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In this podcast interview series, NHS whistleblower Peter Duffy and Patient Safety Learning’s Chief Executive Helen Hughes explore how the healthcare system responds when its staff raise concerns about patient safety. In each episode, Helen and Peter interview someone who has spoken up about patient safety issues in healthcare organisations, or who works to help staff raise concerns where they see unsafe care. In this episode, Peter and Helen speak to consultant endocrinologist Gordon Caldwell, who retired early from the NHS after speaking up about patient safety concerns in his hospital. Gordon shares his experience of raising concerns about unsafe staffing levels while working as a clinical lead and how this led to extreme stress and the decision to retire years before he had planned to. They discuss the importance of transparency, team work and clear record-keeping processes to ensure patients are kept safe and Gordon outlines how lack of accessible patient health records hinders decision-making and can lead to avoidable harm. They also look at how target-led approaches and financial incentives have led to cultural changes in healthcare organisations over the past few decades. Subscribe to our YouTube podcast to keep up to date with the latest episodes. View a transcript of this interview Read a blog from Peter and Helen about the interview series

The Professional Standards Authority is hosting a seminar on how professional regulators and others can help to improve workplace cultures. The event will explore why a positive culture matters for patients and the public, and how to promote sexual safety in the workplace. You will hear from: Paul Whiteing, AVMA Simon Watson, Healthcare Improvement Scotland Professor Rosalind Searle, University of Glasgow Email [email protected] for more information or to register to attend.

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

A new report published by Carers Scotland shows the devasting impact the health and social care crisis is having on the health of Scotland’s 800,000 unpaid carers.  Over a quarter of carers (28%) said their mental health is bad or very bad, rising to 37% for carers on Carer’s Allowance. A third (36%) of carers said that they had thoughts related to self-harm or suicide. Over half (54%) of carers said that their physical health had suffered because of their caring role, with one in five (20%) suffering a physical injury from caring. The results of a survey of over 1,700 Scottish unpaid carers shows the ongoing struggle that they are facing to access the services and support they need to care and manage their health and wellbeing. Despite their huge contribution to the Scottish economy, to our communities and to the lives of the people they care for, carers are facing deteriorating physical and mental health, loneliness and isolation with too many driven to deep mental despair as they are denied the support they need to maintain a healthy life. Only a third (38%) of carers are receiving support from formal social care services and over a third (35%) have not had any break from caring in the last year. There is lack of involvement of carers on hospital discharge with 60% not engaged by health services, despite being expected to provide care to someone at home. Only 18% were provided with sufficient support on discharge to protect their health or the health of the person they care for. Caring, particularly with such insufficient support, is damaging carers mental health. Carers shared in detail the impact that caring had on their mental health, with the majority (88%) having difficulty sleeping, continuous low mood (85%) and feelings of hopelessness (82%) including regularly feeling tearful (71%). This has led a shocking level of carers saying that they have thoughts of self-harm or suicide. And, concerningly, this lack of support from both health and social care services leaves little time for carers to look after their own health, with four in 10 (41%) saying that they have had to put off receiving healthcare treatment because of their caring role.

This is part of our series of Patient Safety Spotlight interviews, where we talk to people working for patient safety about their role and what motivates them. Gordon talks to us about how bureaucracy in the health service can compromise patient safety, the vital importance of agreed quality standards and what hillwalking has taught him about healthcare safety.