity. In November, all trusts in England were told they could dilute staffing ratios in critical care from the standard one nurse to one patient ratio, to one nurse to two patients. Informal reports from around the country suggest some trusts have already had to move beyond these ratios. The letter said trusts had already been asked to surge capacity to 150% cent of the normal baseline on 6 January, and were expected to be at 175% today. But it said some units were still not achieving this and the region was “transferring patients to other regions.” It added: “In addition to this, you need to have well developed plans in place that can be rapidly activated to surge to 200% of baseline, which may need to be enacted in the coming days. Read full story (paywalled) Source: HSJ, 11 January 2021
  24. News Article
    A trust’s gastroenterology service was ‘in a very poor state with significant risks to patient safety’ and had poor teamworking which “blighted” the service, an external review found. The problems in the service at Salisbury Foundation Trust, Wiltshire, were so severe that the Royal College of Physicians suggested it should consider transferring key services such as management of GI bleeds and the care of hepatology patients to other hospitals. The service was struggling with poor staffing which had led to increased reliance on a partnership with University Hospital Southampton Foundation Trust, outsourcing and the daily use of locum consultants, according to the report. The trust board had identified “inability to provide a full gastroenterology service due to lack of medical staff capacity” as an extreme risk. The report said: “This review was complex and necessary as the gastroenterology service is in a very poor state with significant risks to patient safety and the reputation of the trust. We found a wide range of problems which now need timely action to ensure patients are safe.” Read full story (paywalled) Source: HSJ, 7 June 2021
  25. Event
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    Anchor institutions are large organisations, connected to their local area, that can use their assets and resources to benefit the communities around them. Health and care organisations, as well as providing healthcare services, are well-placed to use their influence and resources to improve the social determinants of health, health outcomes and reduce health inequalities. This King's Fund event will explore what anchor institutions are, what they look like in practice and how we can embed some of those ways of working within health and care. We will look at how health and care organisations, working in partnership with other local anchor institutions, are leveraging their role as large employers and purchasers of goods and services and playing an active role in protecting the health, wellbeing and economic resilience of their local communities. Register
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