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Content Article
This blog for Health Services Safety Investigations Board (HSSIB), is authored by Saskia Fursland, Senior Safety Investigator. She talks about her visit to a newly opened paediatric ward where its design has carefully considered children and young people with mental health needs. Saskia reflects on the learning which could support other paediatric wards to improve their environments.- Posted
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Content Article
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- Posted
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Content Article
Leapfrog content to raise awareness of the risks associated with waterborne pathogens. Waterborne diseases account for 118,000 hospitalisations each year in the United States and adds burdens to both patients and hospitals. Learn more about why creating a culture of prevention is important.- Posted
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Content Article
For healthcare to be safe it needs to be accessible. But what does this look like for people with ME (myalgic encephalomyelitis) and Long Covid? This blog from #ThereForME explores the barriers that impact access to NHS care for people with ME and Long Covid, and encourages the patient community to share their experiences. What is ME and why is accessing care difficult? ME (myalgic encephalomyelitis, sometimes referred to as ME/CFS) is a complex, chronic condition affecting multiple body systems.[1] Symptoms include debilitating cognitive dysfunction and post exertional malaise (PEM)—the exacerbation of symptoms following exertion, which can sometimes lead to a long-term deterioration—the cardinal symptom of ME. Patients with ME have one of the worst qualities of life of any disease: lower than various forms of cancer, multiple sclerosis or chronic renal failure.[2] The most severely affected patients are reliant on full-time care, sometimes becoming unable to speak or swallow, and may require hospital care to avoid dehydration and malnutrition. Since 2020 at least two million people in the UK have been affected by Long Covid. Approximately half of those affected meet the criteria for ME (though not all have been formally diagnosed), alongside those who have developed other long-term health issues following Covid infections.[3] For people with ME and Long Covid, accessing healthcare, whether for these or other conditions, can be challenging. PEM means that it can be difficult to receive care without risking a deterioration in symptoms, especially when reasonable adjustments are not made to minimise the exertion involved. A lack of knowledge, misunderstanding and stigma around the conditions exacerbate the issue, sometimes making patients reluctant to seek care and clinicians unlikely to understand the adjustments that are needed. Together, these and other barriers mean that people with ME and Long Covid may avoid, delay or be completely unable to seek the care they need, creating risks for patient safety. Difficulties accessing care at home A 2023 public consultation highlighted failures in the health service that included the accessibility of NHS care for people with ME—particularly for housebound or bedbound patients.[4] This was echoed by a 2024 #ThereForME survey of over 300 people with ME and Long Covid (and their carers).[5] Two-thirds of people responding to our survey said that the NHS had not been there for them when they needed it. The overall accessibility of care was highlighted as a core concern. Housebound patients answering our survey reported struggling to get access to home visits for monitoring and routine screenings or even remote/phone appointments. Patients reported delaying or avoiding seeking care as a result, or in some cases turning to private care as the only option to facilitate routine investigations. Learnings from care for other conditions can show how similar barriers have been addressed—for example, progress in care for people with learning disabilities.[6] Hospital systems and environments People with ME and Long Covid often experience difficulties navigating energy-intensive NHS systems and hospital environments. For many, the process of arranging and receiving medical care may go well beyond their limited energy envelope. This includes challenges like inflexible booking systems, appointments that are changed or cancelled at short notice, long journeys to medical appointments or needing to coordinate with multiple referrals and clinicians. Patients may delay seeking care, even in emergencies, due to the toll that a busy hospital environment is likely to take on their chronic symptoms. Particularly in A&E and inpatient care, busy waiting rooms and hospital wards may exacerbate sensitivity to noise, light and movement. Patients may be unable to sit upright in waiting rooms for long periods of time without their symptoms being exacerbated. While reasonable adjustments are key to accessibility,[7] and the 2021 NICE Guideline for ME/CFS outlines some adjustments that may be needed,[1] knowledge of the Guideline is limited in the NHS and the majority of NHS Trusts and Integrated Care Boards are not implementing it.[8] More widely, limited knowledge about ME, and similarly Long Covid,[9] means that patients don’t receive treatment that is sensitive to their symptoms—and, crucially, that avoids exacerbating them—because clinicians lack basic knowledge. People with ME and Long Covid, who are often particularly vulnerable to infections, may also avoid seeking healthcare due to concerns about acquiring infections. Many people with Long Covid report deterioration after Covid reinfections,[10] as the pandemic continues far from the headlines and with few measures in place to prevent airborne transmission. This may also impact the ability of family carers to access healthcare themselves, fearing acquiring an infection which could set back their loved one’s health. Trauma in healthcare Traumatic experiences in healthcare also play a role. Many patients with ME and Long Covid have experienced feeling dismissed or disbelieved, sometimes discouraging them from seeking care in future. The 2024 #ThereForME survey documented multiple cases of patients who said that, due to such experiences, they would be reluctant to seek NHS care even if experiencing life-threatening symptoms, expressing a sentiment that they would ‘rather die at home’ than seek healthcare in an emergency.[5] ME is significantly more common among women,[11] meaning that experiences of stigma linked to the condition overlap with gendered experiences of healthcare,[12] including how pain among women is routinely dismissed. Sharing your experiences We hope this blog has shone a spotlight on some of the challenges people with ME and Long Covid face when accessing care. If you have ME or Long Covid, or care for someone who does, we’re keen to hear about your experiences: Have there been times where you delayed or were unable to access the care you needed due to these or other challenges? Have you or the person you care for experienced an exacerbation of symptoms due to exertion involved in seeking healthcare? What would make the biggest difference to you to make care more accessible? Do you have any experiences to share where reasonable adjustments were made or a member of staff went out of their way to make it easier for you to access care? We’ll be collating the experiences shared and exploring what can be done about it. You can share your experience by posting in the Comments field below or join our conversation in the Community area of the hub. References NICE. Myalgic encephalomyelitis (or encephalopathy)/chronic794457 fatigue syndrome: diagnosis and management. NICE guideline [NG206], 29 October 2021. Falk Hvidberg M, et al. The Health-Related Quality of Life for Patients with Myalgic Encephalomyelitis / Chronic Fatigue Syndrome (ME/CFS). PLOS One, 2015; https://doi.org/10.1371/journal.pone.0132421. Dehlia MA, Guthridge MA. The persistence of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) after SARS-CoV-2 infection: A systematic review and meta-analysis. J Infection, 2024. Department of Health and Social Care, Department for Education and Department for Work and Pensions. Consultation outcome. Improving the experiences of people with ME/CFS: interim delivery plan, 9 August 2023. ThereForME. Building an NHS that’s there for Long Covid and ME, July 2024. Anderton M. Exploring deep sedation at home to support people with learning disabilities to access medical investigations with minimal distress. Patient Safety Learning, 17 July 2023. Brar P. Diagnostic safety: accessibility and adaptations–a (un)reasonable adjustment? Patient Safety Learning, 19 September 2024. Action for M.E. Patchy, Misunderstood and Overlooked Implementation of the NICE Guideline [NG206] on Myalgic Encephalomyelitis/ Chronic Fatigue Syndrome in England Freedom of Information Findings Report, May 2023. Patient Safety Learning. Long Covid: Information gaps and the safety implications. Patient Safety Learning, 7 June 2021. WHO. Knocked back by COVID-19 reinfection – the experience of Abbie, a British nurse living with long COVID. World Health Organization, 30 November 2023. DecodeME. Initial findings from the DecodeME questionnaire data published, 24 August 2023. Anonymous. One hour with a women's health expert and finally I felt seen. Patient Safety Learning, 7 November 2024.- Posted
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- ME/ Chronic fatigue syndrome
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Content Article
Matthew Zak Sheldrick (Matty) had struggled with their mental health throughout their adult life, but it wasn’t until 2019 that Matty was finally diagnosed with Autism. ADHD and Autistic Spectrum Disorder. However, they had never been sectioned under the Mental Health Act or had spent time as a voluntary patient in a mental health hospital. Matty had moved to Brighton from Surrey in November 2021 having wanted to live independently. They were drawn to Brighton as they wished to be involved in the trans/non-binary community. Matty’s mental health deteriorated during the summer of 2022 due to accommodation issues that they had been facing and issues with an online relationship. By 3rd September they were in crisis. On 5 September 2022 Matty was admitted to A&E at the Royal County Hospital, Brighton. They remained within A&E, short stay ward, for 26 days awaiting a psychiatric bed. During this time no bed was found, and they were eventually discharged back home with support from the Crisis Home Treatment Team. Matty’s mental health had been affected by the unsuitability of the environment within A&E for someone awaiting an inpatient mental health bed. Less than 5 weeks later Matty was again admitted to the A&E department at the Royal Sussex County Hospital on 3rd November 2022 in crisis. Their presentation fluctuated and this led to them being assessed under the Mental Health Act. However, they were not found to be detainable. They left the hospital shortly after the assessment and were sadly found hanging in the grounds of the hospital. Matters of concern The lack of inpatient beds leading to the unacceptable wait time in A&E for those suffering with their mental health who are awaiting beds. In Matty’s case a bed was not found for them within a 26-day period. There being a shortage of beds for Autistic patients (both informal and detained) within the private sector that are being funded by the ICB. Evidence was heard that those providing beds within the public sector very often refused to accept autistic patients due to their additional risks. There being a shortage of beds for transgender patients who are in need of a mixed ward. In Matty’s case it appears there was a lack of appreciation by the ICB of his extensive length of stay in A&E. It appears that this information (and others who had lengthy stays) was not at that time being collected, monitored and acted on by the ICB. The unsuitability of the environment of A&E as a holding place for those in need of a mental health bed. The evidence was that the environment in A&E as a holding place is not conducive for those suffering with Autism and/or who are neurodiverse. The environment in A&E can exacerbate and cause further deterioration in their mental health. There is a gap in services for those who are not ill enough to be detained but who are too high risk to be sent home. There is a significant wait time for referral to the Assessment and Treatment Service. Therefore, any therapeutic input is delayed, and this results in repetitive attendances at A&E when in crisis. Current gaps in service around psychosocial support for transgender, non-binary and intersex adults have been provided by third party charitable organisations. It is understood that much of their funding has recently been withdrawn by the ICB. This is of particular concern as Brighton is recognised as having one of the largest trans communities in the Country.- Posted
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News Article
Doctors call for major incident as hospital 'unsafe'
Patient Safety Learning posted a news article in News
Senior doctors working at a Glasgow hospital have asked for a 'major incident' to be called this week but had their request declined, BBC Scotland News understands. Emergency medicine consultants described conditions in the Queen Elizabeth University Hospital (QEUH) as "grossly" unsafe with no room to take in new patients on Monday evening. NHS Greater Glasgow and Clyde said it has a "robust system" in place to deal with additional pressures which were implemented. Documents seen by BBC Scotland News describe the whole hospital site at the QEUH in Glasgow as being "completely overwhelmed" on Monday evening. The emergency medicine consultants said a lack of capacity in accident and emergency left one patient waiting almost six hours in the back of an ambulance with a fractured hip. At the same time five ambulances were on route and a further 19 expected to attend the hospital. The document states that NHS Greater Glasgow and Clyde chief executive Jane Grant was involved in discussions about whether a major incident should be called, but it is believed she declined the request. The health board say the situation was resolved without involving the chief executive. NHS Greater Glasgow and Clyde said all of its services are under "considerable pressure" with the arrival of winter bringing additional challenges. Read full story Source: BBC News, 3 December 2024- Posted
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Content Article
Climate change is leading to a rise in heat-related illnesses, vector-borne diseases, and numerous negative impacts on patients’ physical and mental health outcomes. Concurrently, healthcare contributes about 4.6% of global greenhouse gas emissions. Low-value care, such as overtesting and overdiagnosis, contributes to unnecessary emissions. This review describes diagnostic excellence in the context of climate change and focus on two topics. First, climate change is affecting health, leading to the emergence of certain diseases, some of which are new, while others are increasing in prevalence and/or becoming more widespread. These conditions will require timely and accurate diagnosis by clinicians who may not be used to diagnosing them. Second, diagnostic quality issues, such as overtesting and overdiagnosis, contribute to climate change through unnecessary emissions and waste and should be targeted for interventions. The review also highlight implications for clinical practice, research, and policy. The findings call for efforts to engage healthcare professionals and policymakers in understanding the urgent implications for diagnosis in the context of climate change and reducing global greenhouse gas emissions to enhance both patient and planetary outcomes.- Posted
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- Climate change
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This investigation by the Healthcare Service Safety Investigation Body (HSSIB) is one of a series on the theme of patient safety in mental health inpatient settings. This investigation focused specifically on the conditions that contribute to safe and therapeutic care for adults who are staying in mental health wards or units. The demand on mental health inpatient services in England is high and has been increasing. It is reported that the quality of care received by patients admitted to these services varies, meaning patients may not receive the therapeutic care they need. Issues include limited shared decision making and a lack of consideration of recovery-focused goals. Patients may also be placed in situations that create safety risks associated with mental, physical or sexual harm. This investigation examines the impact of workforce challenges on the delivery of safe and therapeutic care to adult patients in acute mental health inpatient settings (settings for people who need urgent care and are experiencing a severe mental health problem). It also looks at the wider workplace conditions and the organisation of care to see how these factors affect care. The investigation’s scope included adults, older-adults and secure (adults who pose a risk to the public) inpatient settings. The investigation's findings and recommendations offer opportunities to make improvements to systems, practices and future plans to support the delivery of therapeutic care, and therefore safety, in mental health inpatient settings. Findings Mental health inpatient workforce Patients in mental health inpatient settings did not always feel safe and staff were not always able to develop therapeutic relationships with patients in support of their care and safety. Best practice standards for care were not embedded across inpatient settings. Some inpatient models of safety continued to focus on restrictive approaches, rather than relational approaches. Approaches were influenced by the ability of the workforce to form therapeutic relationships with patients. Workforce challenges across the multidisciplinary workforce had negatively influenced the ability of staff to develop therapeutic relationships with patients and therefore patient safety had been affected. Workforce challenges included difficulties recruiting staff and retaining experienced staff, and concerns around the knowledge and skills available to support therapeutic relationship formation and trauma-informed care. The mental and physical health care needs of patients cared for in acute inpatient settings may have changed and acuity may now be greater than in the past. Staff were not always equipped with the required knowledge and skills to understand and meet the mental and physical needs of patients. Wards were not always staffed to ensure patients could access the knowledge and skills of a multidisciplinary team. Some patients had no or limited access to professionals such as dietitians or speech and language therapists. Workforce challenges varied across regions. Barriers to region-wide coordinated workforce planning included unclear national expectations, difficulties predicting workforce needs, limited provider engagement, and a lack of available staff. The goals of the NHS Long Term Workforce Plan may be unattainable if barriers to implementation are not recognised and addressed. Barriers found included education capacity to build the workforce and poor working conditions affecting retention. There were conflicting views about how best to educate pre-registration nursing (mental health) students and where responsibility should lie to support their development of mental and physical health care skills. Registered nurses (mental health) may be being promoted to supervisory roles with limited experience. Inexperience influenced the supervision and development of new staff, and leaders may be reluctant to challenge attitudes that undermine the quality of care. Built mental health inpatient environments The built environments (estates and physical environments) of inpatient settings varied. Some environments were not therapeutic, did not contribute to formation of therapeutic relationships, and had created situations where patients and staff could and had been harmed. The short-, medium- and long-term investment requirements for safe and therapeutic built environments across mental health inpatient settings were not always known at regional and national levels. Capital funding for the NHS to maintain, improve and create new built environments was finite and unable to meet the needs of mental health inpatient settings. Hazards in built environments could not always be removed or mitigated, and environments could not be improved to be therapeutic. There were concerns about the long-term ability of some high-secure built environments to maintain patient, staff and public safety. There was no specific process for high-secure services to access the capital funds they required for long-term estate planning. There was limited evidence around how best to design therapeutic built environments to meet potential changes in patients’ needs and acuity. Providers wanted clarity on design standards and on the role of technology to support the safety of patients experiencing mental health problems. Social and organisational factors influencing mental health inpatient care The development of psychologically safe and therapeutic social environments was not always possible because of demands on services, workforce constraints, workforce knowledge and skill development, and cultural influences. Providers of mental health inpatient care were not always able to accommodate patients in single-sex spaces. Best practice standards in relation to ensuring sexual safety were not always embedded. Approaches to accommodating patients who were transgender and non-binary varied in mental health inpatient settings. Staff wanted to meet the needs and preferences of all patients but this was not always possible. Digital systems had contributed to incidents where patients had been harmed. Clinical information was not always easily accessible in electronic patient records or had not been shared across different care providers’ systems. Availability and access to physical healthcare services for mental health inpatients varied. Access was influenced by how providers designed and set up their services, the knowledge and skills of staff, and collaboration between acute and mental health care providers. In some locations, care pathways between different care providers were limited. This reduced continuity of care and made it more difficult to access physical health services, which increased the need for patients to be transferred to acute physical health hospitals. Inequalities continued to exist in the care of patients experiencing mental health problems. Availability and access to services for different patient groups further influenced the ability of inpatient providers to deliver safe and therapeutic care. Some organisational cultures and individual beliefs surrounding people experiencing mental health problems continued to negatively influence attitudes towards their care, including access to physical healthcare. Safety recommendations HSSIB makes the following safety recommendations Mental health inpatient workforce HSSIB recommends that The Shelford Group reviews and updates the Mental Health Optimal Staffing Tool on a regular basis following collection of recent data from mental health inpatient settings. This is to ensure the tool remains valid for potential changes in patients’ needs and the level of care they require, and to support providers to make decisions about workforce requirements that support therapeutic and therefore safe care. HSSIB recommends that NHS England works collaboratively with relevant national bodies and stakeholders including professional regulators, the Department of Health and Social Care, and relevant royal colleges to: Identify and clarify the goals of acute mental health inpatient care and the roles, required skills and ongoing professional development needs of the multidisciplinary workforce team. Review and update the NHS Long Term Workforce Plan with consideration of the concerns around changes in patients’ needs and the need for a multidisciplinary approach to ensure therapeutic care is provided. Develop a strategic implementation plan to address workforce issues in mental health inpatient settings that identifies the social and technical barriers to implementation and sets out actions to address them. This is to develop, enable, support and retain a future multidisciplinary mental health inpatient workforce that is able to deliver therapeutic and safe care to patients. Built mental health inpatient environments HSSIB recommends that the Department of Health and Social Care, with input from stakeholders including NHS England, identifies the short-, medium- and long-term requirements of NHS mental health built environments to ensure they enable delivery of safe and therapeutic care to patients, and create a supportive working environment for staff. This is to support the development of a strategic and long-term approach to capital investment and prioritisation for NHS built environments. HSSIB recommends that the Department of Health and Social Care undertakes assessment of the capital requirements of the built environments across high-secure services in England and develops plans to ensure the long-term safety of patients, staff and the public. Social and organisational factors influencing mental health inpatient care HSSIB recommends that NHS England, working with relevant stakeholders, develops guiding principles for providers of mental health inpatient care to support local decision making when accommodating patients, including patients who are transgender and non-binary. This is to ensure a provider’s equality and human rights obligations are considered, and all patients are cared for in environments where they feel safe and that are therapeutic. Safety observations HSSIB makes the following safety observations Providers of mental health inpatient care can improve patient safety by ensuring that where professional judgement is used to help make workforce decisions, this accounts for ward physical environments, changes in patient acuity, and the individual mental and physical health care needs of patients that require support from a multidisciplinary workforce. Those involved in the provision of undergraduate and pre-registration education (educational institutions and placement providers) and preceptorship/induction programmes can improve patient safety by collaboratively ensuring that staff entering mental health related professions are developing the required knowledge and skills, including in trauma-informed care, to care for patients with mental and physical health care needs. Those involved in healthcare research can improve patient safety by seeking to understand the design principles for mental health inpatient settings that underpin safe and therapeutic care. Research should include consideration of sensory environments, the role of technology, and the changing needs of patients. Those involved in the design of new and upgraded built environments for mental health inpatient settings can improve patient safety and the delivery of therapeutic care by involving relevant stakeholders in design processes. Stakeholders include people with lived experience (patients and staff) and experts in human factors and ergonomics. Any design should also consider the changing needs of patients. Providers of mental health inpatient care can support patient safety by evaluating and addressing local barriers to the effective use of technology to support patient care, including through gaining insights from people with lived experience (patients and staff) and ensuring the digital infrastructure is available, usable and reliable. Safety responses HSSIB proposes the following safety responses for integrated care boards HSSIB suggests that integrated care boards work collaboratively with the NHS and independent sector to review their system-level workforce plans to ensure they recognise and mitigate the safety challenges in mental health inpatient settings and agree how variation across a geographical area can be mitigated. HSSIB suggests that integrated care boards: 1) ensure system-level infrastructure strategies clearly reflect the risks across their mental health inpatient built environments, and 2) ensure prioritisation of capital funding is equitable across different healthcare settings in a geographical area. HSSIB suggests that integrated care boards: 1) work with mental health inpatient providers to identify patient needs that require input from other providers and agencies, and 2) facilitate cross-provider working arrangements between mental health, acute and primary care providers to minimise the need for transfers of care unless clinically necessary.- Posted
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- Mental health
- Mental health - adult
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Content Article
Theatres are a high risk area. This poster from the Association for Perioperative Practice and BD illustrates how to plan and practise to manage a surgical fire. Download a pdf of the poster from the attachment below.- Posted
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- Surgery - General
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Content Article
Tony Clarke suffered from a chronic inflammatory skin disease, hidradenitis suppurativa. In September 2020, Tony underwent surgery to remove infected tissue on one side of his body. When he entered the operating theatre, Tony’s surgical team first covered part of his body with an alcohol-based solution, to keep the area clean. Then, when the operation began, the surgeons began cutting off the infected tissue using a diathermy pen, a device that targets electrically-induced heat to stop wounds from bleeding. However, shortly into the surgery, disaster struck: heat from the surgical pen had ignited the alcohol on Tony’s body. “But because alcohol burns so hot, no fire was seen,” says Tony, recalling an explanation he later received from the hospital. “The surgeons were concentrating on the right side of my body. The left side was left burning for about 20 minutes.” For the next four months, Tony travelled back to the hospital every three days, to get his injuries checked and bandages changed. During that time, Tony describes himself as ‘totally disabled.’ In September this year, Tony, as a patient ambassador for prevention of surgical fires, spoke at a conference held in York by the Association for Perioperative Practice (AFPP). There, perioperative practitioners from across the country gathered to listen to Tony’s experience. “I was speaking to lots and lots of different professionals in the medical service and they'd never heard of it [being set on fire during surgery]. It was a rarity for them,” Tony says. Tony’s now working with different health agencies, with the aim of stopping preventable surgical burns entirely.- Posted
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- Surgery - General
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Content Article
This study in the American Journal of Surgery aimed to understand the impact of operating room temperature and humidity on surgical site infection (SSI). The authors found that large deviations in operating theatre temperature and humidity do not increase the risk of SSI.- Posted
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- Surgery - General
- Healthcare associated infection
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Content Article
The climate and ecological crises are both driven by human activities. They each have catastrophic implications for human health and their strong interconnection creates a vicious circle where each is reinforced by the other. A stable natural environment is critical for limiting global warming and achieving the UN’s Sustainable Development Goals (SDGs). Conversely, the loss of biodiversity is a major threat to human, animal, and environmental health. In order to mitigate harm and maximise the co-benefits of action, it is important that policies tackle both climate change and biodiversity loss together. This policy report by the UK Health Alliance on Climate Change, describes the impacts of biodiversity loss on land and oceans for human health and puts forward recommendations to reduce biodiversity loss, restore nature, and achieve climate goals for the benefit of health.- Posted
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- Climate change
- Physical environment
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Content Article
Patient-led assessments of the care environment (PLACE)
Patient Safety Learning posted an article in Environmental
PLACE assessments will provide motivation for improvement by providing a clear message, directly from patients, about how the environment or services might be enhanced. The 2023 programme is planned for launch in early September 2023. Good environments matter. Every NHS patient should be cared for with compassion and dignity in a clean, safe environment. Where standards fall short, they should be able to draw it to the attention of managers and hold the service to account. PLACE assessments will provide motivation for improvement by providing a clear message, directly from patients, about how the environment or services might be enhanced. The assessments involve local people (known as patient assessors) going into hospitals as part of teams to assess how the environment supports the provision of clinical care, assessing such things as privacy and dignity, food, cleanliness and general building maintenance and, more recently, the extent to which the environment is able to support the care of those with dementia or with a disability. Recruitment and training of patient assessors is the responsibility of those organisations undertaking assessments. The assessments take place every year, and results are published to help drive improvements in the care environment. The results show how hospitals are performing both nationally and in relation to other hospitals providing similar services.- Posted
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News Article
Bleach does not tackle fatal hospital superbug, UK researchers find
Patient Safety Learning posted a news article in News
Liquid bleach does not kill off a hospital superbug that can cause fatal infections, researchers have found. Clostridium difficile, also known as C diff, is a type of bacteria found in the human gut. While it can coexist alongside other bacteria without problem, a disruption to gut flora can allow C diff to flourish, leading to bowel problems including diarrhoea and colitis. Severe infections can kill, with 1,910 people known to have died within 30 days of an infection in England during financial year 2021-2022. Those at greater risk of C diff infections include people aged over 65, those who are in hospital, people with a weakened immune system and people taking antibiotics, with some individuals experiencing repeated infections. According to government guidance, updated in 2019, chlorine-containing cleaning agents with at least 1,000 ppm available chlorine should be used as a disinfectant to tackle C diff. But researchers say it is unlikely be sufficient, with their experiments suggesting that even at high concentrations, sodium hypochlorite – a common type of bleach – is no better than water at doing the job. “With antimicrobial resistance increasing, people need to recognise that overuse of biocides can cause tolerance in certain microbes, and we’re seeing that definitely with chlorine and C diff,” said Dr Tina Joshi, co-author of the research, from the University of Plymouth. While chlorine-based chemicals used to be effective at killing such bacteria, that no longer appears to be the case, she said. “The UK doesn’t seem to have any written new gold standard for C diff disinfection. And I think that needs to change immediately,” she said. Read full story Source: The Guardian, 22 November 2023 -
Content Article
Poster presentation from Dr Felicity Brokke and Ken Spearpoint at the recent GOSH Patient Safety and Human Factors Conference.- Posted
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Because hospitals exist for a long time and are expensive to build and to operate, it is crucial to use the abundant, available empirical evidence to guide design. “Evidence-based design” has documented how to make hospitals safer and less stressful. This article, published in The Conversation, looks at the challenges involved. -
News Article
Fumes from idling ambulances stuck outside A&Es endangering staff
Patient Safety Learning posted a news article in News
An ambulance trust is having to protect its staff from the effects of fumes – including potential cancer risk – as they are spending so long in their vehicles outside hospitals. South Western Ambulance Service Foundation Trust (SWASFT) has carried out a risk assessment of the impact of diesel engine emissions after following concerns from staff, many of whom are spending hours waiting to handover on each shift. The region has faced the worst handover delays to emergency departments in recent years. Ambulance engines normally have to be kept on while waiting, to keep essential equipment running, and sometimes for warmth. But with queues of a dozen or more ambulances at times, staff and patients can be exposed to substantial emissions for long periods. The trust’s risk assessment – which has been seen by HSJ – warns exposure to diesel emissions is associated with eye and upper respiratory tract irritation, while prolonged exposure can lead to coughing, increased sputum production and breathlessness. There is also “epidemiological evidence which indicates that sustained occupational exposure to diesel engine exhaust emissions may result in an increase in the risk of lung cancer”. It gives a risk rating of 20 – one of the highest possible – which, under the trust’s policies, indicates “activities must not proceed” until mitigations are in place. Read full story (paywalled) Source: HSJ, 27 March 2024- Posted
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News Article
Overheating and flooding at hospitals in England ‘pose threat to patient safety’
Patient Safety Learning posted a news article in News
Record levels of overheating and a sharp rise in flooding at England’s hospitals are putting vulnerable patients at risk, figures show. Analysis of NHS data by the Liberal Democrats found that the number of health trusts reporting overheating in clinical areas had doubled compared with six years ago, and floods had increased by nearly 60% from last year. An overheating incident is logged when an occupied ward or clinical area’s daily maximum temperature exceeds 26C, the temperature at which some patients become unable to cool themselves effectively. The latest government figures show that in the summer of 2022 there were an estimated 2,985 excess deaths due to heatwaves, the highest number on record. Heatwaves also forced a fifth of UK hospitals to cancel operations. The number of serious flooding incidents, where water caused disruption such as by breaching a building or flooding a road, rose from 176 to 279. The climate crisis is expected to increase these risks to hospitals and patients. Helen Buckingham, the director of strategy at the Nuffield Trust, said: “These figures are a cause for real concern about the resilience of the NHS’s estate to the growing threat from extreme weather in the UK. As temperatures have climbed, so too have the number of overheating incidents in NHS hospitals.” Read full story Source: The Guardian, 27 November 2023- Posted
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Energy-based devices, lasers and diathermy are some of the most commonly used pieces of equipment in operating theatres today. Dangerous emissions can be produced that affect the respiratory systems of everyone in the operating theatre. This study day will look at the occupational hazards of exposure to surgical plume in the operating theatre, as well as the associated risks to the surgical team, patients and visitors. It will also highlight how to assess risk and mitigate against the dangers of surgical plume and how to implement changes. Topics Include: Electrosurgery/diathermy/laser. Anaesthetic airway fires. Laparoscopic surgery aerosolisation. Health and Safety and risk assessment. Surgical plume. Register- Posted
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News Article
Overcrowded A&Es ‘much more dangerous now because of covid’
Patient Safety Learning posted a news article in News
Emergency departments across England are reporting ‘dangerous’ overcrowding similar to levels seen pre-covid, and struggling to maintain social distancing, A&E leaders have warned. The Royal College of Emergency Medicine said it was concerned about covid spreading among the most vulnerable patients, as overall transmission rates continue to rise sharply across the UK. It was always anticipated that A&E activity would return to pre-covid levels this winter, following a significant drop-off in A&E activity during the spring and early summer, and that service transformation would be needed to help maintain social distancing. But the emergence of widespread overcrowding so far ahead of winter is of serious concern to system leaders. A&E staff were already being forced to make difficult trade-offs over which patients to isolate, the college’s vice president told HSJ. He also urged NHS leaders not to place unrealistic expectations on the impact a new model involving walk-in patients booking slots by phone could make on addressing overcrowding in emergency departments. RCEM vice president Adrian Boyle said the NHS was “largely back to the pre-covid levels of crowding” but it was “much more dangerous now because of covid”. He said: “We are hearing that most emergency departments can’t maintain social distancing safely and staff are having to make fairly difficult trade-offs about which people need to be isolated. No one can be safely social distanced in a corridor.” Read full story (paywalled) Source: HSJ, 21 September 2020- Posted
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After coronavirus, we may not recognise changed NHS
Patient Safety Learning posted a news article in News
In many ways it is wrong to talk about the NHS restarting non-coronavirus care. A lot of it never stopped — births, for instance, cannot be delayed because of a pandemic. However, exactly what that care looks like is likely to be very different from what came before. There are more video and telephone consultations and staff treat patients from behind masks and visors. That is likely to be the case for some time, experts have told The Times. Read full story (paywalled) Source: The Times, 6 June 2020 -
News Article
Prime Minister urged to give NHS 100 new hospitals plus an extra £7bn a year
Patient Safety Learning posted a news article in News
NHS leaders have urged Boris Johnson’s government to build 100 new hospitals and give the service an extra £7bn a year for new facilities and equipment. They want the Prime Minister to commit to far more than the 40 new hospitals over the next decade that the Conservatives pledged during the general election. So many hospitals, clinics and mental health units are dilapidated after years of underinvestment in the NHS’s capital budget that a spending splurge on new buildings is needed, bosses say. Too many facilities are cramped and growing numbers are unsafe for patients and staff, they claim. Johnson has promised £2.7bn to rebuild six existing hospitals and pledged to build 40 in total and upgrade 20 others, although has been criticised for a lack of detail on the latter two pledges. The call has come from NHS Providers, which represents the bosses of the 240 NHS trusts in England that provide acute, mental health, ambulance and community-based services. Read full story Source: The Guardian, 3 February 2020- Posted
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News Article
Doctors and nurses must adapt their routines and improvise their actions to ensure continued patient safety, and for their roles to be effective and to matter as new technology disrupts their working practices. Research from Lancaster University Management School, published in the Journal of Information Technology, found electronic patient records brought in to streamline and improve work caused changes in the division of labour and the expected roles of both physicians and nursing staff. These changes saw disrupted working practices, professional boundaries and professional identities, often requiring complex renegotiations to re-establish these, in order to deliver safe patient care. Managers implementing these systems are often quite unaware of the unintended consequences in their drive for efficiency. Read full story Source: EurekAlert, 25 November 2019- Posted
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News Article
Hospital alarms prove a noisy misery for patients
Patient Safety Learning posted a news article in News
When Kea Turner’s 74-year-old grandmother checked into Virginia’s Sentara Virginia Beach General Hospital in the US, with advanced lung cancer, she landed in the oncology unit where every patient was monitored by a bed alarm. “Even if she would slightly roll over, it would go off,” Turner said. Small movements — such as reaching for a tissue — would set off the alarm, as well. The beeping would go on for up to 10 minutes, Turner said, until a nurse arrived to shut it off. Tens of thousands of alarms shriek, beep and buzz every day in every US hospital. All sound urgent, but few require immediate attention or get it. Intended to keep patients safe by alerting nurses to potential problems, they also create a riot of disturbances for patients trying to heal and get some rest. Alarms have ranked as one of the top 10 health technological hazards every year since 2007, according to the research firm ECRI Institute. That could mean staffs were too swamped with alarms to notice a patient in distress, or that the alarms were misconfigured. The Joint Commission, which accredits hospitals, warned the nation about the “frequent and persistent” problem of alarm safety in 2013. It now requires hospitals to create formal processes to tackle alarm system safety, but there is no national data on whether progress has been made in reducing the prevalence of false and unnecessary alarms. The commission has estimated that of the thousands of alarms going off throughout a hospital every day, an estimated 85-99% do not require clinical intervention. Staff, facing widespread “alarm fatigue,” can miss critical alerts, leading to patient deaths. Patients may get anxious about fluctuations in heart rate or blood pressure that are perfectly normal, the commission said. Read full story Source: The Washington Post, 24 November 2019 -
Content Article
Staff safety and wellbeing
Becky T posted an article in Staff safety
An original article that explores the significance of both staff physical safety in the workplace as well as their psychological safety and wellbeing. In particular, I highlight the impact the COVID-19 pandemic has had on both these areas, and discuss the importance of ensuring all aspects of staff safety. All healthcare workers, from nurses to pharmacists, housekeepers to consultants, should be kept safe as they carry out their essential duties in caring for others. Not only is their physical safety important, but their psychological wellbeing is paramount too. Healthcare workers should be kept safe from all forms of physical occupational hazard, including infectious agents, chemical hazards, workplace violence and ergonomic problems.[1] Specific measures have been put in place to protect the occupational health and safety of health workers, and there are consequential duties, rights and responsibilities for healthcare organisations to uphold.[2] However, just as significant is the psychological safety and wellbeing of staff, as this can have far reaching implications at both a personal and work level. Over-stretched staff can experience fatigue, anxiety, depression and, ultimately, burnout, which is a state of emotional, physical and mental exhaustion caused by excessive and prolonged stress.[3] Presently and perhaps most prevalent is the damaging toll, both physically and psychologically, that the COVID-19 outbreak is having on healthcare workers. As staff have been at the frontline of the pandemic, they have been exposed to multiple different occupational hazards and put at risk. These include exposure to SARS-CoV-2 and other pathogens, violence, harassment, stigma, discrimination, unimaginably heavy workloads and prolonged use of PPE.[2] The International Council of Nurses (ICN) estimated in June that at least 450,000 healthcare workers had been infected with COVID-19.[4] It is therefore clearly important that healthcare institutions provide safe work environments for staff to perform their essential duties.[4] Much focus has been placed on vaccinations, enhanced safety protocols and PPE to protect the physical health of clinicians and staff.[5] The scale of the COVID pandemic has caused mass psychological trauma among the world’s nurses. Moreover, difficulty in providing end-of-life support to patients and their families because of visiting restrictions has been a specific stressor for all staff.[7] Under these trying conditions, healthcare workers are likely to experience anxiety, depression, trauma, burnout and other mental health issues.[5] Reports from the US show that 93% of healthcare workers were experiencing stress at the height of the pandemic, with 76% reporting exhaustion and burnout.[6] A UK study reported that nearly half of ICU staff in England had symptoms of PTSD, severe depression, or anxiety.[7] For physicians, burnout was linked to a four-fold increase in suicidal thoughts.[5] Healthcare organisations ought to recognise the impact that emotional distress has on both patient safety and staff retention during and after the pandemic.[5] There is strong evidence that poor mental health is associated with functional impairment which increases the risk of patient safety incidents.[7] Therefore, equally as important as physical protection are resources to protect staff mental wellbeing. Action steps taken by an organisation before, during and after a crisis will reduce psychosocial trauma and increase the likelihood that staff will cope.[8] For example, hospitals could appoint a Chief Wellness Officer (CWO) and establish a professional wellbeing programme for their staff. It is critical for hospitals and health systems to address burnout from a system-wide level to better care for their staff and to become resilient organisations.[5] Healthcare workers who feel well-supported are less likely to leave their job or reduce their hours worked.[7] Research has highlighted the vital importance of fostering a supportive workplace culture, and the need to provide universal access to high quality wellbeing support and occupational health services.[7] Furthermore, a study has shown that people who engaged with receptive arts activities (such as drawing or painting) on a frequent basis had a 31% lower risk of dying,[9] which highlights the significance of fostering a work-life balance that actively supports mental and physical health. The safety of staff in the workplace is crucial, as is their wellbeing. The COVID-19 crisis has had a destructive impact on staff mental health, as shown in multiple studies worldwide, which cannot be overlooked. The massive elective backlog caused by the focus on COVID means that there is unlikely to be an easing of the strain on healthcare professionals for months if not years to come. It is therefore critical that both the physical and psychological safety of healthcare workers is supported and upheld by healthcare organisations in order to maintain a productive workforce who are better able to serve their patients. Becky Tatum Further reading Why is staff safety a patient safety issue? "I know this is burnout. I didn’t want it to be. But it is." Rethinking doctors’ mental health and the impact on patient safety: A blog by Ehi Iden Safety Incident Supporting Our Staff (SISOS): A second victim support initiative at Chase Farm Hospital Understanding moral injury: a short film (HEE and NHSE&I) Hidden Wounds References ‘Health Care Worker Safety Checklists: Protecting Those Who Serve’, Joint Commission International, 2019. [online] Available at: https://store.jointcommissioninternational.org/health-care-worker-safety-checklists-protecting-those-who-serve/?_ga=2.32377150.1488641257.1624913835-465240.1624122412 ‘COVID-19: Occupational health and safety for health workers’, World Health Organisation, 2021. [online] Available at: https://www.who.int/publications/i/item/WHO-2019-nCoV-HCW_advice-2021.1 ‘Burnout Prevention and Treatment’, HelpGuide, 2021. [online] Available at: https://www.helpguide.org/articles/stress/burnout-prevention-and-recovery.htm# Blasi, A., Nunner, K. ‘Ethical principles in health care prove critical to protecting health care workers in pandemic’, Medical Economics, 2020. [online] Available at: https://www.medicaleconomics.com/view/ethical-principles-health-care-prove-critical-protecting-health-care-workers-pandemic ‘WELL-BEING PLAYBOOK 2.0. A COVID-19 Resource for Hospital and Health System Leaders’, American Hospital Association, 2021. [online] Available at: https://www.ihf-fih.org/wordpress/wp-content/uploads/2021/02/caring-for-health-care-workers-covid-19.pdf ‘The COVID-19 Effect: World’s nurses facing mass trauma, an immediate danger to the profession and future of our health systems’, International Council of Nurses, 2021. [online] Available at: https://www.icn.ch/news/covid-19-effect-worlds-nurses-facing-mass-trauma-immediate-danger-profession-and-future-our Mahase, E. ‘Covid-19: Many ICU staff in England report symptoms of PTSD, severe depression, or anxiety, study reports’, BMJ, 2021; 372. [online] Available at: https://www.bmj.com/content/372/bmj.n108 ‘Creating a resilient organization’, American Medical Association, 2020. [online] Available at: https://www.ihf-fih.org/wordpress/wp-content/uploads/2021/02/caring-for-health-care-workers-covid-19.pdf Fancourt, D. ‘The art of life and death: 14 year follow-up analyses of associations between arts engagement and mortality in the English Longitudinal Study of Ageing’, BMJ, 2019; 367. [online] Available at: https://www.bmj.com/content/367/bmj.l6377- Posted
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