Search the hub

In operating theatres and other high pressure clinical environments, clear identification shouldn’t be a nice ‘extra’, it is a patient safety need. When staff cannot quickly recognise names and roles, communication becomes harder, escalation can be delayed and patients are left unsure who is caring for them. Reviews of patient safety repeatedly show that poor teamwork and unclear roles can contribute to avoidable harm. Danielle Checketts, Managing Director of Eco Ninjas, discusses why being able to identify staff by their names and roles is so important not only for the staff themselves but also patients. She explains how a simple idea, reusable hats with detachable name badges that can be removed before laundering, can support safety and teamwork. In theatre, everyone can look the same. Masks, gowns, visors and lead aprons often cover name badges, while lanyards are easily hidden or turned around. Theatre teams include surgeons, anaesthetists, students, agency staff and industry representatives, yet patients and colleagues are still expected to know who is who. When names, roles and seniority are unclear, questions may go to the wrong person, and valuable seconds can be lost. Even when introductions are made during the WHO surgical safety checklist,[1] names and roles can quickly be forgotten once a procedure is underway. In an emergency, it must be immediately clear who is who. This lack of clarity can lead to: Miscommunication at critical moments. Delays in escalation. Reduced patient confidence and psychological safety. Errors due to misunderstood roles or instructions. This isn’t just theoretical. Liz Fitzhugh, net zero lead and former theatre manager at University Hospitals Coventry & Warwickshire (UHCW), put it simply: “If a patient arrests and someone asks for the crash trolley, either everyone goes or no one goes.” In critical moments, teams need to be immediately identifiable so they can act without hesitation. Liz’s team at UHCW were among the first to introduce name and role theatre caps in 2019. It feels fitting that she was also the person who once asked me to write my name on my disposable cap with a marker pen, quietly sparking the idea that grew into this work. For years, poor identification in theatre has become accepted and been treated as normal. But it shouldn’t be. Patients want to know who is caring for them, and staff work more safely when names and roles are clearly visible. That is why the ‘theatre cap challenge’ gained momentum internationally, highlighting a simple idea: if the hat remains visible when wearing sterile attire, it can help make names and roles visible too. Patient perspectives: what matters most Patients consistently say they want to know who is in the room, who is leading their care and who they can turn to for reassurance. Feedback from surgical and maternity care journeys, including caesarean births, shows that visible names and roles help people feel safer, calmer and better able to engage in what is happening around them. Patients describe feeling more reassured when: Staff introduce themselves clearly. Visible names and roles help patients and colleagues remember who is who after introductions, rather than relying on memory alone. There is consistency in communication throughout their care. When identification is unclear, patients can feel anxious and excluded at the point they are most vulnerable. Visible names and roles do more than support courtesy, they strengthen communication, teamwork and reassurance for patients and families. Infection prevention, hygiene and practical constraints Efforts to improve identification must also align with infection prevention standards. Theatre attire cannot simply be adapted without considering contamination risk, laundering processes and the wider pressure to reduce reliance on single use items. The challenge with current approaches The current embroidered theatre caps improve visibility of names and roles, but they are difficult to manage at scale and fail to support consistent identification for all staff. Students, visitors and temporary staff are often excluded, and new starters can wait months before receiving one. They also create ongoing operational challenges, including time-consuming bespoke ordering, poor fit, loss and replacement costs, outdated roles, and complications with laundering. As Alan Dickens, Theatre Manager at MMUH Birmingham, explains: “Bespoke embroidered caps are hard to manage over time. When staff leave or change roles, the hats issued to them often leave with them or need replacing. This creates ongoing cost for the trust and delays in maintaining accurate identification.” Emerging responses across the NHS Several NHS organisations are now testing a more practical approach: reusable hats with detachable name badges that can be removed before laundering. This keeps identification visible while fitting more easily into real hospital systems. In Somerset, a pilot at Musgrove Park showed how a simple change can support safety and teamwork. Mr Andy Stevenson, orthopaedic consultant at Somerset NHS Foundation Trust, said: “In theatre, there can be a really high turnover of colleagues at times, with new people coming and going all the time. This can make it really difficult to know who is who, let alone what jobs they have. Some days, it will be the first time working with half the people in the room. The badge hats have helped to positively transform communication and safety.” A similar message has come from maternity services. Kathryn Harrison, delivery suite manager at Great Western Hospital, said: “Despite staff introducing themselves in the morning, remembering everyone’s name and role throughout the day is challenging, especially when more than 12 people can be in the room at any one time. The badge hats reinforce this critical stage in safe surgery, improve teamwork and communication, and help break down hierarchical barriers. They can be worn by all staff, students, birthing partners and even the patients wear them on our unit”. Building the evidence base There is growing research interest in identification in healthcare.[2][3][4] We have started to work with medical schools on exploring the impact on training environments, role visibility and communication. This is helping to strengthen the evidence base for scalable, system-wide approaches. Students can be included simply using a badge with their name and role alongside a standard fitted hat. Towards integrated, system-based solutions The challenges across current approaches show the need for solutions that fit existing NHS processes, including laundering and distribution, while also identifying temporary staff, visitors and students. The most effective solutions will improve safety without creating new inefficiencies. A call to action Clear identification in healthcare is not optional. It is a practical safety intervention. When people can immediately see names and roles, communication improves, hierarchy softens, patients feel more reassured and teams are better able to act quickly when it matters most. If the NHS is serious about reducing avoidable harm, improving teamwork and strengthening patient experience, visible identification should be part of the solution. Wearing a detachable badge on a reusable theatre cap sounds very simple but this is a small change that can make a very big difference to the safety of patients. References World Health Organization. WHO Surgical Safety Checklist. Kouba LP, Fabi A, Bayer S, et al. Labeled surgical caps improve perioperative patient safety and interprofessional communication in the operating room: a scoping reviewe. Patient Saf Surg, 2026; 20:(9). Liverpool University Hospitals NHS Foundation Trust (LUHFT) and Warwick Med. Case study – Switching to Reusable Theatre Caps. NHS England. Douglas N, Demeduik S, Conlan K. Surgical caps displaying team members' names and roles improve effective communication in the operating room: a pilot study. Patient Saf Surg 2021;15:27. doi: 10.1186/s13037-021-00301-w.

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.

In this interview, David Osborn, chartered occupational safety and health practitioner and member of the Covid-19 Airborne Transmission Alliance (CATA), speaks to Lotty Tizzard, Digital Content Manager at Patient Safety Learning, about how CATA was established during the pandemic to advocate for adequate respiratory protection for NHS employees.  David explains how CATA advocated for the government and heath service to recognise that Covid-19 is passed on by aerosol transmission (through microscopic particles in the air). He also outlines why surgical masks do not adequately protect people against catching airborne viruses and describes how inadequate respiratory protective equipment (RPE) contributed to thousands of NHS staff catching Covid-19 at work. As a result, many healthcare workers died and a large number still live with the ongoing symptoms of Long Covid. David describes CATA's involvement as a Core Participant in the Covid-19 Inquiry and outlines what he hopes will be done to ensure the UK is better prepared for future pandemics. Patient Safety Learning is also a member of CATA. Clarification David wishes to clarify a point raised in the interview: "When talking about the “IPC Cell” I said that they 'didn’t produce minutes'. In fact, notes or minutes were taken at all IPC Cell meetings. The point I was making is that they were not published ('produced' in the sense of being released into the public domain), when the minutes of most other groups such as SAGE and NERVTAG were published. The few IPC Cell minutes that have trickled into the public domain have mostly been as a result of Freedom of Information requests by a colleague and a few that I have managed to obtain myself. In some cases, public authorities have taken around 18 months to disclose documents, and it has required the intervention of the Information Commissioner's Office. I anticipate that more minutes will be disclosed for public scrutiny as time goes on." You can read more about CATA and the Covid-19 Inquiry in David's blogs and presentations on the hub: Respiratory protective equipment: An unequal solution for healthcare workers? A blog by David Osborn Healthcare workers with Long Covid: Group litigation – a blog from David Osborn Covid-19 : A risk assessment too far? A blog by David Osborn CATA and the UK Covid-19 Public Inquiry: Presentation from David Osborn Join the conversation Were you working in health and social care during the pandemic? We'd like to hear about your experience of health and safety at work. Were you provided with adequate PPE to carry out your job safely? Did you catch Covid-19 while at work? You can join the conversation by commenting below (you'll need to sign up first) or get in touch with us directly by emailing [email protected]

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.

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”.