Search the hub

The Health and Social Care Select Committee is currently holding an inquiry to consider the preparedness of the UK to deal with the coronavirus pandemic. MPs will focus their discussion on measures to safeguard public health, options for containing the virus and how well prepared the NHS is to deal with a major outbreak. At Patient Safety Learning we are gathering #safetystories from both staff and patients to highlight the challenges for safety in healthcare that are resulting from the pandemic. Ahead of the Committee’s next oral evidence session we have raised several urgent safety issues with the Chair, Jeremy Hunt MP. The Committee should seek answers and actions from NHS leaders and politicians on the issues identified to ensure the safety of staff and patients. Below is a summary of our submission to the Committee, a full copy of which can be found here. Personal Protective Equipment (PPE) for staff There has been an increasing number of concerns raised by staff through the media over the past week around problems accessing appropriate PPE. While at a senior level there has been assurances about the availability of appropriate PPE for NHS staff, we are concerned that this is not being borne out by their experiences on the front-line, undermining trust and confidence that staff safety is being treated as a priority. In our submission we’ve cited several issues raised by healthcare workers in this regard, such as discrepancies in the amount of PPE available to staff in some roles (e.g. ambulances) as opposed to others (e.g. emergency departments). There have also been concerns about the guidance provided on what PPE is required. We’ve been advised of incidents where this has been downgraded to reflect the availability of supplies; this is clearly highly risky and does not reflect a science-based response to the pandemic. We’re asking the Committee to bring the following questions to the meeting, and to seek answers and action from NHS leaders and politicians: What is being done to ensure all ‘at risk’ staff have access to PPE, not only in the Intensive Treatment Units (ITUs) but Emergency Departments, Wards, Ambulances, in the community, everywhere? Who is in charge in every organisation to ensure that PPE is available and in use, according to robust guidelines? How do staff report concerns and to whom? What assurances are there that the safety of staff is paramount and that the cost of PPE is not preventing staff from having access to life-saving protection? How is the NHS supply chain communicating with trusts over likely lead times for PPE and availability of supplies? Is there transparency in this so that trusts can plan effectively how to use the stocks they have left? Testing There has been a number of reports about how the UK’s approach to testing differs from World Health Organization guidance and we’ve had concerns raised directly with us by staff who are genuinely fearful that they are infected and spreading the virus to their friends, family and the general public without knowing. We’re asking the Committee to bring the following questions to the meeting, and to seek answers and action from NHS leaders and politicians: What is the policy for testing and tracing patients for Covid-19 in the UK? What are the requirements for test production and testing capacity in this country? What are the plans and timescales to deliver this? We think that the scale of testing is compromising our ability to track the spread of the virus and isolate those that are infected. Non Covid-19 care Understandably the healthcare system is focusing its attention on the deadly effects of the coronavirus and we believe that we need to pay attention to patient safety now more important than ever. We are hearing stories of patients whose planned tests, elective operations, diagnostic procedures are being postponed or delayed while the health care system focuses on responding to the pandemic. It is important to assess the impact the coronavirus will have on other areas of care and ensure it does not magnify or exacerbate existing patient safety issues. We’re asking patients to share their safety stories with us to highlight weaknesses or safety issues that need to be addressed and share solutions that are working, so we can seek to close the close the gaps that might emerge as a result of the pandemic. We’re asking the Committee to bring the following questions to the meeting, and to seek answers and action from NHS leaders and politicians: What arrangements are being put in place to inform patients and families of any changes in non Covid-19 care during the pandemic? How are UK patients and families being informed about any such changes in their care? What should patients do if they notice new signs and symptoms? References [1] UK Parliament, Health and Social Care Committee: Preparations for Coronavirus, Last Accessed 25 March 2020. [2] HSJ, Staff in ‘near revolt’ over protective gear crisis, Last Accessed 25 March 2020.

RCEM’s recommendations An additional 4,500 beds across the United Kingdom be made available between now and next Winter, and approximately 8,500 more over the next five years. The allocation of additional beds should be made available based on a local assessment of population needs and not worsen health inequalities. Hospitals should define thresholds for occupancy, and justify if they exceed 85% (sometimes this is appropriate, but more often, not) • Any new hospital buildings should increase the proportion of side rooms in order to restrict the number of beds made unavailable through infection and reduce nosocomial infections. There needs to an increase in Mental Health bed capacity. Assessment areas for short term, resource intensive assessment of people suffering a mental health crisis would improve care and patient experience.

The Covid-19 pandemic has had a significant impact on service delivery, including the use and availability of beds, due to: infection control measures placing limits on ward space. reduced elective capacity. staffing redeployment. For this reason, this analysis uses the pre-pandemic year of 2019/20 as the comparator, to fairly illustrate long-term trends. As a result of the bed shortage demonstrated by this analysis, the BMA is calling for: an increase in core bed stock adequate funding to increase the workforce, ensuring that additional beds can be staffed safely.

Key messages The total number of NHS hospital beds in England has more than halved over the past 30 years, from around 299,000 in 1987/88 to 141,000 in 2019/20, while the number of patients treated has increased significantly. Most other advanced health care systems have also reduced bed numbers in recent years. However, the UK has fewer acute beds relative to its population than many comparable health systems. Since 1987/88, the largest percentage reductions in bed numbers have occurred in mental illness and learning disability beds as a result of long-term policies to move these patients out of hospital and provide care in the community. The number of hospital beds for general and acute care has fallen by 44 per cent since 1987/88; the bulk of this fall is due to closures of beds for the long-term care of older people. Medical innovation, including an increase in day-case surgery, has also had an impact by reducing the time that many patients spend in hospital. Research shows that initiatives to moderate demand for hospital care often struggle to succeed. Progress depends on having sufficient capacity to provide appropriate care outside hospital, yet evidence suggests that intermediate care capacity is currently only enough to meet around half of demand and cuts in funding have led to significant reductions in publicly funded social care. Before the Covid-19 pandemic there was widespread evidence of a growing shortage of beds. In 2019/20, overnight general and acute bed occupancy averaged 90.2 per cent, and regularly exceeded 95 per cent in winter, well above safe levels. It is not yet clear when and at what level hospital beds will stabilise after the pandemic. How hospital beds are used depends on the availability of other services, yet national data does not provide a full picture of NHS bed capacity and requirements. As the health and care system emerges from the pandemic, greater clarity from NHS national bodies is needed on their expectations for overall health and care bed capacity over the medium term, and the consequences of these choices.