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News Article
NHSE cuts elective targets and admits PM’s waiting list pledge under threat
Patient Safety Learning posted a news article in News
NHS England has reduced its elective activity target for the service because of the impact of junior doctors’ strike, and acknowledged the service may not hit the prime minister’s pledge to reduce waiting lists before the next general election if the industrial action continues. NHSE has agreed a deal with ministers which will see the “value based” elective activity target set for the service reduced for 2023-24 from 107 per cent of pre-pandemic levels to 105 per cent (See explainer box on value-based targets below). Trust finance bosses were briefed by NHSE chief finance officer Julian Kelly this morning (Wednesday 12 July) on the eve of junior doctors’ longest strike action to date. Read full story (paywalled) Source: HSJ, 12 July 2023 -
News ArticleStaff fell asleep while on duty at a mental health trust, inspectors found. The Care Quality Commission (CQC) said it was "very disappointed" to find patient safety being affected by the same issues it had seen previously. It said on acute wards for adults of working age and psychiatric intensive care units, five patients described staff falling asleep at night. Despite CCTV being available, managers told the CQC they could not always immediately prove staff had been sleeping as accessing the pictures could take up to a fortnight. The CQC report added trust data from June to December 2022 recorded 20 incidents of staff falling asleep while on duty but no action was taken because the video evidence had not been viewed. Rob Assall, the CQC's director of operations in London and the East of England, said: "When we inspected the trust, we were very disappointed to find people's safety being affected by many of the same issues we told the trust about at previous inspections. "This is because leaders weren't always creating a culture of learning across all levels of the organisation, meaning they didn't ensure people's care was continuously improving or that they were learning from events to ensure they didn't happen again." Read full story Source: BBC News, 12 July 2023
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News Article
Baby died of brain injury after midwives ‘neglected’ mum while breastfeeding
Patient Safety Learning posted a news article in News
Olly Vickers died of a brain injury in February last year just weeks after two midwives at Royal Bolton Hospital let his mother Emma Clark feed him while she was having gas and air – in breach of guidelines. Despite being well when he was born, Olly was found “pale and floppy” hours later due to his airways being obstructed. He developed a brain injury and died five months later. Coroner Peter Sigee ruled his death was a result of “neglect” and due to a “gross failure to provide basic medical care”. An inquest into his death heard a student midwife placed a pillow under his mother’s arm while she was feeding him, “contrary to accepted practice”. Another midwife then gave Ms Clark gas and air while she was feeding Olly as she was stitched up for a tear obtained during labour – which again went against guidance. No risk assessment was carried out and the coroner said Olly’s breastfeeding should have been stopped before the midwives began to suture Ms Clark. Read full story Source: The Independent, 8 July 2023 -
News Article
Racism is ‘stain’ on NHS for staff and patients, says psychiatry chief
Patient Safety Learning posted a news article in News
Racism is “a stain on the NHS” and tackling it is key to recruiting and retaining staff, the outgoing president of the Royal College of Psychiatrists (RCP) will warn. The health service has a moral, ethical and legal duty to do more to stamp out racism, Dr Adrian James is expected to say at the college’s international congress in Liverpool. He will cite pay gaps, disparities in disciplinary processes and a “glass ceiling” for doctors from minority ethnic backgrounds who want to progress into management positions as problems in the NHS that are linked to racism. Last month, the NHS Race and Health Observatory, which was formed in 2021 to examine disparities in health and social care based on race, said better anti-racism policies could strengthen the NHS workforce. The RCP agreed that “better care, training and anti-racist policies” would increase staff numbers in the NHS, and that this would “improve patient experience and save millions of pounds spent annually on addressing racism claims brought by staff, clinicians and patients”. Read full story Source: The Guardian, 10 July 2023 -
News Article
Most doctors think ministers want to destroy NHS, BMA boss says
Patient Safety Learning posted a news article in News
Most frontline medics believe ministers are seeking to “destroy the NHS” because they have starved it of cash and mistreated its staff, the leader of Britain’s doctors has said. Prof Philip Banfield also warned that the health service, which on Wednesday will mark the 75th anniversary of its creation, is so fragile that it may not survive until its 80th. Banfield, the British Medical Association’s chair of council, mounted an unusually strong attack on the government’s handling of the NHS in an interview with the Guardian. “This government has to demonstrate that it is not setting out to destroy the NHS, which it is failing to do at this point in time,” he said. “It is a very common comment that I hear, from both doctors and patients, that this government is consciously running the NHS down. [And] if you run it down far enough, it’s going to lead to destruction. “You’ll struggle to find someone [among doctors] on the frontline who thinks otherwise, because that’s what it feels like.” Read full story Source: The Guardian, 4 July 2023 -
News Article
‘Misogyny’ and ‘medical patriarchy’ widespread at major trust, reports find
Patient Safety Learning posted a news article in News
A major teaching trust is dominated by a “medical patriarchy”, while “misogynistic behaviour” is a regular occurrence, two investigations have discovered. Two reports into University Hospitals Birmingham Foundation Trust have been published. They are the outcome of an investigation into the trust’s leadership carried out by NHS England, and an oversight review by former NHSE deputy medical director Mike Bewick. They follow major concerns being raised over recent months about safety, culture, and leadership at the trust. The NHSE review said the trust “could do more to balance the medical patriarchy that dominates” the organisation. It noted consultants are invited to observe a chief executive’s advisory group meeting, but nursing, midwifery and allied health professional leaders are not.” On culture, NHSE said the trust should take steps to ensure staff can work in psychologically safe environments where “poor behaviours are consistently addressed” and to “eradicate bullying and cronyism at all levels of the organisation”. Staff had described “inequity and cronyism” being a feature of recruitment processes at all levels. Read full story (paywalled) -
News ArticleThe head of NHS England has warned that July's planned strikes in the health service could be the worst yet for patients. Amanda Pritchard said industrial action across the NHS had already caused "significant" disruption - and that patients were paying the price. This month's consultant strike will bring a "different level of challenge" than previous strikes, she said. Junior doctors and consultants will strike for a combined seven days. Ms Pritchard told the BBC's Sunday with Laura Kuenssberg programme that the work of consultants - who are striking for the first time in a decade - cannot be covered "in the same way" as junior doctors. "The hard truth is that it is patients that are paying the price for the fact that all sides have not yet managed to reach a resolution," she said. Read full story Source: BBC News, 2 July 2023
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News ArticleNearly 170,000 workers left their jobs in the NHS in England last year, in a record exodus of staff struggling to cope with some of the worst pressures ever seen in the country’s health system, the Observer can reveal. More than 41,000 nurses were among those who left their jobs in NHS hospitals and community health services, with the highest leaving rate for at least a decade. The number of staff leaving overall rose by more than a quarter in 2022, compared to 2019. The figures in NHS workforce statistics of those leaving active service since 2010 analysed by the Observer show the scale of the challenge facing prime minister Rishi Sunak. He launched a new workforce plan on Friday to train and keep more staff. Sir Julian Hartley, chief executive of NHS Providers, said: “Staff did brilliant work during the pandemic, but there has been no respite. The data on people leaving is worrying and we need to see it reversed. “We need to focus on staff wellbeing and continued professional development, showing the employers really do care about their frontline teams.” Read full story Source: The Guardian, 1 July 2023
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News Article
Trust leadership rated ‘inadequate’ as CQC accuses staff of ‘ignoring’ problems
Patient Safety Learning posted a news article in News
An acute trust’s leadership has been downgraded to ‘inadequate’ after some staff ignored concerns raised directly by CQC inspectors, while others said bullying was ‘rife’. The Care Quality Commission (CQC) found multiple reports of staff raising concerns at York and Scarborough Foundation Trust, but that staff felt they were “ignored”, dismissed or “swept under the carpet”. The trust’s leadership has been rated as “inadequate”, down from “requires improvement”, although its overall rating remains “requires improvement”. The CQC said “poor leadership was having an impact across all of the services” and there were occasions “where leaders displayed defensiveness or appeared to tolerate poor behaviours from staff.” The trust said it had been under “sustained pressure” but had already begun to make improvements, including a new information system in maternity services and a review of nursing establishment numbers. Read full story (paywalled) Source: HSJ, 30 June 2023 -
News ArticleHealthcare staff from the European Union can join or continue to work in the NHS for the next five years without undergoing additional exams or further assessments, the government has decided. The “standstill provisions”, which were put in place after the UK left the European Union in 2020, have been extended by government until 2028. The NHS has become increasingly reliant on recruiting staff from overseas, particularly nurses, but has seen a significant drop in the number of staff joining from the European Union post-Brexit. The review by the Department of Health and Social Care said: “Retaining the standstill provisions for a temporary period of five years will support the [DHSC’s] ambition to attract and recruit overseas healthcare professionals, without introducing complex and burdensome registration routes. “[European Economic Area]-qualified healthcare professionals will be able to continue to register with the relevant professional regulator, without the need to sit additional professional exams, mitigating delays to registration and employment in the NHS.” Read full story (paywalled) Source: HSJ, 29 June 2023
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News Article
NHS staff sickness hits record high in England
Patient Safety Learning posted a news article in News
Staff sickness in the NHS in England has reached record levels. Figures for 2022 show an absence rate - the proportion of days lost - of 5.6%, meaning the NHS lost the equivalent of nearly 75,000 staff to illness. This is higher than during the peak pandemic years of 2020 and 2021 - and a 29% rise on the 2019 rate. Mental health problems were the most common cause, responsible for nearly a quarter of absences, the Nuffield Trust analysis of official NHS data shows. Big rises were also seen in cold, coughs, infections and respiratory problems, likely to be linked to the continued circulation of Covid as well as the return of flu last year. The think tank warned the NHS was stuck in a "seemingly unsustainable cycle" of increased work and burnout, which was contributing to staff leaving. The analysis, exclusively for BBC News, comes ahead of the publication of the government and NHS England's long-awaited workforce plan. Read full story Source: BBC News, 29 June 2023 -
News Article
Nurses strikes to end but now senior doctors vote to walk out
Patient Safety Learning posted a news article in News
Nurses strikes are set to end but the disruption for NHS patients will continue as senior doctors are the latest to vote to walk out. The Royal College of Nursing failed to reach the threshold needed to hold further action, with just 43% of the required 50% of members returning a ballot to hold fresh walkouts. But more than 24,000 members of the British Medical Association (BMA) backed industrial action by 86% on a turnout of 71%, well above the legal threshold of 50%, with senior doctors set to strike on 20 and 21 July. It comes after the union last week announced a five-day strike by junior doctors will be held from 13 July. NHS leaders have said consecutive walkouts from junior doctors and now consultants presents a “huge risk” for the health service. Read full story Source: The Independent, 27 June 2023 -
News Article
Black patients worst affected by 2016 junior doctors’ strike
Patient Safety Learning posted a news article in News
Black patients at trusts most affected by 2016’s junior doctors’ strike suffered significantly more than their white or Asian counterparts, a new analysis has suggested. Research by the Institute for Fiscal Studies analysed 30-day readmission rates after the 48-hour junior doctors’ strike in April 2016. The co-authors of the research, George Stoye and Max Warner, said: “We find that patients treated in hospitals that were more exposed to the strike did not, on average, experience worse outcomes.” However, they added that black patients were “more negatively affected by exposure to the strikes than white patients in the same hospitals”. The April 2016 strike affected both elective and emergency care and was the last before the dispute ended. The current junior doctors’ strike has been ongoing since March. It also affects emergency and elective care but stoppages have been longer, with a five-day strike planned in July. Read full story (paywalled) Source: HSJ, 27 June 2023 -
News ArticleJunior doctors will take part in what is “thought to be the longest single period of industrial action in the history of the health service” for five days next month. The British Medical Association junior doctor committee announced this morning there would be a walkout from 7am on Thursday 13 July and 7am on Tuesday 18 July in its ongoing pay dispute with government. It comes amid growing expectation that a Royal College of Nursing ballot on further strike action over the Agenda for Change pay award, which ends this week, is likely to fail to secure a mandate. But junior doctors’ strikes are continuing to hit elective recovery, and strain relationships, with workload on other groups increased as they are asked to provide cover. Junior doctors have allowed no “derogations” (exemptions) from the action, as they say other staff groups can cover emergency care, and one move to call them in to a busy hospital in the south west, in an earlier round, was abandoned. Read full story (paywalled) Source: HSJ, 23 June 2023
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News Article
Largest private-sector nurses strike in U.S. history begins in Minnesota
Patient Safety Learning posted a news article in News
About 15,000 nurses in Minnesota walked off the job Monday to protest understaffing and overwork — marking the largest strike of private-sector nurses in U.S. history. Slated to last three days, the strike spotlights nationwide nursing shortages exacerbated by the coronavirus pandemic that often result in patients not receiving adequate care. Minnesota nurses charge that some units go without a lead nurse on duty and that nurses fresh out of school are delegated assignments typically held by more experienced nurses, across some 16 hospitals where strikes are expected. The nurses are demanding a role in staffing plans, changes to shift scheduling practices and higher wages. “I can’t give my patients the care they deserve,” said Chris Rubesch, the vice president of the Minnesota Nurses Association and a nurse at Essentia Health in Duluth. “Call lights go unanswered. Patients should only be waiting for a few seconds or minutes if they’ve soiled themselves or their oxygen came unplugged or they need to go to the bathroom, but that can take 10 minutes or more. Those are things that can’t wait.” Read full story (paywalled) Source: Washington Post, 12 September 2022 -
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
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
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
NHS whistleblower recorded her bosses’ ‘racist’ chat
Patient Safety Learning posted a news article in News
A black NHS worker has launched legal action against the health service’s blood and transplant authority after witnessing years of alleged racism within the service. Melissa Thermidor, 40, from Bushey, Hertfordshire, has lodged an employment tribunal claim against NHS Blood and Transplant (NHSBT) and two executives who have since left the authority. Betsy Bassis and Millie Banerjee, who were the chief executive and chairwoman, have denied the allegations and intend to fight the tribunal claims. One colleague allegedly said: “White donors are more likely to shop at Waitrose and black donors at Tesco.” At subsequent meetings, the phrase “Tesco donors” was used. Staff also allegedly referred to “you people” when speaking to black members of the team. Thermidor claims she was constructively dismissed after whistleblowing about racism within NHSBT. The health authority, which supported 3,386 organ donations in the year to March last year as well as collecting blood from 761,000 donors, has been embroiled in allegations of bullying, racism and poor culture under Bassis and Banerjee’s leadership. Read full story (paywalled) Source: The Times, 21 August 2022 Read NHS Blood and Transplant's response to the article. -
News Article
Staffing crisis leaves many English care home residents’ basic needs unmet
Patient Safety Learning posted a news article in News
Thousands of vulnerable people are suffering inadequate care as severe staffing shortages in previously good care homes push operators to break rules and put residents at risk. A wave of inspections has revealed the human impact of a worsening nationwide staffing crisis, with people being left in their rooms 24 hours a day, denied showers for over a week, enduring assaults from fellow residents, and left soaking in their own urine. Stretched staff have described scrambling to help residents with buzzers going off and fear the squeeze on their time is dangerous. Analysis by the Guardian revealed that staff shortages were identified as a key problem in three-quarters of all the care homes in England where the Care Quality Commission regulator had cut their rating from “good” before Covid-19 to “inadequate” this summer. A further 10% of homes whose rankings slumped had enough staff, but failed to recruit safely, either not taking references properly, carrying out criminal records checks, or training staff adequately. Families said the staffing shortages had reached “crisis point”. “Older people are paying a heavy price for these failings, as poor care robs them of their dignity, breaks their will and makes them feel unsafe in their own home,” said Helen Wildbore, director of the Relatives and Residents Association. “Older people need much more than empty slogans from the next prime minister about ‘fixing social care’.” Read full story Source: The Guardian, 21 August 2022 -
News Article
Covid-19 'unmasked' existing problems in Irish healthcare
Patient Safety Learning posted a news article in News
The Irish health services did “relatively well” during Covid-19 but, as in other countries, the pandemic unmasked existing problems, a renowned patient safety expert has said. Peter Lachman of the Royal College of Physicians of Ireland (RCPI), was one of nine international experts who consulted on a new World Health Organization (WHO) report on the implications of the Covid-19 pandemic for patient safety. Dr Lachman said the impact is only starting to be understood. “Ireland did very well early on [in the pandemic], then opened up over Christmas [2020] which led to our numbers going sky-high, then we clamped down again,” he said. "We did well on some things and not so well on others. We have done relatively well when compared with other countries." “Covid-19 was an event which around the world unmasked problems which were there already rather than creating them necessarily,” he said. “The findings start with safety problems — we’ve had safety problems in Ireland but things are getting better. There is a good strategy coming on. I’ve worked with hospitals around the country on this. It’s no worse than other countries.” Read full story Source: The Irish Examiner, 12 August 2022 -
News Article
Inspection blitz on maternity units amid new system safety concerns
Patient Safety Learning posted a news article in News
Almost 200 maternity units in England will be inspected by the Care Quality Commission amid fears for mothers and babies’ safety and concerns that improvements are not happening fast enough. The commission is taking the unusual step as NHS England faces accusations of pressuring hospitals to reorganise the way midwives work when they lack the staff to do it safely. The new model of care, which is designed to provide mothers with a dedicated midwife throughout pregnancy, has been introduced only partially across the NHS, leading to a two-tier service in which hospital wards are left short of staff and women face potentially dangerous delays. Under “continuity of carer”, midwives work in teams and are on call for specific mothers when they go into labour. But this can leave hospital wards understaffed and women not included in the programme waiting for a midwife. NHS England is pushing hospitals to make this the default model of care by March 2024 despite a warning by Donna Ockenden, who led the inquiry into baby deaths at the Shrewsbury and Telford Hospital Trust, and who said in her final report that introduction of the new model should be suspended if services lack enough staff. Read full story Source: The Times, 14 August 2022 Further reading - Midwifery continuity of carer resources on the hub. -
News ArticleSpecialist nurses at an NHS hospital have been told they may be taken off clinical shifts to help clean wards, it has emerged. Bedfordshire Hospitals NHS Foundation Trust has said it asked nursing staff to help clean wards as the hospital faced the “most challenging circumstances” it has ever faced. Clinical specialist nurses, who are advanced nurses and can usually have hundreds of patients under their care, were among those asked to spend entire shifts helping other wards “cleaning”, “tidying” and “decluttering”. The news has prompted criticism from unions, however, multiple nurses have reported that the requests happen “often” during winter. Alison Leary professor of healthcare and workforce at South Bank University warned that asking specialist nurses to drop their work was “very risky”. She said: “This problem keeps cropping up-as soon as there is pressure on wards they are expected to abandon their patients. It usually happens in winter and so it’s concerning that it has now started to happen in summer. “This also shows very little respect for nursing generally and will not help retention. Trusts need to plan workforces accordingly and should ensure they have the right amount of cleaning, administrative and housekeeping staff-all staff groups which contribute to patient safety and care quality." Read full story Source: The Independent, 8 August 2022
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News Article
Child deaths expose mental health unit pressures
Patient Safety Learning posted a news article in News
Deaths, staff shortages and a culture of life-threatening self-harm are exposing deep fears about the quality of mental health care in hospitals for children and young people. Since 2019, at least 20 patients aged 18 or under have died in NHS or privately-run units, the BBC has found. A further 26 have died within a year of leaving units, amid claims of a lack of ongoing community support. The NHS said it had "invested record amounts... to meet record demand". Child and Adolescent Mental Health Services (CAMHS) units look after about 4,000 patients with many different diagnoses each year. The aim is to help them recover over a period of weeks or months through specialist care. Some patients are in and out of the units for years. The BBC has also heard serious claims regarding the unsafe discharge of patients sent home from CAMHS hospitals. Several former patients told the BBC they had serious self-harm incidents or tried to take their own life within days of returning home. Parents have described being on "suicide watch" 24 hours a day, to ensure their child's safety. Read full story Source: BBC News, 9 August 2022 -
News Article
Multiple reporting systems undermine patient safety, says watchdog
Patient Safety Learning posted a news article in News
A single system to report patient safety concerns would “keep people safer”, a newly appointed NHS watchdog has told HSJ. Henrietta Hughes – who will take up the post of patient safety commissioner in September – said both clinicians and patients faced a bewildering choice when looking to raise a safety concern, and that there was a need for a “report once” system. She said that when ”exhausted” clinicians “come to the end of a 12-hour shift, they don’t want to have to do a Datix report and a yellow card report, and if they’ve got a safeguarding concern or a concern about an individual condition, [to have to] send that somewhere else”. Dr Hughes added: ”Wouldn’t it be better if we had one report that you do, and all the information that comes from that report just gets sent to the appropriate authority? That’s the type of change that I think we’d like to see. I know, as a GP myself, that’s what I would rather do as a professional. But also, I think, for all the organisations, we could get so much more richness of information, we would get more reporting, and we’d keep people safer as a result of it.” She added that if a patient “wanted to report an individual clinician” they often ended getting bounced around the system, like a pinball. They get sent from pillar to post.” Read full story (paywalled) Source: HSJ, 8 August 2022
