Search the hub

The purpose of this study was to identify which, and to what extent, demographic and operational factors are indicative of likelihood for a new call handler or paramedic to remain in role within the first two years of employment at an ambulance trust using data held in the trust’s bespoke data warehouse. Several factors showed a significant contribution to the likelihood of remaining in post within an ambulance NHS Trust. Among the findings, short-term sick leave in the first two years of employment was associated with increased retention for paramedics. In addition, female call handlers were found to have increased retention and paramedic retention increased with time outside of ‘job cycle time’ (JCT) activities (ie, activities other than responding to calls). This study presents a method for extracting new insights from routinely collected operational data, identifying common drivers and specific predictors for retention among the ambulance NHS workforce. It emphasises the importance of workforce-centred retention strategies, highlighting the need for non-JCT time, which in turn would allow paramedics to have time to reflect and recuperate to avoid burnout and attrition. The study also suggests that a lack of sick leave might indicate a lack of trust and self-care culture, potentially leading to paramedic staff attrition. Our approach to retention analytics provides a new mechanism for trusts to monitor and respond to their attrition risks in a timely, proactive fashion.

Understaffing by nursing staff in hospitals is linked to patients coming to harm and dying unnecessarily. There is a vicious cycle whereby poor work conditions, including understaffing, can lead to nursing vacancies, which in turn leads to further understaffing. Is hospital investment in nursing staff, to eliminate understaffing on wards, cost-effective? This longitudinal observational study analysed data on 185 adult acute units in four hospital Trusts in England over a 5-year period. The study found that exposure to registered nurse understaffing is associated with increased hazard of death, increased chance of readmission and increased length of stay, while exposure to nursing support understaffing is associated with smaller increases in hazard of death and length of stay but reduced readmissions. Rectifying understaffing on inpatient wards is crucial to reduce length of stay, readmissions and deaths. According to the National Institute for Health and Care Excellence £10 000 per QALY threshold, it is cost-effective to eliminate understaffing by nursing staff. This research points towards investing in registered nurses over nursing support staff and permanent over temporary workers. Targeting particular patient groups would benefit fewer patients and is less cost-effective.

The fundamental importance of having enough registered nurses present to deliver care is well supported by evidence. Lower registered nurse staffing levels are associated with higher risks to patients and poorer quality care.  The Royal College of Nursing has issued their position statement on registered nurse staffing levels for patient safety, care quality and cost effectiveness. The RCN has a duty to uphold standards in nursing, support all members of the nursing team and lead the way towards safe and effective care. In relation to safe staffing, the RCN Nursing Workforce Academy (launched as part of the RCN Institute of Nursing Excellence) is leading the way by: Launching refreshed nursing workforce standards, making explicit what we see as the fundamentals needed to underpin safe and effective care delivery. Sharing the evidence on safe staffing (this article has highlighted some key references, but a more formal summary of the evidence is being produced). Bringing together the nurse staffing guidance that exists for each specialty and making explicit where there are recommended registered nurse to patient ratios. Taking forward the RCN’s commitment to ‘safety critical redlines’ – minimum nurse to patient ratios to protect patients and staff from harm caused by low registered nurse staffing levels. Our forthcoming ‘nest’ community platform will offer all relevant resources, latest publications and networking opportunities.

At 10.45am on 23 November 2024, Peter Anzani sadly died from a pulmonary embolism in Birmingham Heartlands Hospital. He had been admitted to hospital the day before and was receiving treatment for a community acquired pneumonia when he suddenly and unexpectedly collapsed due to a pulmonary embolism. Peter had previously suffered a number of falls at home in August and September 2021 and was subsequently diagnosed with suffering a spontaneous infection of the cervical vertebral canal which caused a complete spinal cord injury and left him tetraplegic. This made him more vulnerable to chest infections and pulmonary embolisms which he experienced in the years that followed. There is no evidence of any human intervention that rendered his death unnatural.  Based on information from the Deceased’s treating clinicians the medical cause of death was determined to be:  1a Pulmonary Embolism 1b 1c 1d II Pneumonia Spinal cord injury resulting in Tetraplegia Matters of concern To The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust I considered evidence from a [REDACTED] who indicated at paragraphs 20-21 of his statement, “I did not see any record of his pulse, blood pressure or oxygen saturation. The normal practice is to complete these observations, and I would expect this to be done, especially with him presenting with chest issues. However, I am unable to comment why this was not recorded or confirm that these were carried out. (21) This is a learning point for the department, and I have taken steps to ensure this learning is taken forward by theTrust. I have alerted the Sister in charge of the Spinal Injuries Outpatients’ Department and requested that adequate measures are taken to ensure that all observations made are recorded in the outpatient forms…” It was unclear whether this was a single one-off event involving human error or indicative of a wider and systemic issue involving a lack of training. There was no evidence before the court that this “learning point” had been actioned or that any adequate steps had been taken to ensure proper and accurate recording of records by staff. There is a real risk of future deaths occurring where staff do not have adequate training and that patient records are not being properly completed. To NHS England / Department of Health and Social Care I heard evidence that The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust (“The Trust”) have been experiencing difficulties with patient waiting lists – due to both an increase in the quantity of patients being treated and staffing shortages – which has led to patients waiting longer than is reasonable or necessary for reviews and treatments. As part of the inquest, there was evidence that Peter Anzani himself had been waiting for nearly a year for a follow-up review, which should have been carried out after no more than 6 months. I heard evidence from representatives of the Trust that they have repeatedly requested additional funds for workforce development and expansion to assist with cutting patient waiting lists and waiting times. I understand that an initial Workplace Funding Review was submitted in 2023 but was rejected by NHS England due to a funding shortage. I understand that a further Workplace Funding Review was submitted in the Autumn of 2024, but in February/March of this year, NHS England indicated that the same would again be rejected under a “no growth policy”. Whilst naturally I am aware of the pressures on the public purse and on the NHS generally, it is concerning to hear that the Trust do not appear to be being adequately supported financially by NHS England, and do not currently appear to be able to address their workplace staffing issues without additional financial support (which does not appear to be forthcoming). It is obvious that where patients are waiting for longer than is reasonable or necessary for treatment or reviews, there is a real risk of deaths occurring. No patient should be waiting longer than absolutely necessary for treatment. In light of HM Government’s decision on 13 March 2025 to abolish NHS England and for its role to be subsumed within the Department of Health and Social Care, this report is being sent to both Agencies to consider, as it relates to issues of both a local and national significance.

Each year since May 2023 the Sands & Tommy’s Joint Policy Unit have published an annual report setting out the extent of pregnancy and baby deaths across the UK. This year’s report argues that progress made to date falls short of what is needed to stop babies dying every day in the UK, and that unacceptable inequalities in pregnancy and baby loss persist despite continued calls for change. It estimates that at least 2,500 fewer babies – the equivalent of around 100 primary school classrooms - would have died since 2018 if the government had achieved its ambition of halving the 2010 rates of stillbirth, neonatal and maternal deaths in England. The report draws on the latest data from MBRRACE-UK, which shows that the gap continues to grow between neonatal death rates in the most deprived areas and those in the least deprived areas of the UK. It highlights that the stillbirth rate among babies of Asian ethnicity has risen sharply, and Black babies are still twice as likely as White babies to be stillborn. It includes 10 key actions for policymakers Renew commitments to save babies’ lives. Specifically, a stillbirth rate of 2.0 stillbirths, and a neonatal mortality rate of 0.5 neonatal deaths for babies born at 24 weeks’ gestation and over (per 1,000 live births). A preterm birth rate of 6.0%. Count miscarriages in the UK. The number and rate of miscarriages are not reported across the UK or for any individual nation. All UK governments should set up routine data collection on miscarriage. Take coordinated and meaningful action to eliminate inequalities. There are a range of policy areas where specific action is needed, including: understanding whether current efforts to reduce inequalities are working, and a comprehensive review of translation and interpreting services in maternity and neonatal care. Strengthen national leadership to make progress on the safety of maternity and neonatal services. Clarify the workforce needed to deliver safe care. Future development of the workforce must move away from a binary debate focussed on whether we do or don’t have enough staff and focus on the staffing requirements needed to deliver safe care, in line with nationally-agreed standards. Put the resources needed in place to deliver safe care. More investment is needed to improve the safety and quality of services if the government is going to deliver on its commitments to reduce rates of stillbirth and neonatal death and eliminate inequalities. Make informed choice a reality. Everyone should receive personalised care, know what they are entitled to, such as their birth choices, and services need the resources and operational capacity to provide this. Address unwarranted variation in care. Too often babies are dying because of care that is not in line with nationally-agreed standards. We need clarity on how national guidance is applied and clear national standards to improve the consistency of service provision. Ensure lessons are learned when babies die. The NHS is still not properly learning lessons when babies die or listening to the experiences of bereaved families to improve care in the future. There must be more robust oversight of the implementation of actions that are identified by reviews and investigations. Prioritise pregnancy and baby loss in research. This requires a broad range of research topics, the involvement of bereaved parents and communities, and a strong connection with policy and practice.

The NHS workforce is under considerable operational pressure at every level from the combined effects of record demand and shortages of capital and resource. In addition, seismic shifts are on the horizon, including the abolition of NHS England (NHSE), the expected recommendations from the second Penny Dash report on patient safety, and the upcoming 10 year health plan. The level of change the NHS is facing, as a safety critical sector, makes culture a strategic priority. To achieve the ambition behind these changes, we need an engaged, motivated workforce and a supportive, enabling environment, writes Isabelle Brown and Laura Turner. Getting the “how” right of any reform that might be introduced by the 10 year health plan is just as important as the “what” and the ”why.”

The fundamental importance of having enough registered nurses present to deliver care is well supported by evidence. Lower registered nurse staffing levels are associated with higher risks to patients and poorer quality care. Here is the Royal College of Nursing's position statement on registered nurse staffing levels for patient safety.

The global nursing workforce has grown from 27.9 million in 2018 to 29.8 million in 2023, but wide disparities in the availability of nurses remain across regions and countries, according to the State of the World’s Nursing 2025 report, published by the World Health Organization (WHO), International Council of Nurses (ICN) and partners. Inequities in the global nursing workforce leave many of the world’s population without access to essential health services, which could threaten progress towards universal health coverage (UHC), global health security and the health-related development goals.  The new report released on International Nurses Day provides a comprehensive and up-to-date analysis of the nursing workforce at global, regional and country levels. Consolidating information from WHO’s 194 Member States, the evidence indicates global progress in reducing the nursing workforce shortage from 6.2 million in 2020 to 5.8 million in 2023, with a projection to decline to 4.1 million by 2030. But, the overall progress still masks deep regional disparities: approximately 78% of the world’s nurses are concentrated in countries representing just 49% of the global population.   Low- and middle-income countries are facing challenges in graduating, employing and retaining nurses in the health system and will need to raise domestic investments to create and sustain jobs. In parallel, high-income countries need to be prepared to manage high levels of retiring nurses and review their reliance on foreign-trained nurses, strengthening bilateral agreements with the countries they recruit from.   

Overseas-trained healthcare workers are reluctant to speak up about issues such as patient safety fearing it could lead to losing their right to work in the UK, according to a review from the National Guardian Freedom to Speak Up Listening and learning: Amplifying the voices of overseas-trained workers, a review of the speaking up experiences of overseas-trained workers in England highlights the unique challenges faced by NHS workers trained outside the UK when speaking up. Overseas-trained workers are a vital part of the NHS workforce. The National Guardian Freedom to Speak Up review sheds light on their experience, looking at the specific issues faced by overseas-trained workers in speaking up. The report also highlighting examples of good practice. The review finds that overseas-trained workers experience additional barriers to speaking up compared to domestically trained colleagues. To make it easier for overseas-trained workers to speak up, we are calling for action to: Make recruitment and retention guidance support speaking up. Design speaking up arrangements that work for everyone. Use better data to understand and improve experiences. Build cultural competence and awareness to remove barriers to speaking up.

The aim of the Yorkshire Quality and Safety Research Group (YQSR) seminar series is to bring together academics, clinicians and NHS managers in an intellectual and social environment to exchange knowledge, experience, and ideas. Invited guests include researchers from our partner institutions (Universities of Leeds, York and Bradford), Yorkshire and Humber research partners, Yorkshire and Humber Academic Health Science Network colleagues, NHS Trust managers, clinicians, and research students. From 2020 YQSR have uploaded the recordings of their seminars.

Allied health professionals (AHPs) in inpatient mental health, learning disability and autism services work in cultures dominated by other professions who often poorly understand their roles. Furthermore, identified learning from safety incidents often lacks focus on AHPs and research is needed to understand how AHPs contribute to safe care in these services. A rapid literature review was conducted on material published from February 2014 to February 2024, reporting safety incidents within adult inpatient mental health, learning disability and autism services in England, with identifiable learning for AHPs. The review found that misunderstanding of AHP roles, from senior leadership to frontline staff, led to AHPs being disempowered and excluded from conversations/decisions, and patients not getting sufficient access to AHPs, contributing to safety incidents. A central thread ‘organisational culture’ ran through five subthemes: (1) (lack of) effective multidisciplinary team (MDT) working, evidenced by poor communication, siloed working, marginalisation of AHPs and a lack of psychological safety; (2) (lack of) AHP involvement in patient care including care and discharge planning, and risk assessment/management. Some MDTs had no AHPs, some recommendations by AHPs were not actioned and referrals to AHPs were not always made when indicated; (3) training needs were identified for AHPs and other professions; (4) staffing issues included understaffing of AHPs and (5) senior management and leadership were found to not value/understand AHP roles, and instil a blame culture. A need for cohesive, well-led and nurturing MDTs was emphasised.

Physicians in the USA are facing a number of changes and challenges in 2025 — with some good news about burnout rates, some bad news around aging physicians and some surprising shifts in the physician workforce makeup. This article highlights 10 things to know about the current state of the physician workforce.

This report on public service performance at the local level, shows that patient satisfaction is higher in GP practices that have more GPs (particularly GP partners), have smaller list sizes, deliver more GP appointments and do more of those appointments face-to-face. Additional direct patient care staff – such as physiotherapists, pharmacists and care co-ordinators – are not associated with higher satisfaction. Despite that, all those trends are heading in the opposite direction: the number of GP partners continues to fall, particularly among those aged under 40. GP practices do far more appointments remotely than they did before the pandemic. The closure and merging of practices means that patient list sizes continue to creep up. In addition, the addition of almost 40,000 direct patient care staff since 2019 does not seem to have improved satisfaction.  The report argues that the government needs to urgently address the crisis in the GP partner workforce, aim to improve the conversion rate from GP traineeship into the GP workforce, understand how to use the expanded direct patient care workforce most effectively, and better communicate how its reform programme will improve patients' experience of general practice.