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News Article
People with cancer face ‘ticking timebomb’ due to NHS staff shortages
Patient Safety Learning posted a news article in News
People with cancer face a “ticking timebomb” of delays in getting diagnosed and treated because the NHS is too short-staffed to provide prompt care, senior doctors have warned. An NHS-wide shortage of radiologists and oncologists means patients are enduring long waits to have surgery, chemotherapy or radiotherapy and have a consultant review their care. Hold-ups lead to some people’s cancer spreading, which can reduce the chances of their treatment working and increase the risk of death, the Royal College of Radiologists (RCR) said. NHS cancer services are struggling to keep up with rising demand for tests, such as scans and X-rays, and treatment, created by the growing number of people getting the disease. All radiology bosses surveyed said during 2024 their units could not scan all patients within the NHS’s maximum waiting times because they did not have enough staff. “Delays in cancer diagnosis and treatment will inevitably mean that for some patients their cancer will progress while they wait, making successful treatment more difficult and risking their survival,” said Dr Katharine Halliday, the RCR’s president. The findings are particularly worrying because research has found that a patient’s risk of death can increase by about 10% for each month they have to wait for treatment. Nine out of 10 cancer centre chiefs said patients were delayed starting their treatment last year while seven in 10 said they feared workforce gaps were putting patients’ safety at risk. Read full story Source: The Guardian, 5 June 2025- Posted
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News Article
‘No staffing growth’ policy implicated in patient’s death
Patient Safety Learning posted a news article in News
Repeated refusals by NHS England to fund extra staff was a key factor in a patient’s death, a coroner has said. The coroner warned that year-long delays to follow-up appointments at the Robert Jones and Agnes Hunt Orthopaedic Hospital Foundation Trust were a factor in the death of Peter Anzani, a spinal injury patient who died from a blood clot in November last year. NHS England turned down two requests to fund extra staff at the trust due to national policy and “a funding shortage”, a recent prevention of future deaths report has said. That’s despite RJAH struggling with patient demand and staffing shortages, leading to longer waits for reviews and treatments, according to the report. Adam Hodson, the coroner for Birmingham and Solihull, said in the report sent to NHSE and the hospital: “It is obvious that where patients are waiting for longer than is reasonable or necessary for treatment or reviews, there is a real risk of deaths occurring. No patient should be waiting longer than absolutely necessary for treatment.” He added: “It is concerning to hear that the trust do not appear to be being adequately supported financially by NHS England, and do not currently appear to be able to address their workplace staffing issues without additional financial support (which does not appear to be forthcoming).” Read full story (paywalled) Source: HSJ, 22 May 2025- Posted
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At 10.45am on 23 November 2024, Peter Anzani sadly died from a pulmonary embolism in Birmingham Heartlands Hospital. He had been admitted to hospital the day before and was receiving treatment for a community acquired pneumonia when he suddenly and unexpectedly collapsed due to a pulmonary embolism. Peter had previously suffered a number of falls at home in August and September 2021 and was subsequently diagnosed with suffering a spontaneous infection of the cervical vertebral canal which caused a complete spinal cord injury and left him tetraplegic. This made him more vulnerable to chest infections and pulmonary embolisms which he experienced in the years that followed. There is no evidence of any human intervention that rendered his death unnatural. Based on information from the Deceased’s treating clinicians the medical cause of death was determined to be: 1a Pulmonary Embolism 1b 1c 1d II Pneumonia Spinal cord injury resulting in Tetraplegia Matters of concern To The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust I considered evidence from a [REDACTED] who indicated at paragraphs 20-21 of his statement, “I did not see any record of his pulse, blood pressure or oxygen saturation. The normal practice is to complete these observations, and I would expect this to be done, especially with him presenting with chest issues. However, I am unable to comment why this was not recorded or confirm that these were carried out. (21) This is a learning point for the department, and I have taken steps to ensure this learning is taken forward by theTrust. I have alerted the Sister in charge of the Spinal Injuries Outpatients’ Department and requested that adequate measures are taken to ensure that all observations made are recorded in the outpatient forms…” It was unclear whether this was a single one-off event involving human error or indicative of a wider and systemic issue involving a lack of training. There was no evidence before the court that this “learning point” had been actioned or that any adequate steps had been taken to ensure proper and accurate recording of records by staff. There is a real risk of future deaths occurring where staff do not have adequate training and that patient records are not being properly completed. To NHS England / Department of Health and Social Care I heard evidence that The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust (“The Trust”) have been experiencing difficulties with patient waiting lists – due to both an increase in the quantity of patients being treated and staffing shortages – which has led to patients waiting longer than is reasonable or necessary for reviews and treatments. As part of the inquest, there was evidence that Peter Anzani himself had been waiting for nearly a year for a follow-up review, which should have been carried out after no more than 6 months. I heard evidence from representatives of the Trust that they have repeatedly requested additional funds for workforce development and expansion to assist with cutting patient waiting lists and waiting times. I understand that an initial Workplace Funding Review was submitted in 2023 but was rejected by NHS England due to a funding shortage. I understand that a further Workplace Funding Review was submitted in the Autumn of 2024, but in February/March of this year, NHS England indicated that the same would again be rejected under a “no growth policy”. Whilst naturally I am aware of the pressures on the public purse and on the NHS generally, it is concerning to hear that the Trust do not appear to be being adequately supported financially by NHS England, and do not currently appear to be able to address their workplace staffing issues without additional financial support (which does not appear to be forthcoming). It is obvious that where patients are waiting for longer than is reasonable or necessary for treatment or reviews, there is a real risk of deaths occurring. No patient should be waiting longer than absolutely necessary for treatment. In light of HM Government’s decision on 13 March 2025 to abolish NHS England and for its role to be subsumed within the Department of Health and Social Care, this report is being sent to both Agencies to consider, as it relates to issues of both a local and national significance.- Posted
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My experience of the 'Wait 45' policy
Anonymous posted an article in Florence in the Machine
The images on the left highlight the increased delays in ambulance responses and the potentially catastrophic consequences. Equally, the panic-inducing headlines of measures brought in to resolve the crisis. I work on the healthcare frontline and I’d like to share my experience of the 'Wait 45' policy in my trust and the impact it is having. Implementation of a new policy In December 2024, all ambulance trusts in England were told to implement a new policy, ‘Release to Respond’, also known as the ‘Wait 45’ policy, which means ambulances will only wait at Emergency Departments (ED) for 45 minutes before patients are left and the crews make their way to the next call. This was initiated following increasing waits for crews to handover patients to the ED. These waits were not inconsiderable periods of time, with many reports of crews spending their entire shift parked outside the ED with just one patient. This has resulted in some appalling headlines—for example, elderly people being left waiting for up to 15 hours for an ambulance to arrive and people having cardiac arrests where ambulances are not available to respond. Based on this, the adoption of the ’Release to Respond' policy makes sense. However, the introduction of this policy has been met with some scepticism and equally horrendous headlines about patients being dumped while crews run. The policy states that crews will not dump and run, and that handovers will be given, and patients will be placed on a chair, trolley or wheelchair in a dedicated space. But this policy is another example of not identifying the whole problem and bringing in a measure that only addresses the needs of one part of the healthcare system, while making it considerably worse for other parts! What is the point of an integrated care system (ICS) and board (ICB) if they do not look at an integrated intervention to address this situation? What is the reality of the ’Wait 45’ policy? The Wait 45 policy in my trust has completely changed the way the ED manages patients. Corridor care is a term used to describe the practice of providing medical attention to patients in hallways or other non-designated clinical areas due to overcrowding or resource shortages. It used to be that corridor care was for patients who had been seen, had a plan and who were either waiting to go home or for a bed on a ward. Now, in my trust, the corridor is for undifferentiated patients (patients who present with symptoms that have not yet been diagnosed or categorised) that come in directly from the ambulances. This has increased the risk to patients and staff. The corridor is used as soon as the department is full and then, only when the corridor is full to capacity, does the Wait 45 policy get initiated. At this point it is almost guaranteed that the corridor will need additional staffing from somewhere, while the first crew need to wait their 45 minutes—the hospital now has 45 minutes to find these additional staff otherwise the nurse: patient ratio increases in the corridor. The ratios of nurse to patients differs depending on the area of the hospital: in major treatment areas it is 1:4 but in the corridor it is 1:6; however, there is no upper limit of patients in the corridor and staff are often moved from other in-patient areas to work in the ED where they are invariably working in the corridor. These nurses will not have a ED background and will find it challenging and may miss the subtle signs that an experienced ED nurse may spot. There is often a lack of support for nurses in the corridor, leaving additional staff having to rely on their previous experience and judgement to guide them on what needs to be done. Handover criteria not being met Ambulance trust and the acute trust staff should at handover discuss the criteria for placing patients in a corridor—i.e., patients are supposed to be independent, able to move themselves to the toilet, be clinically stable and not have an infectious presentation However, in my experience this criteria is often not followed, as highlighted in the following examples I have seen and heard: Suspected neutropenic patients placed in the corridor. These patients have a low neutrophil count (a type of white blood cell) and are more vulnerable to infections. The concern for those on immunosuppressants seems to be non-existent now; there was a significant concern during the Covid-19 pandemic, but now being immunosuppressed is met with a tut, roll of the eyes and a shrug of the shoulders. It rarely features in handovers. Ambulance crews handing over patients that needed a hoist transfer at their nursing home; it is clearly not appropriate to care for these patients in a corridor where they should be mobile to use bedpans or commodes. Elderly patients who have fallen—either with significant trauma or with no apparent injuries—placed in the corridor. One patient had pain in their neck and received a trauma CT scan in the corridor—surely this patient should not have been in a corridor in the first place! Patients with diarrhoea and vomiting placed in the corridor, sometimes next to the neutropenic patients. Those with significant respiratory symptoms suggestive of influenza or Covid-19 placed in the corridor, despite the known risks to those that are in the corridor with them. I have even had a patient with a Glasgow Coma Scale of 10 (this is a tool that healthcare providers use to measure decreases in consciousness) handed over to the corridor… Wouldn’t resuscitation be a better location for them? Unintended consequences It is easy to understand why ‘Release to Respond’ policies are needed. With no external pressure, it appeared that many trusts lacked the willingness to investigate changes to reduce the overcrowding in the ED. However, while I recognise that the ambulance trusts need to have their staff available and not tied up at hospitals, this is making the ED unsafe. Another unintended consequence of these policies is that the working relationships between the ED nurses and the ambulance crews has deteriorated. I have noticed an increasing lack of willingness to help each other and incivility is growing. Asking simple questions results in dirty looks and aggressive questioning about ’who are you‘. The natural feeling is now one of defence, protecting each other against comments, pulling back into areas of comfort and knowledge. The standard replies are now ‘no’ and a feeling that this is not my problem or my fault. Unilateral measures that do not address the whole problem I cannot help but think implementing a unilateral solution like the ‘Release to Respond’ policy is based entirely on ‘work as imagined’ and benefits only one part of a highly complex area. It places additional burdens on already overstretched resources. The worst of which is that EDs are still seen as being made of elastic, with the ability to continually expand even when the evidence shows every hospital is beyond capacity every day of the year! When I first heard about ICSs and ICBs, I really hoped we would start to see a time of collaboration, working together to solve some of the issues within healthcare. Sadly, there does not yet seem to have been a change. In fact, it feels very much that we renamed but stayed the same. Probably, because all that has happened since the ICSs were introduced is restructuring after restructuring. They are not being allowed to work. Please, don’t get me wrong. I can see why these policies are in place. If I called an ambulance, I would like it to be available to respond and unfortunately currently they are not and have not been for a while. But I cannot help but think that until the ICS and regional NHS organisations take ownership of these problems, and all the stakeholders are represented at the table to analyse, design, implement and, most important of all, EVALUATE an intervention, we are condemned to keep implementing unilateral measures that do not address the whole problem. Further reading on the hub The crisis of corridor care in the NHS: patient safety concerns and incident reporting A silent safety scandal: A nurse’s first-hand account of a corridor nursing shift A nurse's response to the NHSE guidance on their principles for providing safe and good quality care in temporary escalation spaces How corridor care in the NHS is affecting safety culture: A blog by Claire Cox Share your insights Do you have experience of corridor care either as a patient or a healthcare professional? What impact have you seen on patient safety? You can comment below (sign up here for free first) or email the editorial team at [email protected]- Posted
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News Article
NHS staff levels ‘alarmingly low’ on wards, study finds
Patient Safety Learning posted a news article in News
A new poll reveals a deepening staffing crisis within the NHS, jeopardising patient safety, particularly in maternity and rehabilitation wards. A Unison survey of nurses, healthcare assistants, and midwives found that a staggering 69%of shifts were understaffed, a marked increase from 63% just two years ago. The survey, conducted across 42 hospitals in England, Wales, and Northern Ireland, paints a stark picture of the strain on frontline staff. Workers anonymously reported their experiences after their shifts in October and November of last year, totaling 1,470 shifts surveyed. Alarmingly, 81% of respondents working in maternity and rehabilitation units, and 82% in elderly care, expressed serious safety concerns due to inadequate staffing levels. The findings highlight a worrying trend of "red flag" events, indicating serious safety risks, occurring on over half (56%) of all shifts. Read full story Source: The Independent, 23 April 2025- Posted
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News Article
Around 49,000 A&E patients had to wait 24 hours or more for a hospital bed in England last year, according to NHS figures. Data compiled by the Liberal Democrats from freedom of information requests shows the longest wait was 10 days and 13 hours. The party said there were 48,830 "trolley waits" of 24 hours or longer in 2024. That is 19.8% higher than 2023 (40,735) and 57.9% higher than 2022 (30,921). A "trolley wait" is the time taken for a patient to be transferred to a ward after a decision has been taken to admit them to hospital. The Lib Dems said the real numbers were likely to be far higher because only 54 out of 141 NHS trusts had provided full data. The Royal College of Nursing said the figures "only begin to scratch the surface" of a "crisis in corridor care" - and that declining recruitment in nursing was adding to the problem. General secretary Professor Nicola Ranger said corridor care is "undignified and unsafe" and "must be eradicated". Read full story Source: Sky News, 21 April 2025 Further reading on the hub: How corridor care in the NHS is affecting safety culture: A blog by Claire Cox The crisis of corridor care in the NHS: patient safety concerns and incident reporting Response to RCN report: On the frontline of the UK’s corridor care crisis- Posted
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News Article
Secret files reveal 1 in 3 hospitals in England missing 10% of nurses
Patient Safety Learning posted a news article in News
After a ten-month battle, Channel 4 News’ FactCheck team has obtained NHS data revealing 1 in 3 of England’s hospitals are missing at least 10% of their planned-for nurses across their wards. After the Mid-Staffordshire scandal, the government at the time promised to shine a light on the nursing understaffing that had contributed to putting patients at risk, sometimes even costing their lives. For several years, crucial data was publicly available from NHS England. But in 2018, it was quietly shelved, and it hasn’t been possible to see it nationally since. The situation is even more serious in critical care where 20% of nurses were missing from 1 in 5 units. While in neonatal care that increases to 1 in 3 wards. Watch the full news story Source: Channel 4 News, 20 March 2025- Posted
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News Article
Brexit has left the NHS increasingly dependent on doctors and nurses from poor “red list” countries, from which the World Health Organization says it is wrong to recruit. The health service in England has hired tens of thousands of health staff from countries such as Nigeria, Ghana and Zimbabwe since the UK left the EU single market at the end of 2020. A post-Brexit surge in the number of health professionals from red list countries working in England has sparked criticism that hiring so many is “unethical” and “immoral”, and will damage those countries’ health systems. The big jump means the NHS now employs 65,610 staff from the WHO’s 55 red list countries in its 1.5 million-strong workforce. It has taken on 32,935 of those since the start of 2021, including 20,665 who joined in the 20 months between March 2023 and November 2024 alone, according to NHS figures obtained by the Nuffield Trust health thinktank. Mark Dayan, a policy analyst at the thinktank and Brexit programme lead, said: “Recruiting on this scale, from countries the World Health Organization believe have troublingly few staff, is difficult to justify ethically for a still much wealthier country. “Yet again, British failure to train enough healthcare staff has been bailed out by those trained overseas.” Read full story Source: The Guardian, 21 March 2025- Posted
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- Recruitment
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News Article
Teen died from asthma attack after she was wrongly discharged from hospital
Patient Safety Learning posted a news article in News
A coroner has voiced serious concerns over a recurring "lack of observations" at London's Royal Free Hospital following the death of a teenager. Sixteen-year-old Billie Wicks died after suffering her first ever asthma attack. Her parents rushed her to the Hampstead hospital on 17 September last year, but a new report reveals the A&E department was "understaffed" that night. The coroner's concerns highlight a potential systemic issue at the hospital regarding patient monitoring. Senior coroner for Inner North London, Mary Hassell, said that Billie should have had routine checks, or observations, taken every hour. If she had these observations, then medics would have recognised the severity of Billie’s illness, Ms Hassell said. “Billie was inappropriately discharged at approximately 3.30am without adequate repeat observations or senior clinical review, and so her asthma was not diagnosed or treated. If it had been, she probably would have survived,” she wrote in a prevention of future deaths report. “Billie should have had observations every hour. If she had had these observations, the emergency registrar who discharged her would have recognised that she was not as well as he thought, and would have sought senior medical review. “That senior medical review would have changed the course of her management and saved her life.” Read full story Source: The Independent, 18 March 2025- Posted
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On 17 September 2024, Edwin Buckett, commenced an investigation into the death of Billie Wicks aged 16 years. The investigation concluded at the end of the inquest on 6 March 2025. Billie had been brought to the Royal Free Hospital just before midnight the night before her death with an asthma attack. A first presentation of asthma at the age of 16 years without any family history is unusual, and it was a busy night in the accident and emergency department. Billie was inappropriately discharged at approximately 3.30am without adequate repeat observations or senior clinical review, and so her asthma was not diagnosed or treated. If it had been, she probably would have survived. The MATTERS OF CONCERN are as follows: On the night Billie attended, the Royal Free emergency department was understaffed, and that it remains understaffed of doctors, nurses, and even a healthcare assistant who could take basic observations. Billie should have had observations every hour. If she had had these observations, the emergency registrar who discharged her would have recognised that she was not as well as he thought, and would have sought senior medical review. That senior medical review would have changed the course of her management and saved her life. The registrar who saw Billie the night before her death prescribed an antibiotic, but he was not in the habit of giving the first dose in the department and he did not on this occasion. This meant that Billie’s infection was not tackled as quickly as it could have been. This seems to indicate a training and potentially a guideline need. At the time of Billie’s presentation, the registrar was unaware of the possibility of adult onset asthma. This seems to indicate a training and potentially a guideline need. I heard that Billie was safety netted when she was discharged. Her parents were told to bring her back if they had any concerns. I have heard this safety netting advice being described many, many times in different inquests. What worries me about it in this context is that Billie’s parents had brought her to hospital because they were concerned. They were then reassured by hospital staff. It is therefore difficult to see how this particular advice could be a meaningful instruction. In reality, her parents’ initial concern was well placed and they had responded to it appropriately by bringing Billie to hospital. When Billie began to deteriorate again, her parents’ natural instinct had been blunted by their first visit to the hospital. Whilst I doubt that it would have made a difference in this case, I understand that blood pressure is not yet an observation included in the national paediatric early warning score (PEWS).- Posted
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Between August 2020 and April 2024, US hospitals were mandated to report weekly occupancy to the Department of Health and Human Services as part of Covid-19 data tracking efforts, providing unprecedented insight into mean daily census and inpatient bed supply across nearly all hospitals nationwide. In this report, the authors repurposed this Covid-19 dashboard to describe several possible US hospital bed occupancy scenarios arising from an aging US population over the next decade, while varying hospitalisation rates and staffed hospital bed supply. The study found that the US has achieved a new postpandemic hospital occupancy steady state 11 percentage points higher than it was prepandemic. This persistently elevated occupancy appears to be driven by a 16% reduction in the number of staffed US hospital beds rather than by a change in the number of hospitalisations. Experts in developed countries have posited that a national hospital occupancy of 85% constitutes a hospital bed shortage (a conservative estimate); these findings show that the US could reach this dangerous threshold as soon as 2032, with some states at much higher risk than others. These scenarios suggest that an increase in the staffed hospital bed supply by 10%, reduction in the hospitalisation rate by 10%, or some combination of the two would offset the aging-associated increase in hospitalizations over the next decade.- Posted
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Content Article
This report sets out the Care Quality Commission (CQC) activity and findings during 2023/24 from their engagement with people who are subject to the Mental Health Act 1983 (MHA) as well as a review of services registered to assess, treat and care for people detained using the MHA. The MHA is the legal framework that provides authority for hospitals to detain and treat people who have a mental illness and need protection for their own health or safety, or the safety of other people. What the report found: Systems We remain concerned that the high demand for mental health services, without the capacity to meet it, means people cannot always get the right care at the right time. Not being able to access care in a timely way can lead to people’s mental health deteriorating while they wait for support. Through our monitoring activity, we have seen how system pressures mean people are detained far from home or in environments that do not meet their needs. Many services told us that patients seem to be more unwell on admission than in the past. Services need to balance the increase in demand for inpatient beds with ensuring existing patients are not discharged too soon. Workforce In 2023/24 there were continuing problems with workforce retention and staffing shortages, as well as concerns around training and support for staff. Although the mental health workforce has grown by nearly 35% since 2019, shortages in both medical and support roles continue to have a negative impact on patient care. Shortages of doctors also continue to affect the delivery of our second opinion appointed doctor (SOAD) service. We remain concerned about the long-term sustainability of the service, with proposals in the Mental Health Bill due to increase the numbers of second opinions required while reducing the timeframes for delivery of some second opinions. Inequalities We are concerned that some of the key issues we raise in this report, including access to mental health support, are particularly challenging for certain groups of people, such as people from ethnic minority groups and those living in areas of deprivation. We identified several issues around people not understanding their rights, despite services having a legal duty to provide this information. There was variation in how well services met people’s needs. While many provided access to spiritual leaders, we remain concerned about gaps in the knowledge of staff around caring for autistic people. Children and young people Children and young people continue to face challenges in accessing mental health care. Increasing demand is leading to long waits for beds, and increases the risk of being placed in inappropriate environments and/or being sent to a hospital miles away from home. Once in hospital, we are concerned that access to specialist staff is being affected by low staffing levels, leading to patients’ needs not being met. In addition, the quality of physical environments for children and young people varies; access to food and drink, and food preparation facilities were key issues for many children and young people. Challenges in transitions of care between children and young people’s mental health services and adult mental health services remain, with many young people still falling through the gaps and not getting the care and support they need. Environment Through our MHA monitoring visits, we found that the quality of inpatient environments continues to vary. We are concerned about the impact of poor-quality environments on patients and have seen examples of how ageing and poorly-designed facilities affect people’s care. Being able to go outside brings therapeutic benefits for patients, but access to outdoor facilities varied across services. Gardens were usually well maintained, and in some services, patients were encouraged to grow plants and vegetables. However, we also found examples of unwelcoming gardens and at some services, patients’ access to outdoor spaces was limited. This issue was also raised by members of our Service User Reference Panel.- Posted
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- Mental health
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News Article
How systems are managing the radiologist shortage
Patient Safety Learning posted a news article in News
A radiology shortage has been plaguing health systems in the US for a few years and is expected to get worse in coming years — but systems are making changes to reduce its impact. A shortage of up to 42,000 radiologists is expected by 2033. Currently, the radiology technologist vacancy rates are up to 18.1%, compared to 6.2% three years ago. Further complicating the matter, the number of imaging studies has increased by up to 5% per year, but the number of radiology residency positions has increased by only 2%. If current imaging rates remain standard, there will be an estimated 16.9% to 26.9% increase in imaging utilization by 2055. "We (the industry) waited too long to start discussing the shortage," leaders from Evanston, Ill.-based Endeavor Health told Becker's. "Had we been proactive in understanding this phenomenon, we could have avoided some of the deficit. Now we are in reaction mode and trying to catch up." With America's aging population, many radiologists are also going to be retiring in coming years, with fewer radiologists coming up to replace them. And the challenges for health systems do not end there. "The relatively higher fixed costs smaller private groups bear for billing services, malpractice insurance, benefits, etc. make it increasingly difficult to offer competitive wages, so recruitment and retention in a competitive market become challenging," they said. "We have also experienced unplanned increases in teleradiology pricing over the last year, resulting in a negative margin for this volume subset as the reimbursement for most interpretations outweigh the professional fee collections." Read full story Source: Becker's Hospital Review, 5 March 2025- Posted
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A new global survey of care workers reveals a deepening staffing crisis in the health and care sectors, with nearly 70% of workers frequently understaffed and over a third (36.4%) saying they are always working short-handed. Released on the fifth anniversary of the WHO’s Covid-19 pandemic declaration, the UNI Global Union report—based on responses from 11,233 workers across 63 countries—exposes a care system still in freefall. Despite being hailed as heroes, care workers face chronic understaffing, poverty wages, and surging workplace violence, driving many out of the profession and leaving patients at risk. Workers without union protections are affected by this trend even more intensely. The same failures that cost tens of thousands of lives during the pandemic remain dangerously ignored. UNI warns that these conditions are driving workers away from the sector, exacerbating a crisis that governments and employers have failed to address. The survey shows that union membership and collective bargaining significantly improve worker retention and satisfaction. Safe staffing levels are essential for high-quality care and safer work environments, but chronic shortages in hospitals and care homes undermine patient health – even causing preventable deaths. For care workers, understaffing leads to poor morale, increased workplace violence and injury rates, and high turnover. “Five years after the pandemic, care workers are still being overworked, underpaid and exposed to dangerous conditions,” said Christy Hoffman, General Secretary of UNI Global Union. “This report is a wake-up call. Without immediate action to raise wages, improve staffing levels, and combat workplace violence, care systems will collapse.”- Posted
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Adult social care covers a large range of services given to the frail and disabled, from home visits to end-of-life care. The sector employs 1.6 million people in England (about the same as the NHS). There are many concerns about the sector: staff shortages, low pay, rising costs, poor conditions, patchy quality etc. But with a rapidly ageing society, the main area of worry is old-age care, and how to pay for it. The NHS Confederation estimated that in 2019/20 alone, 855,000 emergency admissions to hospital of older people could have been avoided with the right care at the right time. And as of September 2024, 13% of NHS hospital beds were occupied by people waiting for social care.- Posted
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News Article
Top emergency doctors have criticised a new guide on how to treat patients in corridors, warning it is “normalising the dangerous”. New guidance produced by NHS England in September on how to provide “safe and good quality care” in “temporary” spaces. The Royal College of Emergency Medicine (RCEM) has denounced the guide as “nonsensical” and “out of touch”, saying that it is “not possible to provide safe and good quality care” in corridors and cupboards in a new position statement. While acknowledging that corridor care is “not acceptable”, the guidance says hospitals are having to use temporary spaces more regularly - and use is no longer “in extremis”. It advises staff on how they can deliver the “safest, most effective and highest quality care possible” in such circumstances. The RCEM’s new statement on the guidance said: “Advice from arm’s length bodies that appear out of touch with what is happening in our departments was always going to be poorly received.” Using corridors will result in long emergency department waits which are “associated with measurable harm to patients”, it said. Use of corridors will lead to long waits in emergency departments which is “associated with measurable harm to patients”, it added. Patient dignity and privacy is “not maintained” when they are cared for in corridors, with sleep “difficult, if not impossible” and unfeasible circumstances for maintaining patient confidentiality. Read full story Source: The Independent, 16 December 2024 Related reading on the hub: A nurse's response to the NHSE guidance on their principles for providing safe and good quality care in temporary escalation spaces A silent safety scandal: A nurse’s first-hand account of a corridor nursing shift- Posted
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On the 16 January 2025, the Royal College of Nursing (RCN) published a new report presenting the findings of a survey of nursing staff outlining the extent of corridor care across the UK. This blog sets out Patient Safety Learning’s response to this report. In a new report this month, On the frontline of the UK’s corridor care crisis, the RCN have set out in stark terms how corridor care has become normalised in the NHS.[1] [2] Documenting the experiences of more than 5,000 nursing staff, the report reveals the widespread issues of corridor care across the UK. It also highlights from a survey of RCN members that: Almost 7 in 10 (66.8%) of those surveyed said they were delivering care in over-crowded or unsuitable places. More than 9 in 10 (90.8%) of those surveyed said patient safety is being compromised. Corridor care can broadly be defined as care being provided to patients in corridors, non-clinical areas or unsuitable clinical areas because of a lack of hospital bed capacity. In the RCN survey, when asked what inappropriate settings staff had provided care for patients, the main responses were corridors (62.34%), additional bed or chair in a bay (16.12%) and waiting rooms (5.93%). However, 15.31% of respondents also cited other settings, including bathrooms, cloakrooms, chairs in lounges, store cupboards and ward reception areas. Implications for patient safety Corridor care raises significant patient safety concerns. It can present problems providing appropriate care, as these unsuitable spaces can make it difficult to administer specific treatments, such as intravenous medication, or the ability to access oxygen, medication and lifesaving treatment in an emergency. It also makes it more difficult to monitor patients, which can result in delays in providing further treatment if their condition begins to deteriorate. But it is not just the physical environment that’s the challenge, it’s also an indication of an organisation that isn’t coping with the demand and capacity being exceeded, in the emergency department and also on the wards. The overspill into corridors is a reflection of that. It is also highly likely that the organisational infrastructure and clinical support services are struggling to cope—for example, getting diagnostic tests and scans. These will take longer, contributing to delays in clinical review and decision making, which in turn could lead to delays in treatment and care. The constraints on space that working in these conditions impose may mean that relatives are not able to be accommodated, reducing their ability to support patients whose condition may not otherwise be closely monitored. This lack of space can also result in physical hazards, with the potential for escape routes becoming blocked in emergencies. Corridor care also has a particular negative impact on patient dignity and confidentiality. Reflecting of examples of this in practice, in a blog shared on the hub last year a nurse noted that: “Often, we need to perform an ECG, which involves removing clothes from the upper body. There is supposed to be a room set aside for this, but it is often occupied by someone else in need—a mental health patient, a family member or a woman who has just miscarried. This task then has to be completed in the corridor. The screens we have do not provide any privacy and this leaves patients feeling exposed, vulnerable and cold. One other example relating to this lack of dignity happened when a patient’s catheter overflowed because it had not been emptied. He was on a narrow trolley with a thin mattress and had become very wet. I simply couldn’t offer him the personal care he needed. There was not enough space, no privacy and no easily accessible hot water. Once I was able to gain support from staff to help me change the patient he had been laying in wet clothes and sheets for the whole morning—four hours. This is basic nursing care that I was not able to perform."[3] Working in these conditions also has a significant impact on healthcare professionals too, trying to do their best in less than ideal circumstances that are now a daily occurrence. No-one joins a caring profession to continually deliver sub-optimal care that isn’t safe and this adds to the trauma already experienced by patients. Reflecting this, the RCN report included the following response highlighting the impact on one staff member: “It was cold room with no natural light or access to toilet or shower facilities near by. Temporary measure for no beds in the hospital. Patients felt undervalued and forgotten about. It was out the way of the main ward and felt unsafe. I escalated these concerns nothing was done. I am now in the process of leaving the NHS due to the pressure and culture after a 10 year nursing career. It is fraying at the seam’s and has left me with mental health problems and trauma.”[1] Normalisation of corridor care Thirty years ago corridor care was rare, but it is now so normalised that in September last year NHS England published new guidance setting out principles for providing safe and good quality care in what it describes as ‘temporary escalation spaces’ (TES).[4] The guidance contradicts itself stating that the delivery of care in temporary escalation spaces is not acceptable, but then goes on to say that the principles have been developed to support staff to provide the safest, most effective and highest quality care possible. Reflecting on this from a frontline NHS perspective, a anonymous blog contributor on the hub highlighted various problems with this position, stating that: “I am unsure which patients are ‘suitable’ for the corridor. I am not aware of anyone who would like to be cared for in an open space, with no privacy or dignity, with no access to emergency equipment or appropriate staffing.”[5] This guidance has also drawn national criticism in the form of a position statement issued from the Royal College of Emergency Medicine in December 2024, stating that: “Advice from arm’s length bodies that appear out of touch with what is happening in our departments was always going to be poorly received. Where such spaces are in use it is inevitable that this will be associated with long waits in Emergency Departments. We know that long waits in Emergency Departments are associated with measurable harm to patients. Care will therefore not be safe.”[6] Further to this guidance, we are also now seeing corridor care become part of workforce planning, with examples of Trusts specifically recruiting nursing roles specifically to carry out shifts in corridors.[7] A systemic problem Corridor care is a complex issue that is the result of a range of systemic problems faced by the health and care sector. The roots of this have been considered in a range of previous articles and reports, and recently in a report by the RCN published last summer, Corridor care: unsafe, undignified, unacceptable.[8] [9] [10] Factors contributing to there being insufficient capacity in hospitals that are leading to the persistence and growth of corridor care include: Lack of sustainable investment across the health and care system. Infrastructure investment, in both new healthcare facilities and essential maintenance for existing buildings, not keeping pace with service requirements. Increasing healthcare demand, with an ageing population living for longer in ill health. ·Lack of hospital bed capacity, exacerbated by delayed hospital discharges due to a lack of access to appropriate social care. Staff shortages, with demand for health and care services outstripping workforce growth. Patients waiting longer for diagnostic tests or elective services and becoming more unwell whilst they wait, which could lead to an increase in demand for emergency care. Lack of investment in prevention and public health, with worsening wider population health. Commenting on the winter pressures faced by the NHS, the Health and Social Care Secretary Wes Streeting MP said in the House of Commons this week: “I want to be clear, I will never accept or tolerate patients being treated in corridors. It is unsafe, undignified, and I am determined to consign it to the history books.”[11] There is no quick fix to achieve this. It will require system leaders to get to grips with these issues and, supported by evidence and research, put in place plans to address them. If the Government is to realise its ambition to consign corridor care to the history books, this work must be an integral part of the forthcoming 10-Year Health Plan.[12] Reporting incidences of corridor care Patient Safety Learning believes that corridor care should be avoided whenever possible. Even in the context of the ongoing immense pressures being faced by the health service, this should not be normalised. In situations where this is unavoidable, there clearly needs to be guidance and safeguards put in place to minimise risks as far as possible. But we do not think this can ever really be characterised as good quality care, which is far removed from the patient and healthcare professional experience of this. As we have noted, to eliminate corridor care will ultimately depend on long-term action to address its systemic causes. However, we do think there are actions that can be taken now to better understand and respond to the patient safety problems that this raises. We support the recent calls by an RCN-led coalition on the UK government to commit to transparency on the true extent of the corridor care. It is important that there is regular reporting of incidents of corridor care, and we agree with their recommendation that: “Mandatory reporting about incidents of care in inappropriate spaces, including TES, must be implemented by the UK government to NHS England, in partnership with local NHS Trusts. This data should be released publicly on a regular basis alongside A&E attendance and waiting time data, forming part of NHS England’s winter situation report data series and monthly performance statistics release.”[13] We also welcome the recent NHS England announcement that it will begin to report on the number of patients who receive care within temporary escalation spaces from the 25 January onwards.[8] Capturing the patient safety consequences of corridor care While it is important incidences of corridor care are regularly recorded, we also need to better understand the patient safety consequences of this and how organisations are mitigating risks to patients and staff. We believe that the NHS needs to give further consideration as to how incidents of avoidable harm, where corridor care is a contributory factor, are captured. One aspect of this would be looking at how such incidents can be recorded in the Learn from Patient Safety Events (LfPSE) service. LfPSE is the national NHS service for the recording and analysis of patient safety events that occur in healthcare. Trusts can currently see reports of their own data in this, but it would be beneficial if they could also access system-wide findings from this on issues such as corridor care to help them assess risk or engage with others. Consideration also needs to be given to the ease at which staff are be able to record incidents of near misses and incidents in corridor care. If this is an increasingly frequent occurrence, this may become difficult to manage in addition to providing patient care in an overstretched healthcare setting. We also believe that NHS England should look at how learning and recommendations from investigations related to corridor care at individual healthcare providers under the Patient Safety Incident Response Framework are shared widely for national improvement. If patients’ safety has been compromised by being cared for in unsuitable environments, this must be captured and shared for learning. We believe that organisations should share how they are mitigating the risks to patient and staff safety. NHS England’s guidance suggests that patient safety considerations should be imperative when using temporary escalation spaces. It states that: “Local patient safety checklists should be used to ensure the patient is safe to be cared for in this setting. This should include an inclusion and exclusion checklist.”[4] However, it is not immediately clear what checklists this is referring to, with a localised approach meaning this could vary from organisation to organisation. There does not currently appear to be much evidence on how organisations are responding to this guidance, or shared examples of where this has been implemented well that could be used by others. Further to this, to ensure we are capturing and acting on the patient safety consequences of corridor care, it is important that: Patients, families and carers are invited to and feel able to feedback about their experiences, both at a local and national level, to inform learning and improvement. Frontline staff are supported and feel able to report patient safety concerns around corridor care. This requires a wider organisational culture that enables speaking up and demonstrates that the organisation listens to and acts on the findings of incident reports. Healthcare managers need to maintain a focus on ensuring patient safety issues relating to corridor care are consistently identified and acted on, despite the enormous pressures the system faces. Organisational leaders should maintain a credible and meaningful focus on patient safety as a priority agenda item internally and externally to create the culture and landscape for solutions to be identified and implemented. However, the above points can only be realised if system leaders, from Integrated Care Boards up to the Department of Health and Social Care, buy into this. This requires honesty and transparency about the scale of corridor care and a commitment to work collaboratively to share practices to minimise the patient safety risks it creates. Share your views and experiences with us We would welcome your views on the patient safety concerns raised in this blog. Are you a patient, or a friend or family member of a patient, who has experienced corridor care? Or perhaps a healthcare professional who has experience of delivering corridor care and would like to share your story? You can share your views and experiences with us directly by emailing [email protected]. References Royal College of Nursing. On the frontline of the UK’s corridor care crisis, 16 January 2025. Royal College of Nursing. Corridor care: ‘Devastating testimony’ shows patients are coming to harm, 16 January 2025. Anonymous. A silent safety scandal: A nurse’s first-hand account of a corridor nursing shift, Patient Safety Learning, 22 February 2024. NHS England. Principles for providing safe and good quality care in temporary escalation spaces, 16 September 2024. Anonymous. A nurse’s response to the NHSE guidance on their principles for providing safe and good quality care in temporary escalation spaces, Patient Safety Learning, 20 September 2024. Royal College of Emergency Medicine. RCEM Position Statement on NHS guidance ‘Principles for providing safe and good quality care in temporary escalation spaces’, 16 December 2024. Lintern S, Wheeler C. Hospital advertises for ‘corridor care’ nurses to ease NHS crisis. The Times, 11 January 2025. Hadden C, Tse J. Corridor care: unsafe, undignified, unacceptable. Royal College of Nursing, 3 June 2024. Wilson H. We shouldn’t get comfortable with corridor ‘care’. The Health Foundation, 14 February 2024. Royal College of Emergency Medicine. The management of emergency department crowding, January 2024. Department of Health and Social Care. Oral statement to Parliament – Health and Social Care Secretary’s statement: winter 2025, 15 January 2025. Department of Health and Social Care. Change NHS: help build a health service fit for the future, 18 November 2024. Royal College of Nursing. Corridor care: RCN-led coalition demands transparency and mandatory reporting, 13 January 2024- Posted
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The NHS workforce has gone through shifts and rebalances of roles since the service began. In recent years there has been a rebalancing through expanding other roles, such as advanced practitioners and physician associates. This report, commissioned by NHS Employers, reviews the evidence around introducing these new roles and offers lessons for implementation.- Posted
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Corridor care can broadly be defined as care being provided to patients in corridors, non-clinical areas or unsuitable clinical areas because of a lack of hospital bed capacity. This report from the Royal College of Nursing presents the findings of a survey of nursing staff outlining the extent of corridor care across the UK. The responses confirm that corridor care is a widespread issue, with hundreds of unedited responses included in the report. You can read Patient Safety Learning's response to this report here.- Posted
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Hospitals across the UK are running with 20% fewer children’s doctors than they need on daily shifts, new research shows. NHS staff are facing “unacceptable” pressures as paediatric units report a shortfall of 20 per cent in doctors and trainees on shift, the Royal College of Paediatrics and Child Health (RCPCH) has warned. Top doctors have said the government’s plans to bring down waiting lists would be “doomed to fail” if the workforce gaps for children’s services were not filled. Professor Steve Turner, president of the RCPCH, said the gaps were having a detrimental impact on the wellbeing, morale and training of doctors and ultimately impacted patient care. He said: “This report highlights how paediatricians are being stretched far too thin every day. It is completely unacceptable that our current paediatric services are only operating at 80 per cent capacity when the level of demand on these services is now higher than ever…We cannot allow 80 per cent to become the new normal. “Our children and the clinicians who serve them deserve more. Investing in and reforming paediatric services is not only valuable but is fundamental to the future health and economic wellbeing of our country.” Read full story Source: The Independent, 10 December 2024- Posted
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Vulnerable mental health patients are being traumatised, sexually assaulted and physically harmed in UK hospitals – and have even managed to escape, the safety watchdog has warned in its first major national investigation. The report by the Health Services Safety Investigation Body (HSSIB), launched by former health secretary Steve Barclay after The Independent exposed a series of failings in the sector, warns the government and healthcare leaders that cash starved “oppressive” mental health hospitals are causing harm to patients. Inpatient mental health services across England are failing to keep highly vulnerable patients safe and are even re-traumatising them, according to the HSSIB. It highlights a litany of concerns over safety, much of it driven by national shortages of mental health staff and warns the flagship NHS long-term workforce plan ambitions may be “unattainable”. Other failings highlighted by the safety watchdog include: Short-staffed mental health wards are failing to protect patients from sexual harm as staff also “normalise” sexualised behaviour. Female patients are still regularly housed in mixed-sex wards despite national rules banning this, as hospitals lack funding to change wards. Patients are self-harming, subjected to violence and able to escape as hospitals lack the number of staff to prevent this. Mental health patients are not getting therapeutic care in mental health wards. “Oppressive” and “grim” hospital buildings are re-traumatising patients. Read full story Source: The Independent, 24 October 2024- Posted
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High staff turnover rates linked to patient deaths
Patient Safety Learning posted a news article in News
More than 4,000 people could be dying per year because of high turnover rates of nurses and doctors in NHS hospitals, according to new research from the University of Surrey. The university said the research had shown a clear association between high turnover rates of nurses and doctors in NHS hospitals and a "troubling" rise in patient mortality rates. The study analysed nearly a decade of data from 148 NHS hospitals in England using anonymised patient and worker records. The researchers found that a one standard deviation increase in nurse turnover is associated with 35 additional deaths per 100,000 hospital admissions within 30 days. With an average of 8.2 million hospital admissions occurring annually, the turnover rates of hospital nurses and senior doctors could translate to nearly 335 additional deaths each month across the NHS. Dr Giuseppe Moscelli, lead researcher of the study at the University of Surrey, said: "Our findings underscore the vital role that stable staffing plays in ensuring patient safety. "High turnover rates are not simply an administrative issue; they have real, life-or-death implications for patients. It's time for healthcare leaders to focus on retention strategies that prioritise workforce stability." Read full story Source: BBC News, 21 November 2024- Posted
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College chiefs demand NHS workforce plan inquiry is reopened
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Royal college chiefs have called for an inquiry into the NHS long-term workforce plan to be reopened amid “significant concerns” over its projections. Seven colleges led by the Royal College of GPs have written to the Commons’ public accounts committee asking it to restart its probe into the workforce plan’s modelling, which began earlier this year but then halted ahead of July’s general election. It comes after the National Audit Office found “significant weaknesses” in the workforce plan’s projections, such as the number of fully qualified GPs. HSJ has previously revealed GP numbers will barely increase under the national workforce plan. NHSE has previously said the long-term workforce plan “is based on credible and robust modelling”, which was independently assessed by the Health Foundation think tank. A letter to new PAC chair Sir Geoffrey Clifton-Brown, which has been signed by the Royal College of Nursing and the Royal College of Physicians among other bodies, said: “During the inquiry, written evidence submissions reflected significant concerns and recommendations regarding certain aspects of the LTWP. “However, the general election halted this process, and the inquiry was closed before it was concluded. We are therefore calling on the committee to re-open its inquiry into the LTWP.” The letter, shared with HSJ, called for the findings of the reopened inquiry to be published ahead of the workforce plan’s next iteration in summer 2025. Read full story (paywalled) Source: HSJ, 25 October 2024- Posted
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Georgia Stevenson discusses NHS England’s Long Term Workforce Plan, evaluating its potential to alleviate staffing shortages, enhance training routes, and ultimately improve care quality in maternity and neonatal services.- Posted
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What is the optimal skill mix for virtual wards? Do new roles such as clinical pharmacists or advanced practitioners act as substitutes for, or additions to, existing staff? What works to retain staff? How much do current rates of attrition and turnover cost the NHS and social care? Evidence gaps in workforce research are holding back healthcare improvements, say Tara Lamont, Cat Chatfield, and Kieran Walshe in this BMJ opinion piece.- Posted
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