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Corridor care is increasingly being used in the NHS as demand for emergency care grows and hospital departments struggle with patient numbers. In a series of blogs for the hub, we shine a light on some of the key patient safety issues surrounding corridor care. 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. Documenting the experiences of more than 5,000 nursing staff, a recent report from the Royal College of Nursing has set out in stark terms how corridor care has become normalised in the NHS. 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 has now become so normalised that in September 2024 NHS England published new guidance setting out principles for providing safe and good quality care in what it describes as ‘temporary escalation spaces’ (TES). Key patient safety concerns At Patient Safety Learning we will continue to raise awareness of the significant patient safety concerns relating to corridor care, including: Delayed treatment. Inadequate monitoring. Compromised infection control. Patient dignity not being supported. Relatives not being able to support patients who may not otherwise be closely monitored. Moral injury and impact on staff delivering poor standards of care. Manual handling safely. Trip hazards and obstructions. Blocked evacuation routes in the case of fires of other major incidents. Corridor care blogs In a series of blogs for the hub, we shine a light on some of the safety concerns surrounding corridor care. Response to RCN report: On the frontline of the UK’s corridor care crisis 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. The crisis of corridor care in the NHS: patient safety concerns and incident reporting In this blog, Patient Safety Learning’s Director Clare Wade reflects on the challenges that growing prevalence of corridor care poses to reporting and acting on patient safety concerns in the NHS. How corridor care in the NHS is affecting safety culture: A blog by Claire Cox Patient Safety Learning’s Associate Director Claire Cox looked at how corridor care within the NHS is affecting safety culture and examined its implications for both healthcare professionals and patients. Corridor care: are the health and safety risks being addressed? Patient Safety Learning’s Associate Director Claire Cox writes about the associated health and safety risks, questioning whether these are being properly addressed. Claire draws out key areas for consideration and suggests practical measures that can help protect patient safety in such challenging working environments. A nurse's response to the NHSE guidance on their principles for providing safe and good quality care in temporary escalation spaces In this blog, an anonymous nurse reflects on the recent NHS England (NHSE) guidance on the use of "temporary escalation spaces" and why this is so far removed from 'work as done' on the frontline. A silent safety scandal: A nurse’s first-hand account of a corridor nursing shift In this anonymous account, a nurse shares their experience of corridor nursing, highlighting that corridor settings lack essential infrastructure and pose many safety risks for patients. They also outline the practical difficulties providing corridor care causes for staff, as well as the potential for moral injury. Using the System Engineering Initiative for Patient Safety (SEIPS) framework, they describe the work system, the processes and how that influences the outcomes. My experience of the 'Wait 45' policy In this blog, a frontline healthcare worker shares their experience of the 'Wait 45' policy in my trust and the impact it is having. 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]

In a blog earlier this year, Patient Safety Learning’s Associate Director Claire Cox looked at how corridor care within the NHS is affecting safety culture and examined its implications for both healthcare professionals and patients. In this new blog, she turns her attention to the associated health and safety risks, questioning whether these are being properly addressed. Claire draws out key areas for consideration and suggests practical measures that can help protect patient safety in such challenging working environments.  In recent years, corridor care has become an unfortunate reality in many NHS hospitals across the UK. With hospitals operating over capacity, patients are often treated in corridors due to a lack of available beds. While this practice may provide temporary relief in overcrowded healthcare settings, it also introduces significant health and safety risks for patients, staff and visitors. What is corridor care? 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. This is typically due to emergency departments being overwhelmed or a shortage of inpatient beds. Corridor care is no longer an exception—it has become the norm in many hospitals. A new report published in January by the Royal College of Nursing illustrated the prevalence of this, sharing the experiences of more than 5,000 nursing staff on corridor care in the UK.[1] [2] In February, the Royal College of Physicians published a snap survey of its members highlighting the prevalence of corridor care, with 78% of respondents having provided care in a temporary environment in the previous month.[3] Key health and safety risks of corridor care When speaking about the impact of corridor care, understandably our initial focus tends to be on its direct impact on the care of the patient and the staff member providing that care. However, a somewhat overlooked aspect of this is how it can impact on the wider health and safety of those working in, or using, healthcare facilities. This can manifest itself in a number of different ways: Infection control risks Corridors lack the necessary infection control measures—for example, hand washing facilities and appropriate waste disposal, including sharps—which increases the risk of hospital-acquired infections, such as MRSA and Clostridium difficile.[4] The inability to maintain appropriate isolation for infectious patients poses a serious public health concern.[5] Delayed emergency response Corridors are not equipped for life-saving interventions in emergencies. Delayed access to equipment, medication and clinical teams in a corridor setting can increase mortality and morbidity.[6] A lack of emergency call bell alarms may incur delays in receiving appropriate emergency help. Swift transfer of unwell patients is often made challenging due to obstacles obstructing a usually clear path. Emergency teams may find it difficult to locate the unwell patient in a corridor as there may be numerous ‘temporary escalation’ areas within the department. Obstruction and fire safety hazards Corridors crowded with trolleys, equipment and patients create obstructions that can impede fire evacuation routes. Fire doors may be left open to accommodate trolleys, compromising compartmentalisation and increasing the spread of fire and smoke. NHS Trusts are legally required under the Regulatory Reform (Fire Safety) Order 2005 to ensure that escape routes remain unobstructed, which is often compromised by corridor care.[7] The London Fire Brigade recently highlighted these issues with their local hospitals, citing concerns about obstruction of fire escape routes, increased fire load in circulation spaces and delayed evacuation times in the event of an emergency.[8] Manual handling and staff safety Healthcare staff face increased manual handling risks while manoeuvring equipment and providing care in narrow corridors. This can lead to musculoskeletal disorders and workplace injuries, further exacerbating staff shortages.[9] The question is, are these risks being addressed? Risk assessments: A key to mitigation While some NHS Trusts have implemented risk assessment templates for corridor care, these are not yet standardised across the system. The Health and Safety Executive (HSE) recommends that risk assessments for corridor care include: infection control protocols fire safety compliance manual handling risk reduction patient privacy and dignity measures emergency response protocols.[9] What about fire safety? Fire safety is one of the most pressing concerns associated with corridor care. Under the Regulatory Reform (Fire Safety) Order 2005, NHS Trusts are required to ensure that: Escape routes remain clear at all times. Adequate fire risk assessments are conducted and updated regularly. Staff are trained in evacuation procedures, especially in high-risk areas like corridors.[7] Are Trusts compliant? While most Trusts have fire risk assessments in place, reports from the Care Quality Commission (CQC) indicate that compliance varies across the country. Some hospitals have been flagged for failing to adequately mitigate the fire risks associated with corridor care.[10] What measures can we take to protect patient safety? The below points offer some practical health and safety measures that can be put in place to help reduce risk: Fire risk management: Regular audits to ensure corridors are not overcrowded and escape routes remain clear. Patient identification and monitoring: Implementing digital systems to track patient location and their condition when placed in corridors. Enhanced infection control: Providing hand hygiene stations and maintaining isolation protocols even in corridor settings. Staff training and awareness: Ensuring staff are trained in dynamic risk assessments and evacuation procedures. Establishing escalation protocols: Creating clear guidelines on when to escalate corridor care situations to prevent patient harm. The need for systemic change Corridor care is a symptom of a healthcare system under immense pressure. While temporary risk mitigation measures can improve safety, long-term solutions require increased capacity, better resource allocation and investment in community-based care to prevent unnecessary admissions. If the current trend continues, addressing health and safety risks associated with corridor care must become a top priority to protect both patients and healthcare staff. Call to action Do you work in healthcare or health and safety? Your expertise can make a real difference! Share your corridor care risk assessments with Patient Safety Learning to help identify risks, prevent harm and improve outcomes for patients. Comment below (sign up first for free) or email [email protected]. References Royal College of Nursing. On the frontline of the UK’s corridor care crisis, 16 January 2025. Patient Safety Learning. Response to RCN report: On the frontline of the UK’s corridor care crisis, 17 January 2025. Royal College of Physicians. Doctors confirm ‘corridor care’ crisis as 80% forced to treat patients in unsafe spaces, 26 February 2025. National Institute for Health and Care Excellence (NICE). Infection Prevention and Control Quality Standard, 2014. London: NICE. Public Health England. Guidelines on Infection Prevention and Control, 2019. London: PHE. Royal College of Emergency Medicine (RCEM), 2021. Crowding and its Consequences: Policy Brief. London: RCEM. HM Government, 2005. The Regulatory Reform (Fire Safety) Order 2005. London: The Stationery Office. London Fire Brigade. Letter to Trusts to review your Fire Risk Assessments, 17 February 2025. Health and Safety Executive (HSE). Manual Handling Operations Regulations 1992 (as amended), September 2016. London: HSE. Care Quality Commission (CQC). State of Care Report, September 2021. London: CQC. Related 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 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

Patient falls are a significant concern in healthcare settings, often leading to severe injuries, prolonged hospital stays and increased healthcare costs. The importance of fall prevention extends beyond patient safety—it reduces hospital liability, enhances patient outcomes and improves overall healthcare efficiency. By proactively assessing and addressing fall risks, healthcare providers can significantly lower the incidence of falls, ensuring a safer environment for patients. Given the aging population and increasing chronic disease burden, fall prevention remains a top priority in improving patient care and quality of life. This blog from Augustine Kumah, Deputy Quality Manager at The Bank Hospital, Accra, Ghana, explores the significance of fall risk assessment, its implementation and its role in reducing fall-related incidents in healthcare settings. Introduction Falls among patients, particularly in healthcare facilities, remain a pressing concern worldwide. These incidents not only lead to injuries, prolonged hospital stays and increased healthcare costs, but can also have lasting psychological impacts on patients. Preventing patient falls necessitates a multifaceted approach, with fall risk assessment at its core.[1] Understanding the impact of patient falls Patient falls are defined as unintentional descents to the ground that occur in healthcare facilities, including hospitals, nursing homes and rehabilitation centres. According to the World Health Organization (WHO), falls are the second leading cause of unintentional injury deaths globally, with older adults being most at risk.[2] In healthcare facilities, the consequences of falls extend beyond physical injuries; they also affect a patient’s confidence, independence, and quality of life. The financial burden of falls on healthcare systems is substantial. Costs include direct expenses such as treatment for fall-related injuries and indirect costs like litigation, reputation damage and loss of trust. Additionally, healthcare providers experience emotional distress and professional repercussions when preventable falls occur under their watch. Hence, fall prevention is not just a patient safety priority but also an ethical obligation and a cost-saving measure. The role of fall risk assessment Fall risk assessment is a systematic process to identify patients at risk of falling. Healthcare providers can implement targeted interventions to mitigate these risks by evaluating intrinsic and extrinsic factors. Intrinsic factors include age, medical history, mobility impairments and cognitive status, while extrinsic factors encompass environmental hazards, medication side effects and inadequate assistive devices. Risk assessment tools, such as the Morse Fall Scale, Hendrich II Fall Risk Model and STRATIFY Risk Assessment Tool have been widely used. These tools provide a structured approach to assess risk levels and guide preventative measures. However, their effectiveness depends on accurate application and regular updates based on patient conditions. Implementing effective fall risk assessments To maximise the efficacy of fall risk assessments, healthcare facilities must adopt evidence-based strategies and integrate them into their workflows. Key steps include: Standardised assessment protocols: Developing and adhering to standardised protocols ensures consistency in evaluating fall risks across different departments and shifts. Protocols should specify the frequency of assessments, criteria for reassessment and documentation requirements. Staff training: Comprehensive training programme for healthcare workers are essential to enhance their competency in conducting fall risk assessments. Training should cover assessment tools, recognition of risk factors and communication of findings to the care team. Patient and family education: Involving patients and their families in fall prevention efforts fosters a collaborative approach. Educating them about potential risks and preventive measures empowers them to contribute to safety. Technology integration: Advanced technologies such as wearable sensors, predictive analytics and electronic health records (EHRs) can augment traditional fall risk assessments. For instance, sensors can monitor patient movements and alert staff to potential falls, while EHRs can flag high-risk patients for closer observation. Challenges in implementing fall risk assessments Despite its benefits, implementing fall risk assessments is not without challenges. Common barriers include: Resource constraints: Limited staffing, time pressures and inadequate funding can hinder comprehensive risk assessments. Overburdened staff may struggle to prioritise fall prevention alongside other responsibilities. Inconsistent application: Variability in applying risk assessment tools can lead to inaccurate results. Subjective judgment, incomplete data collection and lack of protocol adherence contribute to inconsistencies. Resistance to change: Resistance from staff and administrators to adopt new practices or technologies can impede the integration of fall risk assessments into routine care. Patient non-compliance: Some patients may resist interventions such as bed alarms, mobility aids or supervision, increasing their risk of falling. Strategies to overcome the challenges To address these challenges, healthcare facilities can adopt the following strategies: Leadership support: Strong leadership commitment is crucial to allocating resources, establishing accountability and creating a safety culture. Interdisciplinary collaboration: Engaging multidisciplinary teams, including nurses, physicians, physical therapists and pharmacists, ensures a holistic approach to fall risk assessment and prevention. Continuous Quality Improvement: Regular audits, feedback sessions and performance evaluations help identify gaps in fall prevention efforts and drive improvements. Tailored interventions: Personalising interventions based on individual patient needs and preferences increases their acceptability and effectiveness. Conclusion Preventing patient falls requires a proactive and comprehensive approach, with fall risk assessment as a foundational element. Healthcare facilities can significantly reduce fall-related incidents and their associated consequences by identifying at-risk individuals and implementing tailored interventions. However, the success of fall prevention efforts hinges on overcoming implementation challenges through leadership support, interdisciplinary collaboration and continuous improvement. As healthcare systems evolve, leveraging technology and prioritising patient-centred care will be instrumental in advancing fall risk assessments. By embracing these advancements, healthcare providers can create safer environments that uphold all patients' dignity, independence, and well-being. References The Joint Commission. Fall Reduction Program - Definition and Resources, 28 August 2017 WHO. Falls Factsheet. World Health Organization, 26 April 2021.

The Invisible Hazard: Tackling Surgical Smoke for Healthcare Worker and Patient Safety will delve into the risks posed by surgical smoke, its impact on both healthcare professionals and patients, and the latest safety measures to mitigate these dangers. This webinar, hosted by the Safety For All campaign, will provide valuable insights into the health risks associated with inhaling surgical smoke, the current legislation governing its management, and the introduction of smoke evacuation products to enhance safety in operating theatres. This session is essential for perioperative practitioners, safety officers, healthcare professionals, and policymakers looking to better understand the hidden risks of surgical smoke and explore practical solutions for improved workplace safety. Speakers 🔹 Lisa Nealen – A Perioperative Practitioner at Gateshead Health NHS Foundation Trust, Lisa brings hands-on experience in the surgical field and will share insights into the real-world challenges of managing surgical smoke in operating theatres. 🔹 Daniel Rodger – A Senior Lecturer in Perioperative Practice at London South Bank University and a registered Operating Department Practitioner (ODP), Daniel is a specialist in perioperative safety and will outline evidence-based practices for surgical smoke safety. Key Topics The health risks of surgical smoke exposure for healthcare workers and patients Current legislation and standards regarding smoke evacuation in healthcare settings The introduction and benefits of smoke evacuation products in perioperative environments Best practices for mitigating risks and implementing safety protocols in operating theatres Live Q&A Session The webinar will conclude with an interactive Q&A session, where attendees can engage directly with our expert speakers, ask questions, and explore strategies for improving surgical smoke safety in their workplaces. Don’t miss this opportunity to hear from leading experts, gain actionable knowledge, and contribute to a safer and healthier surgical environment. Register here.

This is the recording of a webinar hosted by the Safety for All Campaign discussing the latest advancements in personal protective equipment (PPE) standards within surgical settings. The session featured presentations by Dr Ali Mehdi and Edward Curtin, who provided in-depth analyses of current PPE protocols and their implications for perioperative safety. Their insights sparked a dynamic discussion among participants, addressing topics such as the integration of innovative PPE technologies, adherence to evolving safety regulations, and strategies for mitigating risks to both healthcare professionals and patients.

From coughs and sneezes to mental health apps, these tips from the MHRA will help you stay safe during the festive season and beyond.

As reported recently, the Scottish Healthcare Workers Coalition called upon the Scottish Government to reinstate 'universal masking' in health and social care settings.  In this statement written in support of their campaign, an occupational safety and health practitioner, David Osborn, explains the legal requirements for risk assessments that the Government ought to have undertaken before reaching such a decision that exposes healthcare staff to the life-changing consequences associated with repeat Covid-19 infections.  He also explains the legal duty of the Government to consult with workers before implementing changes that may affect their health and safety. Neither duty (risk assessment nor prior consultation with workers) appears to have been well met, putting the Scottish Government and Health Boards in breach of UK-wide health and safety law.  The decision by the Scottish Government to withdraw the coronavirus guidance for extended use of facemasks across health and social care is clearly a matter that has significant implications for the safety of health and social care workers. It is a legal requirement under the Health and Safety at Work Act etc 1974 that employers (including Governments and their Health Boards) must do at least two things before implementing a change that may materially and substantially impact workers’ health and safety at work: They must conduct a suitable and sufficient risk assessment of the proposed actions; and They must consult with all employees or their elected representatives concerning the proposed change. 1. Risk assessment To be “suitable and sufficient” the risk assessment for the abandonment of universal masking should have considered several factors such as: The fact that variants of the SARS-CoV-2 virus continue to evolve which are becoming more immune resistant and subject to vaccine escape. The opportunity for viruses to mutate in this way depends upon the sheer number of viruses in circulation within the population. The greater the number, then statistically the more likely it is that a variant could evolve with potential to partially or wholly defeat our current vaccines and greatly impair the nation’s recovery from the pandemic. It just takes for one single virus to mutate in a certain catastrophic way for this to happen – as will have been the case in Wuhan in 2019. Any responsible Government and Health Board should take all reasonably practicable steps to reduce the number of viruses circulating in the population, particularly in health and social care premises. The Scottish Government appears blind to this simple but important duty that it owes to the Scottish people and its healthcare workers in particular. Evidence is emerging that cases of SARS-CoV-2 reinfection and associated hospitalisations and deaths have increased in relative frequency as new Omicron lineages have emerged with enhanced transmissibility or immune escape characteristics. The evidence also suggests that the time interval between repeat infections is decreasing, particularly (and rather peculiarly) amongst individuals who have previously been infected with the Alpha (‘Kent’) variant which arose during the second wave (winter 2020-21). Many healthcare workers will have been infected during that period. The consequence is that these workers are (a) that these infections may recur more frequently and (b) are at greater risk from these repeat infections. It has long been established that each time a person is infected or reinfected with the SARS-CoV-2 virus they have a risk of developing Long Covid, which can have severe detrimental effect on their health and quality of life – sometimes causing debilitating, irreversible, long-term health conditions. The more times they become reinfected, the worse these conditions may be and the longer they may last. By law, the risk assessment must be recorded (on paper or electronically) and be made available to employees and their representatives immediately upon request. I therefore call upon the Scottish Government to confirm whether or not such a risk assessment was undertaken before the decision was taken to abandon universal masking. If one was done, then the Government and the Health Boards should publish it so that interested parties, such as the Coalition, can determine whether it has properly considered all relevant factors that have a direct bearing on the increased risk of healthcare worker infection and how they plan to mitigate that risk. If no such risk assessment was done, either by the Government centrally or by its Health Boards, then they have acted recklessly and unlawfully. 2. Consultation For clarity, the “consultation”, which is required by the Safety Representatives and Safety Committees Regulations 1977 and the Health and Safety (Consultation with Employees) Regulations 1996, has a very clear meaning. It means: a) providing employees, or their safety representatives, with all relevant information relating to any proposed change in health and safety arrangements (including giving them sight of any risk assessments) before that change is implemented; b) allowing the employees and their representatives sufficient time to discuss amongst themselves and seek any further advice they may need to inform an opinion about the change; c) the employer must then take account any the feedback that it receives. These are serious matters. The UK Government and the devolved administrations, through inept planning for pandemics and the issue of seriously flawed guidance, failed to provide health and social care workers with the necessary PPE to prevent them inhaling airborne virus whilst they cared for highly infectious patients. It is quite understandable that our brave healthcare workers are now so aggrieved by the Government’s decision. These are the same people for whom we, the public, stood and clapped so proudly at our doorsteps during those dark days. The chaotic state of the UK’s planning and preparedness for pandemics has been laid bare at the UK Covid-19 Public Inquiry. During future sessions, the Inquiry will receive evidence concerning the deception which was wrought upon healthcare workers that the flimsy paper masks they were given would keep them safe from the disease when health and safety law requires proper tested and certified respirators to be used (such as FFP3 and equivalent) when workers are exposed to dangerous microbiological hazards in their workplace. Current World Health Organization guidance still advocates that universal masking policies in health and social care premises do still have their place in Governments’ armoury of defence measures to keep healthcare workers safe. Given all that they have already been through, combined with the ongoing suffering that many of them are experiencing from the disease they have contracted whilst caring for us, surely it is now time for the Scottish Government to pay greater consideration and respect for their health and safety. Some commentators may view the abandonment of universal masking as the Government playing “Russian Roulette” with their health by "letting the virus rip" – as sadly it is likely to do as the autumn and winter seasons approach.

This blog from Matthew Bacon, CEO of TCC-CASEMIX Ltd, looks at why a multi-factorial dataset is needed to create holistic understanding of medical device performance and is the only effective means for determining the multi-factorial causes of failure. The Department of Health and Social Care has proudly announced that it has mandated the tracking of high-risk medical devices within NHS trusts – all in the name of avoidance of harm to patients. So, the Cumberlege report is now sorted! Advocates of patient safety need to be far more critical. I for one am astonished by the nativity of this simplistic strategy. A recent article in the New York Times suggesting that medical device makers have bankrolled a cottage industry of doctors and clinics that perform artery-clearing procedures that can lead to amputations is a great example of why I hold this opinion. The central point of failure here was not so much the failure of the medical devices (for example, stents, guidewires and catheters), but the procedural method associated with use. There will also be patient risk factors that are pertinent to the failure as well. The loss of a limb is the direct consequence of the surgical intervention. At TCC-CASEMIX Ltd we do not only identify each use of the device (Class IIb & Class III), but we also acquire a multi-factorial dataset to create holistic understanding of medical device performance. A few examples of the datasets that we consider are critical are: Patient risk factors (a few pointed out in the article New York Times article). We correlate these factors presented through the electronic patient record, with post-intervention outcomes following a procedural intervention tracking the use of the medical devices. This is how patient learning becomes part of the feedback loop to inform which devices, aligned to specific methods and outcomes, enable predictive safety. Procedural method. The best medical device used inappropriately (often with lack of evidence to inform the decision making by the health professional) can substantially increase the risk of harm to the patient. In many different interventions there are a variety of alternative procedures and associated medical devices available, each of which can be correlated to different patient complexities (risk factors). Human factors. Research shows that there can be repeated failures of the devices because of the incorrect/ inappropriate medical device selection. For example, for the less experienced healthcare professional, the choice of the correct size of stent, guidewire or catheter will be critical to the success of the outcome. Incompatibility between any of these devices can lead to an adverse event. Literature clearly identifies that the majority of device failures go unrecorded. This data acquisition platform records exactly what happens during a specific (atomic level) procedure associated with a specific devices or multiple devices used for it and is an effective means for determining the multi-factorial causes of failure. Routine data acquisition beyond simply identifying which device has been used with which patient is clearly insufficient. It will do nothing to improve patient safety.

I guess that a common feature linking most visitors to Patient Safety Learning is that they have a profound interest in two things. First, recognising and applauding innovations and ‘best practice’ in healthcare. Second, recognising, exposing and denouncing bad practice. The thing they have in common is the desire to learn from the mistakes in the past to do better in the future. When it comes to ‘bad practice’ in healthcare it is usually in connection with some adverse and damaging impact on patients. Our thoughts turn perhaps to certain medical failures, such as the ‘Mid‑Staffs scandal’. Seldom do we find the need to consider the adverse and damaging impacts on the doctors, nurses and all the other staff who work in the health and social care sector. However, those of you who watched the recent BBC Panorama programme, 'Forgotten heroes of the Covid frontline' will have been appalled at the scandal that now confronts so many frontline staff for whom we stood outside our front doors and clapped for so enthusiastically back in those dark days at the height of the pandemic. This blog is dedicated to those 'forgotten heroes'. I hope that it demonstrates that they are not, in fact, forgotten I hope that the resources linked to this blog may be of help to them. The BBC Panorama programme, Forgotten heroes of the Covid front line, touched on a number of important issues, which I will briefly summarise. Transmission of the disease from person to person The Government (and World Health Organization) claimed that Covid-19 was spread by droplets from the nose and mouth of infectious patients, which would quickly fall to ground within 2 metres. Many eminent scientists across the world warned that the disease is also spread by a more insidious mechanism known as 'airborne transmission'. This refers to tiny aerosols that hang in the air and can cause infection by inhalation. But these warning were ignored. Protection of healthcare workers It doesn’t take a rocket scientist or a competent epidemiologist to appreciate that these brave people were at considerable risk of catching Covid-19 themselves while caring for infectious patients in hospitals, residents in care homes, etc. We had all seen the news in February 2020 as the disease rampaged through Italy and noted, with considerable alarm, the number of healthcare workers who were dying from the disease. The UK Government and health authorities had plenty of time to ensure that our healthcare workers were properly protected with the best possible equipment. But they weren’t. Instead of being provided with proper respirator masks, such as those known as FFP3s (Filtering Face‑Pieces), they were provided with flimsy surgical masks which (a) do not filter out the virus‑laden aerosols, and (b) do not provide a tight seal to the face, meaning that the aerosols can get in via the gaps around the edge. Anyone who has ever worn that type of mask and also wears glasses will have evidence of how the exhaled aerosols escape from the mask and mist up their glasses. What goes out, can come in… To add insult to injury the authorities had the effrontery to refer to these masks as “personal protective equipment” (PPE), assuring workers that these would protect them from the disease. For the avoidance of doubt: they are not designated as PPE under UK legislation. They never have been PPE and they are not fit for that purpose. Surgical masks do not protect against airborne hazards such as infectious aerosols. Those who recommended them for this purpose either knew that or should have known that. The "unkindest cut of all” As healthcare workers became infected with the disease, many NHS health trusts and health boards robustly denied that there was any possibility whatsoever that their infections could possibly have been associated with their work. “Nothing to do with us” they said (or words to that effect). Then, once those who were so badly afflicted with the after effects of the disease (known as Long Covid) had been off work for a certain length of time, they were unceremoniously sacked. As the Panorama programme reveals, it is this “denial of occupational exposure” by the NHS which is the most hurtful and vile aspect of the treatment meted out to our “heroes of the Covid frontline”. It is nothing less than a national scandal. As a society, we surely owe it to our healthcare workers who have been harmed in this way to support them through the difficulties that lie ahead of them. In many cases they will have the after effects of Covid-19 for the rest of their lives. We should never forget that their grievous situation has arisen through no fault of their own, but is directly attributable to their selfless bravery back in the darkest days of the pandemic and the misinformation they were given about PPE. Help for health and social care workers Earlier, I mentioned resources that may be of help to those health and social care workers who wish to stand up for themselves and demand that their cases of Covid-19 be recognised as “occupational exposure” (as defined in UK law) and have their cases officially recorded and reported as required by health and safety legislation known as RIDDOR (The Reporting of Injuries Diseases and Dangerous Occurrences Regulations 2013). There are two important points to remember: You do not have to prove that the actual virus which triggered your disease entered your body at work rather than out in the community. It just has to be more likely than not (otherwise known as 'the balance of probabilities), which is easy to demonstrate, given the circumstances of the work at the time. The excuses given by health trusts and health boards for not RIDDOR-reporting generally centre around claims that they were “following Government guidance” and “issued PPE in accordance with that guidance”. However this has no legal validity whatsoever. Let’s take a look at what the RIDDOR actually require… If a disease was (a) diagnosed by a doctor based on symptoms alone or, in the case of Covid-19, by a positive test result (since it was not always possible to see a doctor); and (b) was more likely than not caught through your work, then it is reportable. Whether the employee was given no PPE, the wrong PPE or the very best PPE, it is still reportable. Whether the employer was or was not following official guidance, it is still reportable. There is nothing whatsoever in these regulations that exempts an employer from making the statutory report on these grounds. Four resources you may find useful 1. A letter sent to NHS Employers. This challenges the advice that NHS Employers issued in the form of a flow-diagram regarding RIDDOR-reporting and explains why it was flawed and bore little resemblance to the RIDDOR regulations. In fairness, upon receipt of this letter NHS Employers have replied confirming that they have removed the offending diagram and are now consulting with the Health and Safety Executive (HSE). https://www.tridenthse.co.uk/riddor/Letter_NHS_Employers_2023-03-20.pdf 2. A letter sent to HSE, which is overtly critical of the fact that they did not properly enforce RIDDOR reporting within the healthcare sector. Although this is a long letter, the intention was to set out an unassailable argument, based on the law, HSE guidance and the implementation of RIDDOR in other sectors of industry, as to why healthcare workers’ disease should be reported. The aim of this letter was not just to communicate these facts to the HSE (since they should already know them) but mainly to provide information and assistance to any affected healthcare workers who may wish to read them. HSE have replied to this letter, giving the following explanation: “RIDDOR was originally drafted to capture single one-off unexpected events (accidents and incidents). It was not intended to be used in a pandemic involving thousands of instances of infection, where an employer may be required to make a judgement as to whether a worker caught the infection as a result of a workplace exposure or in the wider community.” One would have hoped that the HSE would have a better understanding of the role of RIDDOR and its origins. The Regulations have never just been about 'accidents and incidents'. It has always been about diseases and long-term health issues – that is what the first 'D' in RIDDOR stands for. Neither has it been solely about 'capturing single one-off unexpected events', it has been about identifying trends that need further investigation. Dating back to HSE Guidance L.73 in 1995: “The [RIDDOR] reports alert the enforcing authorities to individual incidents. They also provide data which indicates how risks arise and show up trends.” Had RIDDOR-reporting been properly enforced trends would (or should) have been spotted in relation to overall infection-rates among healthcare workers. In any event, I am not persuaded that this is a valid reason for denying recognition and official recording of 'occupational exposure' to a lethal disease against which our healthcare workers so valiantly battled at extreme risk to their own health. It only takes a few minutes to tap the relevant details into the online RIDDOR system for each case. It is not a lot to ask. Interestingly, whereas my concern centres around under-reporting, HSE respond by saying that “they have found a significant amount of over-reporting”. I am lost for words! Please refer to the last page of my letter to them and make up your own minds. https://www.tridenthse.co.uk/riddor/Letter_HSE_2023-03-20.pdf 3. In response to the flawed flow-diagram produced by NHS Employers, I have prepared my own flow-diagram setting out the way in which RIDDOR should have been (and should continue to be) implemented in the healthcare sector during the pandemic. I must emphasise that this diagram represents my own personal and professional interpretation of the reporting mechanism and has no official status. HSE will undoubtedly push back on some aspects of this, particularly the aspects of worker-to-worker cross-infection within healthcare premises which their guidance states is non-reportable. I state that it is reportable and I give my reasons. I am pleased to note that in their letter of reply they do not contest this point. https://www.tridenthse.co.uk/riddor/Flow_Diagram_2023-03-20.pdf 4. For healthcare workers with Long Covid, I have produced a template letter which you are welcome to download and adapt according to your own particular circumstances, with a view to sending it to your health trust, health board or other employer, setting out your reasoning as to why your case is, even now (may be a year or two after their initial infection), RIDDOR-reportable. https://www.tridenthse.co.uk/riddor/HCW_RIDDOR_Template_Letter.doc I have also provided some guidance notes to assist you in using the template letter: https://www.tridenthse.co.uk/riddor/HCW_RIDDOR_Template_Letter_Notes.pdf. Even if this letter fails to persuade the more intransigent health trusts/boards to RIDDOR-report (and one can anticipate them being instructed by HSE not to), such a letter may be helpful in demonstrating 'occupational exposure' in the event that they eventually become eligible for some form of State support which they so richly deserve. Conclusions Healthcare workers have not been, and are still not, treated fairly or ethically by the Government, their Departments and Agencies or their own employers. Health and Safety legislation is not being applied equitably between the healthcare sector and other industry sectors. This applies both to the regulations known as COSHH (relating to safe working with hazardous substances, including pathogenic organisms), where the basic requirements for respiratory protection have not been met, and RIDDOR (as described above), where it is basically a postcode lottery as to whether healthcare workers’ COVID-19 infections are recognised and recorded as 'occupational exposure' or not. Going forward, to strike a more positive note, my greatest hope is that a just and fair arrangement is put in place to support those health and social care workers whose lives have been ruined through their selfless devotion to duty during the pandemic. It matters not whether this is achieved via the Industrial Injuries Disablement Benefit scheme or a bespoke scheme comparable with the Armed Forces Compensation Scheme for injured veterans. After all, throughout the pandemic we have referred to them as “frontline workers”.