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News Article
Paramedics are ‘leaving in droves’ as ambulance callouts almost double
Patient Safety Learning posted a news article in News
The number of calls for an ambulance in England have almost doubled since 2010, with warnings of record pressures on the NHS that are seeing A&E patients stuck in corridors and many paramedics quitting the job. Ambulance calls have risen by 10 times more than the number of ambulance workers, according to a new analysis of NHS data carried out by the GMB union. An increase in people seeking emergency treatment, GPs unable to cope with demand and cuts to preventive care are all being blamed for the figures. While the figures represent all calls for an ambulance, some of which go unanswered and do not lead to a vehicle being sent, they reveal the increasing pressures that have led to claims that patient safety is being put at risk by ambulance waiting times. There has been a significant increase in the number of the most serious safety incidents logged by paramedics in England over the past year. Paul, a paramedic and GMB deputy branch secretary, said he had recently seen a crew waiting almost 10 hours between arriving at hospital and transferring a patient to hospital care. “They arrived at the hospital at 20.31,” he said. “They then cleared from the hospital at 05.48 in the morning. The impact of the lack of resources is affecting the ambulance service. “We are also seeing people become aggressive to the ambulance crew, because they’ve waited hours upon hours in an ambulance." Read full story Source: The Guardian, 12 June 2022 -
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
Eight trusts win place on elective recovery project
Patient Safety Learning posted a news article in News
Eight trusts have been awarded roles trialling a new accreditation scheme for surgical hubs as part of an NHS England pilot that will run until March. The creation of up to 140 surgical hubs, sites which are ring-fenced for surgical work only, is a key plank of the NHS England and government elective recovery plan for addressing the backlog. The full benefits are still being finalised but accredited trusts will likely get better access to additional recovery funding and central support from the Getting It Right First Time team. The hubs will focus mainly on providing high volume, low complexity surgery, as previously recommended by the Royal College of Surgeons of England, with particular emphasis on ophthalmology, general surgery, trauma and orthopaedics (including spinal surgery), gynaecology, ear nose and throat, and urology. Read full story (paywalled) Source: HSJ, 12 January 2023 -
News Article
NHS trust cancels all routine operations for three weeks
Patient-Safety-Learning posted a news article in News
Some hospitals in Scotland have been told to postpone surgeries to ‘decongest’ the system as the crisis in the health service deepens. A group of NHS hospitals has stopped routine surgery for three weeks in an unprecedented step, as pressures mount on the health service. Health bosses at the NHS Ayrshire & Arran trust warned of “extremely high demand” across the system, as they also asked GPs to see only urgent cases. Rishi Sunak has repeatedly urged trusts to avoid cancelling elective surgery, urging hospitals not to repeat the errors made in the pandemic, which resulted in record backlogs. Clare Burden, the chief executive of NHS Ayrshire & Arran, said the cancellations were necessary "due to a combination of staff absence across the system, high bed occupancy levels in our acute and community hospitals, high levels of flu and Covid in our community, some delayed transfers of care, and high volumes of frail patients whose recovery includes complex care.” Read full story (paywalled) Source: The Telegraph, 11 January 2023 -
News Article
‘No quick fix’ to NHS struggles, says Nuffield Trust chief exec
Patient-Safety-Learning posted a news article in News
Nigel Edwards is the Chief Executive of the think tank the Nuffield Trust. In this interview, he outlines the discharge problems currently faced by NHS hospitals, highlighting lack of staff and resources in the social care sector as major causes of hospital capacity issues. Source: Channel 4 News -
News Article
NHS Wales consultant explains why healthcare system is on verge of collapse
Patient Safety Learning posted a news article in News
The NHS is on the verge of collapse due to demand for healthcare rising significantly faster than funding levels, a consultant has warned. Peter Neville, a consultant for NHS Wales, took to social media to explain why, in his view, the system is failing. The consultant physician, who has been working in the NHS in Yorkshire and Wales for 32 years, set out the challenges facing the health service in a Twitter thread. He said he had experienced the NHS at its best, in 2008, and its worst, in 2022. He wrote: "Over at least the past 15 years, we have seen a relentless increase in demand, both in primary care and in hospital care. This has been absolutely predictable by social statisticians for decades and is based on the fact that our elderly are surviving much longer. "Our elderly use a very large percentage of NHS of resources, unsurprisingly because they are more prone to disease, frailty, and dementia. They need more social care and hospital care as they get older. And they are living longer. (Immigrants, by the way, use much less care). "Over this period NHS funding has, broadly speaking, risen about 1-2% over inflation. If NHS funding increases with inflation yet demand increases, then clearly spend per person will drop. Demand has increased considerably above 2%, which is why the NHS is failing to manage it." Read full story Source: Wales Online, 3 January 2023 -
News Article
Ministers told to set out plan for hiring mental health nurses in England
Patient Safety Learning posted a news article in News
UK ministers must set out how to recruit and retain thousands more mental health nurses to plug the profession’s biggest staff shortage, healthcare leaders are warning. Mental health nurses account for nearly a third of all nursing vacancies across England, resulting in overstretched services that are struggling to deliver timely care, according to research carried out by the NHS Confederation’s mental health network. Sean Duggan, the network’s chief executive, said: “Mental health leaders and their teams are pulling out all the stops in what are very constrained circumstances, but they cannot be expected to solve this staffing crisis alone. “The knock-on effect means that the mental health crisis the nation is facing will in turn become a crisis for the whole healthcare system and the country. This relentless pressure on mental health staff cannot be allowed to continue with the ultimate impact being on the patients who most need that care.” Read full story Source: The Guardian, 16 May 2023 -
News Article
Hospital to send hundreds of births elsewhere
Patient Safety Learning posted a news article in News
The trust at the centre of a maternity scandal is trying to reduce the number of births at its main maternity units by 650 a year following a highly critical Care Quality Commission (CQC) visit. East Kent Hospitals University Foundation Trust is looking at ways to reduce pressure on staff at the William Harvey Hospital in Ashford, including stopping bookings from women who are “out of area”. The unit currently has around 3,600 births a year, of which 200 are out-of-area bookings. The trust is also seeking to send more births to its other site, in Thanet. It comes after the CQC used enforcement powers to order immediate improvements at the unit, following a visit in January, when it had “significant concerns about the ongoing wider risk of harm to patients”. Earlier this year, the trust’s new chief executive, Tracey Fletcher, held what board papers describe as an “emotional” meeting with 135 midwives, other staff and senior Royal College of Midwives representatives. She was told by staff that the service at the WHH was not felt to be safe due to a lack of substantive staff, high acuity of patients and the level of activity. Read full story (paywalled) Source: HSJ, 28 April 2023 -
Content ArticleNHS England recently published its Delivery Plan for Recovering Urgent and Emergency Care Services, with goals and actions for the next two years. David Oliver, consultant in geriatrics and acute general medicine, gives his opinion on the plan.
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Content ArticleIn this episode of The Human Risk podcast, host Christian Hunt speaks to Dr Gordon Caldwell, a retired NHS Consultant and Clinical Lead about the impact of medical bureaucracy. In 2019, Gordon had a photograph taken of himself lying next to a long line of forms, to highlight the amount of paperwork healthcare professionals need to fill in. Gordon is a campaigner against bureaucracy, and he wanted to make the point that time spent filling in forms is time spent not looking after patients. In the podcast, Christian and Gordon discuss: the genesis of the photograph and why Gordon felt motivated to take it the reasons why there is so much bureaucracy within the NHS the impact this has on patient care what Gordon sees as ways to improve it. See also: The Spectator: The NHS is drowning in paperwork Pictured: Doctor shows army of ‘pointless’ forms burying NHS hospitals
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Content ArticleThis study in JAMA Health Forum aimed to assess the costs of inpatient falls and cost benefits associated with the Fall TIPS (Tailoring Interventions for Patient Safety) Program. The authors carried out an economic evaluation across a large cohort of 900,635 patients. The average total cost of a fall was $62 521 ($35 365 direct costs), and injury was not significantly associated with increased costs. The Fall TIPS Program was associated with $22 million in savings at study sites across the five year study period. The findings of this study indicate that implementation of cost-effective, evidence-based safety programs was associated with lower cost and care burdens associated with inpatient falls and are a step toward safer, more affordable patient care.
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Content ArticleEmergency access to healthcare is in crisis. Unmet need in primary and community care and low capacity in hospitals and social care has left the emergency health services gridlocked and overwhelmed, unable to provide safe care. This Cross party House of Lords Public Services Committee report recommends that a COBR Committee be assigned the responsibility to address the crisis in emergency healthcare. In the long-term, it recommends a a substantial overhaul is needed, one which sets out a bold new operating model for the system as a whole, and which is backed by equally bold leadership.
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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 ArticleIn this blog, Jonathan Back, Intelligence Analyst at the Healthcare Safety Investigation Branch (HSIB), looks at the opportunities the healthcare system has to adopt proactive risk management to improve patient safety. He highlights that understanding the value of different perspectives may provide new opportunities for improvement if applied across the health and care system. He also outlines the role of the new integrated care boards (ICBs) in achieving this whole-system approach, which should include a clinical governance perspective, organisational and local system perspective and societal perspective.
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Content ArticleThis BMJ Opinion piece is written by Chris Ham (in a personal capacity)who was chief executive of The King’s Fund from 2010 to 2018. Chris talks about the recent funding announcement to support hospital discharges in order to free up bed space. He highlights a number of key considerations including: the impact on patient involvement in their discharge decisions staff shortages in care homes bed capacity in care homes. Chris questions whether these decisions are 'symbolic policy making' or whether they will actually make a difference to patients.
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Content ArticleIn this article for The Guardian, an anonymous hospital consultant describes the situation in many NHS emergency departments in January 2023—patients ready for medical admission waiting in ambulances in the hospital car park, patients receiving IV antibiotics in chairs in the corridor and staff completely overwhelmed by the workload. The author highlights that accident and emergency departments are now being used for a purpose for which they were not designed—looking after patients who need to be admitted to hospital wards. They describe the implications of this on patient safety and staff wellbeing and argue that the NHS and Government need to call the situation what it is—a crisis—or we will come to accept poor quality care and low patient safety standards as the norm.
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Content ArticleIs it realistic to think of separating NHS hospital sites more effectively for “cold” (elective) and “hot” (acute and urgent) care, so that outbreaks or seasonal surges don’t lead to elective care being cancelled or delayed? David Oliver, consultant in geriatrics and acute general medicine, explores this idea in a BMJ article.
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Content ArticleWe know that NHS organisations may sometimes need to reorganise their services to consider how they can best deliver care to patients. This can mean there is a need to repurpose existing environments, for example hospital wards or clinical areas. Staff may also be redeployed to deal with surges in demand when the pressure on the system is at its greatest. We commonly see this during winter, with ‘winter pressures’ wards, but we have also seen this become more common during other times of the year as the NHS deals with the lasting impact of coronavirus (COVID-19) and staff shortages in some key areas. It’s important that the NHS has this ability to adapt to try and make sure it can deliver the best and safest care to as many patients as possible. The ability to flex in this way helps to keep the NHS operating when it is at its busiest and makes sure that patients can still access appropriate care. Scott Hislop, the Healthcare Safety Investigation Branch (HSIB) Principal National Investigator, looks at the challenges faced by the NHS when flexing to meet demands and how to mitigate potential risks to patient safety.
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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 ArticleThis report from the Institute for Fiscal Studies examines how NHS funding, resources and treatment volumes compare with pre-pandemic levels. The study examines how the funding, staffing and hospital beds available to the NHS have changed since 2019, comparing the number of patients treated by the NHS in eight different areas compares with 2019 levels. For most areas of care, the NHS is still struggling to treat more people than it was pre-pandemic, despite having – on the face of it – additional staff and funding. The report considers a range of different factors that could explain this seeming fall in performance and output.
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Content ArticleWeaknesses resulting from a patchwork of patient safety processes developed by individual healthcare organisations over the past quarter-century, exposed by the Covid-19 pandemic, can be remedied through both local systems design support and widespread best practices uniformity.
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Content ArticleLetter from Sir David Sloman Chief, Operating Officer NHS England, Professor Sir Stephen Powis, National Medical Director NHS England, and Dame Ruth May, Chief Nursing Officer, to ICBs and Trusts regarding the upcoming ambulance industrial action.
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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.
