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Found 38 results
  1. News Article
    The staff-to-patient ratios for intensive care are being dramatically reduced as the NHS seeks to rapidly expand its capacity to treat severely ill covid-19 patients, HSJ has learned. Acute trusts in London have been told to base their staffing models for ICU on having one critical care nurse for every six patients, supported by two non-specialist nurses and two healthcare assistants. Trusts have also been told by NHS England and NHS Improvement’s regional directorate to plan for one critical care consultant per 30 patients, supported by two middle grade doctors. The normal guidance is the consultant-to-patient ratio “should not exceed a range between 1:8-1:15”. Nicki Credland, chair of the British Association of Critical Care Nurses, confirmed the plans had been agreed today nationally. She told HSJ: “There will absolutely be a lot of concern about this in the profession, but it’s the only option we’ve got available. We simply don’t have the capacity to increase our staffing levels quickly enough." “It will dilute the standard of care but that’s absolutely better than not having enough critical care staff. There’s also a massive issue around the ability of critical care nurses not only to care for their patients but also monitor what the non-specialists in their teams are doing.” Read full story (paywalled) Source: HSJ, 24 March 2020
  2. News Article
    A major London hospital has declared a “critical incident” due to a surge in patients with coronavirus, with one senior director in the capital calling the development “petrifying”. In a message to staff, Northwick Park Hospital in Harrow said it has no critical care capacity left and has contacted neighbouring hospitals about transferring patients who need critical care to other sites. The message, sent last night and seen by HSJ, said: “I am writing to let you know that we have this evening declared a ‘critical incident’ in relation to our critical care capacity at Northwick Park Hospital. This is due to an increasing number of patients with Covid-19. “This means that we currently do not have enough space for patients requiring critical care. “As part of our system resilience plans, we have contacted our partners in the North West London sector this evening to assist with the safe transfer of patients off of the Northwick Park site” Read full story (paywalled) Source: HSJ, 20 March 2020
  3. News Article
    System leaders are telling hospitals to prepare for a potential suspension of all non-emergency elective procedures which could last for months, as they get ready for a surge in coronavirus patients. Senior sources told HSJ NHS England had asked trusts to risk stratify elective patients in readiness for having to suspend non-emergency work to free up capacity. HSJ understands trusts have been told to firm up their plans for how they would incrementally reduce and potentially suspend non-emergency operations, while also protecting “life saving” procedures such as cancer treatment. An announcement is expected soon, with patients affected given at least 48 hours notice. It has not been decided how long it might last for, as the duration of any surge in cases and acute demand is unknown. But HSJ has been told it could stretch out for several months, with three or four months discussed, which would potentially mean tens of or even hundreds of thousands of cancelled operations. Read full story (paywalled) Source: HSJ, 12 March 2020
  4. News Article
    NHS national leaders are set to reassure doctors they should not fear regulatory reprisals, within reason, if they end up working outside their areas of expertise during the coronavirus outbreak. HSJ understands the UK’s four chief medical officers and the General Medical Council are drafting a letter to be sent to all UK doctors, which will contain the reassurances, as the system braces for a sharp rise in covid-19 cases. The letter will also urge doctors to be flexible and not to resist new ways of working, with senior figures expecting many clinicians working in other specialities or locations during the outbreak. The letter will say doctors, while still expected to follow good medical practice, should not fear reprimand from their employers or national bodies such as the GMC, NHS England or other regulators. Read full story (paywalled) Source: HSJ, 11 March 2020
  5. News Article
    Third year undergraduate trainee nurses will be invited into clinical practice to support the coronavirus effort, while routine care quality inspections are “going to need to be suspended”, the Chief Executive of NHS England has said. Speaking at the Chief Nursing Officer’s summit event in Birmingham this morning, Sir Simon Stevens told delegates NHSE was working with the Nursing and Midwifery Council to “see how many of the 18,000 [relevant] undergraduates are available”. It is understood they would be paid, and follows government moves to pass emergency legislation to relax rules around working in healthcare. Asked about Care Quality Commission inspections during the outbreak, Sir Simon said: “There will be a small number of cases where it would be sensible to continue for safety related reasons… but the bulk of their routine inspection programmes is clearly going to need to be suspended and many of the staff who are working as inspectors need to come back and help with clinical practice.” Read full story (paywalled) Source: HSJ, 11 March 2020
  6. Content Article
    Sometimes, you have those days where you have had enough. ENOUGH. That’s really where the Genie started. I began my career in the private sector, joining the NHS as an ‘experienced hire’ some five years later through ‘Gateway to Leadership – Cohort III’. I probably should have known that a moniker based on the Roman army was telling me something. I had moved from an organisation where the worst thing that had happened was moving the water machine, to an organisation where the water machines had been removed some years before for "cost improvement" purposes. The organisation was struggling to cope on a number of levels, and there was no single answer to solve any of the issues. Sticking plasters were used to cover gaping holes, and we had significant clinical and financial issues. Please don’t misunderstand. I had a baptism of fire, with many incidents I wouldn’t want to put into print, but my wholehearted support of the healthcare workforce, of their resilience and humour, their ability to innovate, and their willingness to stand up and fight, was sown in those first few weeks as a fresh-faced newbie with a desire to change the world. I was approached to join another organisation in those heady days of ‘turnaround’ which gradually became ‘transformation’, as realisation dawned that death by a thousand cuts wasn’t actually saving any money, was impacting on care quality, and maybe (just maybe) we needed a different approach. I was often asked to work with the nursing and midwifery teams based on experiences in my first NHS trust. The issues were often the same. Finance and HR had data – not necessarily matching data – and nursing and midwifery had ‘professional judgement’. Somehow that didn’t hold as much weight, so working together with nursing from ward to board, we would produce our own data based on care levels, costs and WTE, so we could come to the table to ask some really simple questions: “Would you want to be cared for on this unit based on the care that is available?” It made a huge difference, and started to change the conversation from one of conflict and protectionism to one of collaboration. After seven years of working through the same issues in each organisation it reached that point again. Surely there must be a better way? What would happen if we could extend our single organisation work to one that could look at variation between organisations, and include outcome measures, and look at workforce planning across all settings of care? So, with an idea in our minds and a plan to do good, Creative Lighthouse Ltd was formed. Establishment Genie was born in a shed and has been both kicked and nurtured by some wonderful critical friends and safe staffing experts. The hard work, bloodied knuckles from knocking on so many doors, and the highs and lows of running a tech start-up in a sector that often doesn’t embrace technology started to pay off. The Genie achieved NICE endorsement in April 2017 and was awarded a grant by Innovate UK to develop and test the Genie across all settings of care. We have now worked with front-line staff from more than 500 teams and organisations to review, remodel and report on their workforce, supporting them to meet the challenges of safe and affordable care with a backdrop of clinical and financial shortages, and track their progress using outcome measures to show that they are improving quality of care. However, the journey doesn’t stop there. Dear reader, to paraphrase poorly, I have a dream. I have a dream that one day every health and social care organisation will put workforce at the centre of all their planning processes. A dream that all health and social care organisations will use the same approach to plan their workforce and share outcomes and data for the benefit of all, and the future of health and social care. A dream that our frontline health and social care leaders will work beyond professional and organisational boundaries to ensure that every person has the best and most appropriate care, provided in the most appropriate place, with the safety of every individual at the core of every action and intervention. Thankfully I love to travel and cannot wait to meet more innovative disruptors who share that same dream. Jump onboard – it’s going to be one heck of a ride! Read on the hub case studies showing how trusts are developing their approach to workforce planning.
  7. News Article
    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
  8. Content Article
    Case study examples The following case studies show how trusts have been using the tool. Roles and responsibilities of staff have been reviewed and new workforce plans have been co-designed with staff at the frontline to deliver new ways of working that put the patient at the centre of care – whatever the setting. The Hillingdon Hospitals - Safety Supervision and Savings.pdfThe Hillingdon Hospitals - Ward Reconfiguration for Safety.pdf GIG Cymru NHS Wales - Residential Nursing homes Case Study.pdfChelsea and Westminister Hospital Case Study - Empowering Staff.pdf GIG Cymru NHS Wales - District Nursing Principles Case Study (1).pdfBerkshire Health Community Nursing Case Study.pdf Organisational benefits Integrated care levels, costs and common language enables clinical and corporate leads to collaborate and meet the requirements of a next-generation health and social care workforce: Precise staffing profiles and options appraisal support CIP development and budgeting. Gap analysis compared to budget and standards for exact hours and WTE requirement for each band. Uplift for leave is specific to each role and expected joiners, avoiding blanket uplifts that may not fit the needs of the unit. Governance and control underpinned by agreed, costed roster templates, with ready reckoners to keep within range. Improved recruitment and retention with evidence of staffing levels and support. Outcomes track quality, with benchmarking to assure. Clinical benefits Professional judgement in workforce planning is supported by this NICE-endorsed tool: Planning care levels and WTE for expansion, efficiency, reconfiguration and new service models. Evaluating alternative shift models to reorganise, invest or save. Modelling skill-mix and impact of new roles. Understanding and validating variation. Challenging peaks and troughs in cover to improve safety, release capacity and release cost savings. Benchmarking and triangulation of patient care levels, with outcomes for correlation. Mapping other staff group input across each setting. Background on 'Establishment Genie' Creative Lighthouse was founded in response to frustration at the focus on financially led decisions in health and social care management that did not consider the safety and care of patients or staff. We set out to build a platform that would allow all management groups in the healthcare sector to collaborate on safe staffing and financial governance. Creative Lighthouse self-funded the development of a unique workforce-planning tool under the brand name ’Establishment Genie’, endorsed by the National Institute of Health and Care Excellence (NICE) in 2017. In April 2017, the Creative Lighthouse team were awarded a grant from Innovate UK to continue to develop the tool to include all settings of care in the knowledge that patient safety and workforce planning is not only the responsibility of acute services, but of all providers and commissioners of care. This is a critical aspect of enabling the improvement of quality and patient outcomes in a cost effective way, whilst providing data driven analytics to support professional judgment. About the author I am a healthcare professional with over 15 years’ experience working in and consulting to public and private health and social care organisations. I have worked with a variety of health and care sector clients in the delivery of complex change, from transformational change and organisational design process to programme leadership and execution. I am passionate about the safe staffing agenda, recognising that in order for any organisation to ensure appropriate care and evidence for professional judgement, there must be consistency in approach and a way of linking staffing levels to quality outcomes that can then be benchmarked within and across organisations. This passion resulted in the birth of ‘Establishment Genie’.
  9. News Article
    Critically ill children are being rushed from one part of England to another because NHS hospitals are running short of intensive care beds in which to treat them, the Guardian has revealed. An increase in severe breathing problems in children driven by winter viruses and infections, including flu, means some are having to be transferred sometimes many miles from their home area because there are not enough paediatric intensive care (PICU) beds locally. Specialist doctors who staff the units say the situation is “dangerous and rotten for the families” involved and that staff are firefighting to handle the number of children needing sometimes life-saving care, many of whom are on a ventilator to help them breathe. In the past few weeks, young patients have been sent from the Midlands to Sheffield, from London to Cambridge, and from one side of the Pennines to the other in order to get them a place in a PICU. One doctor at a PICU in the Midlands said: “PICU beds are always in high demand. But since winter hit this year, around six weeks ago, the situation feels like we are simply firefighting. Many days I come on shift to find there are no beds in [our] region and the patients referred to us end up in Southampton, Sheffield, Oxford and other centres far away." “The PICU network is overstretched. There aren’t enough beds, nurses or skilled doctors.” Read full story Source: The Guardian, 29 December 2019
  10. News Article
    Hospitals will be required to employ patient safety specialists from next April as part of efforts by the health service to reduce thousands of avoidable errors every year. NHS trusts will be told to identify staff who will be designated as the safety specialist for each organisation. These workers, who will get specific training and work as part of a network across the country, will help to tackle a fragmentation in the way safety issues are dealt with in the NHS and ensure nationwide action on key safety risks is coordinated. The proposals are part of a national patient safety strategy which is aiming to save 928 lives and £98.5m across the NHS, as well as reducing negligence claims by £750m by 2025. The specialists will be identified from existing staff, with part of the role focused on embedding a so-called “just culture” approach to safety. This means reducing blame, supporting staff who make honest errors and tackling systemic causes of mistakes. Read full story Source: The Independent, 26 December 2019 What do you think? Join the conversation on the hub.
  11. News Article
    Nurses in Northern Ireland have announced their plans for further strike action in the new year. Earlier this month, more than 15,000 nurses took to the picket lines over pay and staffing levels. It was the first time in the 103-year history of the Royal College of Nursing (RCN) that its members had taken such action. It has announced nurses will strike on 8 January and 10 January 2020, unless a resolution is reached. Read full story Source: BBC News, 24 December 2019
  12. News Article
    An NHS hospital has been so overwhelmed that it told senior doctors to make “the least unsafe decision” when treating patients. Medical groups have voiced concern that Norfolk and Norwich hospital trust’s instruction to its consultants this week showed it was struggling so much to cope with the number of people needing care that patient safety was being put at risk. At the time the hospital had no spare beds, a full accident and emergency department, 35 patients waiting on trolleys to be admitted, and had declared a major internal incident. In its message, seen by the Guardian, it said: “We would like you to know that the trust will support you in making difficult decisions that may be the least unsafe decision, and we would appreciate your cooperation over the coming days with this.” The circular from the Norwich hospital added: “We are facing our most challenging situation with our trust today,” because it was so overcrowded and unable to find a bed for the 35 patients doctors had decided needed to be admitted as emergencies. Read full story Source: The Guardian, 20 December 2019
  13. News Article
    A lot has been written about the workforce crisis in health and social care. 43,000 registered nurse vacancies, a 48% drop in district nurses in eight years and not enough GPs to meet demand. When we talk about workforce, the focus is always on numbers. There are campaigns for safe staffing ratios and government ministers like to tell us how many more nurses we have. But safety is not just about numbers. Recent workforce policy decisions have promoted a more-hands-for-less-money approach to staffing in healthcare. More lower-paid workers mean something in the equation has to give. In this case, it’s skill and expertise. In this article in The Independent, Patient Safety Learning's Trustee Alison Leary discusses how healthcare has failed to keep frontline expertise in clinical areas due to archaic attitudes to the value of the experienced workforce. Read full story Source: The Independent, 15 December 2019
  14. News Article
    The NHS is relying on less qualified staff to plug workforce gaps because of a huge shortage of nurses, according to a new report. Support staff, such as healthcare assistants and nursing associates, have been used to shore up staffing numbers, said the Health Foundation charity. The NHS has relied upon overseas recruitment, but a lack of EU nurses because of Brexit means it is now taking more nurses from countries such as India and the Philippines. At present, there are almost 44,000 nursing vacancies across the NHS (12% of the nursing workforce), but this could hit 100,000 in a decade, the report said. The report said most changes to the skill mix – meaning the ratio of fully qualified to less qualified staff – are implemented well and led by evidence, but added: “It is important that quality and safety are at the forefront of any skill mix change.” Read full story Source: The Guardian, 28 November 2019
  15. News Article
    Hospitals are so short of doctors and nurses that patients’ safety and quality of care are under threat, senior NHS leaders have warned in a dramatic intervention in the general election campaign Nine out of 10 hospital bosses in England fear understaffing across the service has become so severe that patients’ health could be damaged. In addition, almost six in 10 (58%) believe this winter will be the toughest yet for the service. The 131 chief executives, chairs and directors of NHS trusts in England expressed their serious concern about the deteriorating state of the service in a survey conducted by the NHS Confederation. The findings came days after the latest official figures showed that hospitals’ performance against key waiting times for A&E care, cancer treatment and planned operations had fallen to its worst ever level. However, many service chiefs told the confederation that delays will get even longer when the cold weather creates extra demand for care. “There is real concern among NHS leaders as winter approaches and this year looks particularly challenging,” said Niall Dickson, the chief executive of the confederation, which represents most NHS bodies, including hospital trusts, in England." “Health leaders are deeply concerned about its ability to cope with demand, despite frontline staff treating more patients than ever." Read full story Source: 19 November 2019
  16. Content Article
    This report builds on those of previous years to provide analysis of longer-term trends and insights into the changing NHS staff profile. It focuses specifically on the critical NHS workforce issues that have been repeatedly identified in recent years: nursing shortages, and shortages of staff in general practice and primary care. The report also explores key pressure points: student nurses the international context and international recruitment retention. The report concludes by summarising the key workforce challenges that will need to be considered in the development of the full NHS people plan. Patient Safety Learning's repsonse to the report: This report on NHS workforce trends released by the Health Foundation today includes some really interesting findings, particularly around the changes in the skills mix between nurses and clinical support staff (including health care assistants and nursing assistants). The report states that in 2009/10 there were equal numbers of nurses and support staff, with one clinical support staff member for every FTE nurse in the NHS. In 2018/19, the number of support staff per FTE nurse had risen 10% to 1.1 FTE per nurse. Looking at the numbers, this translated to the NHS employing 6,500 more clinical support staff to doctors, nurses, and midwives, compared to 4,500 more FTE nurses. While changes to ratio of nurses to clinical support staff may reflect changing patient needs, technological advances and other factors, the report also notes concerns that these may be ‘introduced in an unplanned way in response to negative factors – such as cost pressures or recruitment difficulties – rather than positive drivers of improvement’. At Patient Safety Learning we believe to achieve a patient-safe future, patient safety must be more than a priority for an organisation. It must be core to its purpose, reflected in everything that it does. This should apply to the NHS when considering changes in workforce staffing and numbers so that the impact that these may have on patient safety is considered as an intrinsic part of the decision making process. While the report notes that in many cases decisions on skill mix changes are implemented well and evidence led, it’s not clear whether patient safety has been taken into account. Our view is that these decisions should involve a explicit, evidence-based assessment of the impact on patient safety which leads to the selection of the option that offers that safest outcome for patients.
  17. Content Article
    This paper presents a narrative review of the evidence relating to the quality and safety of locum medical practice. Its purpose is to develop our understanding of how temporary working in the medical profession might impact on quality and safety and to help formulate recommendations for practice, policy and research priorities. The authors conclude that there is very limited empirical evidence to support the many commonly held assumptions about the quality and safety of locum practice, or to provide a secure evidence base for the development of guidelines on locum working arrangements. It is clear that future research could contribute to a better understanding of the quality and safety of locum doctors working and could help to find ways to improve the use of locum doctors and the quality and safety of patient care that they provide.
  18. Content Article
    This report features practical solutions from staff. Frontline clinicians attended workshops to help highlight the issues and identify what needs to change to keep services safe when facing surges in demand.
  19. Content Article
    Our recent observational study, published in the Health Informatics Journal, focussed on staff safety in the mental healthcare setting. We worked with a mental healthcare provider to extract and analyse incidents of adverse events. In one aspect of the work, we looked specifically at the incidents that were reported that had recorded a member of staff as a ‘victim’ of the adverse event. From the 1 September 2014 to the 31 March 2017, 19,693 members of staff were reported as victims across 10,119 adverse events. For context, this was the equivalent of around 25 incidents per week, but it is important to keep in mind that this was for both harmful and non-harmful incidents and near misses. The most common incident was ‘aggression by patient on staff or other’. We were interested in exploring whether nurse staffing levels affected adverse events on staff. To investigate this we made use of nurse staffing data for each inpatient area. We were able to obtain data that quantified the planned, the clinically required and the actual, staffing level of nurses. We found that, in many cases, registered nurse staffing affected staff safety. Where there were more registered nurses, there tended to be less adverse events on staff. We also found that, although there was also a relationship with unregistered nurses, staff harm was more resilient to understaffing of unregistered nurses. This leads us to hypothesise that the role of the registered nurse provides additional benefits to risk mitigation and that it’s not simply about head count but rather the type of skills and care provision that the healthcare team provides. However, it is important to note that these relationships were not consistent across all locations and all shifts. On the night shift, for example, we found that as the clinically required level of unregistered nurses decreased, the number of adverse events to staff increased. This suggested that where the perceived clinical demand was low, the risk to staff was highest. This has important implications. This implies that the perceived clinical demand for nursing staff doesn’t appropriately consider the risk of harm to staff, particularly during the night shift when the clinically required levels of unregistered nurses is insufficient to project staff from harm. The use of these data in this way is novel and as researchers, we are very excited about the promise of utilising routinely collected data to predict both patient harm and staff harm. We hope that this will provide significant opportunities to improve healthcare safety. In order to provide effective and sustained high levels of mental health care, we need to understand the challenges presented by the mental healthcare environment, and the need to staff these environments in such a way that keeps the workforce safe. We are doing a long term study to explore the environment and workforce retention in secondary and mental healthcare. You can find out more here.
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