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Content ArticleScrutiny of NHS chief executive officers (CEOs) has tended to focus on the generally short tenure of their position. The implications of high turnover have been assessed but there has been limited research looking at CEOs who remain in post for long periods, whether in the same organisations or in multiple ones. This study by researchers from the University of Manchester draws on interview data collected in 2019 with 10 long serving CEOs in the English NHS, with an average tenure of 17 years.
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Last week the Professional Standards Authority for Health and Social Care (PSA) published a new report, Safer care for all – solutions from professional regulation and beyond, which examines the current state of professional health and care regulation in the UK. In this blog, Patient Safety Learning considers this report from a patient safety perspective. PSA's chief executive, Alan Clamp, has also written a blog for the hub on the report, which can be read here. -
Content ArticleThe NHS Confederation, NHS Providers, the Academy of Medical Royal Colleges, National Voices and the Richmond Group of Charities have penned a joint letter to the new Prime Minister warning that without urgent action on key priorities the NHS risks being trapped in a relentless cycle unable to meet rising patient need and demand. The five organisations, which together represent NHS leaders, clinicians and patients, are calling on the new government to take rapid action to address five key priorities in the short term. These priorities are: Workforce Social care Capital funding The impact of the cost of living crisis and inflation Strengthening the voice of people living with ill health in decision making.
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Content ArticleThe UK has fewer hospital beds than almost any other European comparator and we can ill afford any loss of hospital capacity. While Covid has undoubtedly worsened performance, crowding in emergency departments was a problem before the pandemic. There are frantic attempts to shore up battered and fragile rotas and rota coordinators are scratching their heads. Meanwhile there has been a steady increase in the number of staff off work with Long Covid. While many have been flexible and accommodating to try to maintain their services, there is increasing burnout and uncertainty as to when all this will end. The workforce needs to feel valued and supported, writes Adrian Boyle, a consultant in emergency medicine. There needs to be an acknowledgment that the system is broken.
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Content Article“I will deliver on the National Health Service” was as much detail as the new prime minister offered on health policy in her victory speech on Monday. One idea floated during her campaign, that £13bn of new funding earmarked for the NHS should be diverted to social care, might once have won plaudits. But such is the crisis now engulfing hospitals that the moment has passed. Next week, a ballot opens that could see nurses in England and Wales go on strike for the first time. A record 132,139 – or almost 10% of all NHS posts – were vacant in June. This shocking rise in the number of NHS vacancies is a symptom of the government’s dangerous neglect, says the Guardian newspaper in its Editorial.
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Content ArticleMedical litigation claim and costs in UK are rising. This study from Lane, Bhome and Somani analysed the 10-year trend in litigation costs for individual clinical specialties in the UK from 2009/10 to 2018/19.The authors concluded that addressing the issue of litigations is complex. Medically there are speciality specific issues that require attention, whilst some general measures are common to all: effective communication, setting realistic targets and maintaining a motivated, adequately staffed workforce. These, alongside legal reforms, may reduce the financial burden of increasing litigation on the NHS.
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Content ArticleThe pandemic has had an enormous impact on health and care services in the UK. In this article, Nuffield Trust fellows Jessica Morris and Sarah Reed take a closer look at access and waiting times before and after the start of the Covid-19 pandemic. They highlight that before the pandemic, pressure on the system was already reducing access to NHS services and making waiting times longer. Covid-19 has made the situation significantly worse due to the need for heightened infection control practices, rising levels of staff sickness and burnout, the cancellation of routine care and redirection of staff. Enabling services to recover will be challenging given these ongoing pressures and real-term budget cuts for the NHS this year. The article examines the impact of the pandemic on waiting times relating to: General practice Elective (planned) care Diagnostic testing Cancer care A&E Ambulance
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Content ArticleThis report from the Royal College of Nursing sets out the range of different factors that influence the total demand for staff and highlights the variety of methods for planning or reviewing staffing. However, recognising the complexities and difficulties of ensuring that staffing levels are safe is not an excuse for inaction. Health care systems are without doubt complex; which provides more reason, not less, to have a rational system in place to ensure that staffing levels and mix are evidence based and patient safety is maintained.
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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 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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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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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 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 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 Academy of Medical Royal Colleges looks at the possibilities for establishing a system of staggered changeover start dates for trainee doctors. Evidence suggests that there is an increase in patient morbidity and mortality at the beginning of August each year, which corresponds with the time when trainee doctors rotate positions. The paper, produced by the Academy’s Staggered Trainee Changeover Working Group (STCWG), recommends that the most effective solution for safe trainee changeover is a roll forward model of staggering, where the more senior trainees rotate one month later. A survey of Foundation doctors demonstrated support for a system where all Specialty Training programmes start at the beginning of September, one month after the end of the Foundation Programme.
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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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Content ArticleOver the last four years, Health Education England (HEE) has led a collaborative effort, on behalf of patients, the profession and the NHS, to co-create reforms across medical education and training. HEE launched the Future Doctor Programme last year, linked to work on the NHS People Plan, to inform and galvanise change in medical education and training to achieve the vision for future healthcare as set out in the NHS Long Term Plan. The Future Doctor Programme provides a clear view of what the NHS, patients and the public require from future doctors within a transformed multi-professional team. This co-created vision for the future has also identified much of what is required to respond to the projected demands and needs of the workforce in the future.
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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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This is part of our series of Patient Safety Spotlight interviews, where we talk to people working for patient safety about their role and what motivates them. Jordan talks to us about his journey from drama school to patient safety, how the new Patient Safety Incident Response Framework (PSIRF) will change the way the NHS looks at safety, and how his love of driving makes him think differently about his role. A transcript of the interview is also available below.- Posted
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Content ArticleThis report outlines the Royal College of Psychiatrists in Scotland's priorities for the Scottish Parliament. The report centres on the idea that there should be 'no wrong door' for individuals in all communities to accessing the right care, in the right place, at the right time for mental ill health. It highlights the significant effects of the Covid-19 pandemic on the mental health of the population: The number of people with high levels of psychological distress (indicating a potential psychiatric disorder) has doubled during the Covid-19 pandemic to 35.6%. Those most vulnerable to psychological distress (67%) were those with pre-existing mental ill health–the population already supported by psychiatrists. Women, young people, ethnically diverse communities and the economically disadvantaged have also been disproportionately affected.
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Content ArticleThe House of Commons Health and Social Care Select Committee has published a report highlighting the current health and social care workforce crisis in England. The 'Workforce: recruitment, training and retention' report, which calls for a robust workforce strategy, states that within the NHS in England there’s a shortage of over 50,000 nurses and midwives, while in April this year hospital waiting lists reached an all-time high of almost 6.5 million.
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Content ArticleReducing hospital bed days is currently the ultimate currency in healthcare. Large amounts of money seem to increasingly be diverted from tried and tested workforces into new services, new jobs, and new technology in order to prevent patients being admitted to hospital. Some of these new ideas could work well, while others have the potential to be a catastrophe, but what unites them all is a focus on a single outcome: saving bed days in the acute hospital. But The NHS's single minded pursuit of admission avoidance risks ignoring other important outcomes, writes Alison Leary in this BMJ opinion piece.
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Content ArticleDavid Oliver is a consultant in geriatrics and acute general medicine who has worked in the NHS for 33 years. In this blog, he talks about his personal experience of running covid 'hot' wards during the different waves of the pandemic, describing the toll working in these conditions has taken on the health of him and many of his colleagues. He highlights the impact of looking after dying patients without adequate PPE, informing family members of patients' death over the phone, being responsible for many more patients than usual and witnessing colleagues die from Covid-19. The result has been burnout, mental health issues and low morale for a workforce that was already stretched before the pandemic hit the UK. David finally caught Covid-19 himself in March 2022 and he talks about how the virus—plus the cumulative effect of working under such strain for over two years—has meant he is not able to work and has been signed-off sick since mid-May.
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Content ArticleIn this press release, The Health Foundation responds to the Autumn Statement delivered by the Chancellor of the Exchequer Jeremy Hunt on 17 November 2022. They highlight that although the planned additional funding for the NHS and social care is welcome, abandoning planned changes to introducing a cap in social care costs will leave older and disabled people without the care they need, with many facing catastrophic costs. They also highlight that although the Chancellor committed to publishing long-term workforce projections, he did not offer additional funding or any plan to actually expand the workforce.
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