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Content Article
I am one of many staff that undertake additional shifts as bank staff or agency staff. The reasons are varied and personal. This is a reflection on a shift that I undertook a few weeks ago. I have taken the decision to remain anonymous in this account.- Posted
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News ArticleNHS patients are being left unseen in pain and in some cases to die alone because shifts do not have enough registered nurses, a survey shows. The Royal College of Nursing said analysis of a survey it carried out showed that only a third of shifts had enough registered nurses on duty. The union has also gathered testimonies from nurses who talk of always “rushing” and being asked to do more; working in “completely unsafe” levels of care; and having to make “heartbreaking” decisions on who does or doesn’t get seen. Shortages mean individual nurses are often caring for dozens of patients at a time, the RCN said. It has called for limits on the maximum number of patients for whom a single nurse can be responsible. Nicola Ranger, the RCN’s acting general secretary and chief executive, said the survey showed that patients were being failed. “In every health and care setting, nursing staff are fighting a losing battle to keep patients safe,” she said. “Without safety-critical limits on the maximum number of patients they can care for, nurses are being made responsible for dozens at a time, often with complex needs. “It is dangerous to patients and demoralising for nursing staff.” Read full story Source: The Guardian, 1 July 2024
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News Article
'We desperately need safety-critical nurse-to-patient ratios enshrined in law'
Patient Safety Learning posted a news article in News
The latest release of data from the Royal College of Nursing's Last Shift Survey shows the urgent need for investment in the nursing workforce and safety-critical nurse-to-patient ratios enshrined in law. New analysis finds more than 11,000 members reveals just a third of shifts had enough registered nurses. Chronic staff shortages mean individual nurses are often caring for 10, 12, 15 or more patients at a time. The RCN are now calling for safety-critical limits on the maximum number of patients a single nurse can be responsible for. Our survey found that 1 in 3 hospital shifts were missing at least a quarter of the registered nurses they needed. In A&E settings, significant numbers of nurses reported having more than 51 patients to care for. Across all settings, 80% of respondents said there aren't sufficient nurses to meet the needs of patients safely. RCN Acting General Secretary and Chief Executive Professor Nicola Ranger said: “Without safety-critical limits on the maximum number of patients they can care for, nurses are being made responsible for dozens at a time, often with complex needs. It is dangerous to patients and demoralising for nursing staff. “When patients can’t access safe care in the community, conditions worsen, and they end up in hospital where workforce shortages are just as severe. This vicious cycle fails staff and patients – it can’t go on. “We desperately need urgent investment in the nursing workforce but also to see safety-critical nurse-to-patient ratios enshrined in law. That is how we improve care and stop patients coming to harm.” Read full story Source: RCN, 1 July 2024 -
News Article
Deadly cancer treatment delays now ‘routine’ in NHS, say damning reports
Patient Safety Learning posted a news article in News
Hundreds of thousands of people are being forced to wait months to start essential cancer treatment, with deadly delays now “routine” and even children struck by the disease denied vital support, according to a series of damning reports. Health chiefs, charities and doctors have sounded the alarm over the state of cancer care in the UK as three separate studies painted a shocking picture of long waits and NHS staff being severely hampered by a worsening workforce crisis and a chronic lack of equipment. The first report, by Cancer Research UK, found that 382,000 cancer patients in England were not treated on time since 2015. The charity investigated how many patients had begun treatment 62 days or longer after being urgently referred for suspected cancer. The national NHS target – under which at least 85% of people should start treatment within 62 days – was last met in December 2015. The second report, by the Royal College of Radiologists (RCR), said delays in cancer care had become routine, with nearly half of UK cancer centres experiencing weekly delays in starting treatment. The RCR also warned of a “staggering” 30% shortfall in clinical radiologists and a 15% shortfall in clinical oncologists – figures it projects will get worse in the next few years. The third paper, from four children’s cancer charities – Young Lives vs Cancer, Teenage Cancer Trust, Ellen MacArthur Cancer Trust, and Children’s Cancer and Leukaemia Group – said young patients were being failed by a lack of support after diagnosis. Naser Turabi, the charity’s director of evidence, said the crisis was causing widespread treatment delays that “negatively impact” patients. “One study has estimated that a four-week delay to cancer surgery led to a 6-8% increased risk of dying, and delays can also reduce the treatment options that are available. There are also the psychological effects – with waiting causing major stress and anxiety for cancer patients and their loved ones.” Read full story Source: The Guardian, 13 June 2024 -
Content ArticleThe Royal College of Radiologists (RCR) have published their 2023 clinical radiology and clinical oncology workforce census reports. These reveal dangerous shortages of doctors essential in the diagnosis and treatment of cancer, and other conditions including stroke.
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Content ArticleIn a new Royal College of Nursing report, survey findings and member testimonies show the full grave picture of corridor care across the UK. Of those forced to deliver care in inappropriate settings, over half (53%) say it left them without access to life-saving equipment including oxygen and suction. More than two-thirds (67%) said the care they delivered in public compromised patient privacy and dignity. Thousands of nursing staff report how corridor care has become the norm in almost every corner of a typical hospital setting. Heavy patient flow and lack of capacity sees nursing staff left with no space to place patients. What would have been an emergency measure is now routine. The report says corridor care is “a symptom of a system in crisis”, with patient demand in all settings, from primary to community and social care, outstripping workforce supply. The result is patients left unable to access care near their homes and instead being forced to turn to hospitals. Poor population health and a lack of investment in prevention is exacerbating the problem, the report says. The RCN are asking for mandatory national reporting of patients being cared for in corridors, to reveal the extent of hospital overcrowding, as part of a plan to eradicate the practice. They also need members to raise concerns when care in inappropriate settings takes place. Related reading on the hub: A silent safety scandal: A nurse’s first-hand account of a corridor nursing shift
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News ArticleHospitals which rely heavily on locum doctors are 'undoubtedly' risking patient safety, a study of NHS practice found. While temporary staff are a 'vital resource' to plug workforce gaps, issues such as unfamiliarity with protocols and procedures mean they 'pose significant patient safety challenges' for the NHS, experts say. The report warned many were left feeling isolated and stigmatised by resident staff, creating a 'hostile environment'. This has led to a 'defensive' culture over mistakes, hindering improvements to care, according to researchers. Calling for greater monitoring by inspectors, NHS leaders must rethink how these professionals are supported and used, the authors said. Writing in a linked editorial, Professor Richard Lilford, of the Institute of Applied Health Research at the University of Birmingham, said the findings suggested 'the life of the locum is a difficult and lonely one, opening up many pathways to unsafe practice.' Likening it to airline pilots, he suggested staff would benefit from standardised practices – such as how the medicine cabinet is stocked – to minimise mistakes. Agencies providing staff should be given routine feedback by employers and locum staff, to enhance patient safety, he said. Read full story Source: MailOnline, 16 April 2024
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Content ArticleThe use of temporary doctors, known as locums, has been common practice for managing staffing shortages and maintaining service delivery internationally. However, there has been little empirical research on the implications of locum working for quality and safety. This study aimed to investigate the implications of locum working for quality and safety. The participants of the study described the implications of locum working for quality and safety across five themes: (1) ‘familiarity’ with an organisation and its patients and staff was essential to delivering safe care; (2) ‘balance and stability’ of services reliant on locums were seen as at risk of destabilisation and lacking leadership for quality improvement; (3) ‘discrimination and exclusion’ experienced by locums had negative implications for morale, retention and patient outcomes; (4) ‘defensive practice’ by locums as a result of perceptions of increased vulnerability and decreased support; (5) clinical governance arrangements, which often did not adequately cover locum doctors. The study concluded that locum working and how locums were integrated into organisations posed some significant challenges and opportunities for patient safety and quality of care. Organisations should take stock of how they work with the locum workforce to improve not only quality and safety but also locum experience and retention.
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Content ArticleTommy Gillman died on 8 December 2022 from sepsis and multi organ failure secondary to Salmonella Brandenburg meningitis. There were missed opportunities to provide him with earlier antibiotics, fluid resuscitation and intensive monitoring from 12.35pm on the 7 December 2022 at Kings Mill Hospital. Once the severity of his illness had been recognised at approximately 17:00 hours on that day, he was provided with prompt treatment for septic shock and meningitis. Sadly however he did not respond to this treatment and died the following day following transfer to Leicester Royal Infirmary. Whilst there were serious missed opportunities to provide earlier treatment of sepsis and meningitis.
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News Article
Doctor exodus: tens of thousands planning to move abroad, NHS warned
Patient Safety Learning posted a news article in News
Tens of thousands of doctors are hoping to quit the NHS and move abroad this year in search of better pay, the medical regulator has warned. Half of the doctors planning to leave said they wanted to move to Australia, which has been the most popular destination for emigrating UK doctors for the past five years. The General Medical Council surveyed 3,154 doctors about their attitudes towards leaving the UK, including 1,000 who had recently left to practise abroad. Some 13% of those working in the NHS said they were “very likely” to move in the next 12 months, while another 17% said they were “fairly likely” to move. The GMC said this would amount to 96,000 doctors quitting over the next year if applied to the total number of doctors on the medical register, although it acknowledged that the actual rate of departures was likely to be much lower. Read full story (paywalled) Source: The Times, 12 April 2024 -
Content ArticleThe UK is suffering from a chronic shortage of midwives, a shortage that has had an inevitable impact on maternity safety. While services in Scotland, Wales and Northern Ireland certainly have their challenges, it is England where the problems have been most severe, with a current estimated shortage of 2,500 midwives. The result is that midwives and working an estimated 100,000 hours’ unpaid overtime every week— burnout is widespread and the NHS is struggling to retain staff. This report by the Royal College of Midwives makes several suggestions to recruit and retain midwives in our maternity services. These include improving the quality of midwifery education. paying student tuition fees and employers developing more flexible working practices.
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Content ArticleWhen Adam Luck’s mother, Ann, was admitted to hospital with a suspected stroke, it was the beginning of a distressing seven-week stay. The previously cheerful 82-year-old became stuck in a dysfunctional health system. Her story is presented here via her son Adam’s diary of her hospitalisation.
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Content ArticleNHS strikes have become such a familiar feature of our lives over the past two years that there is a risk we can become inured to their impact. This King's Fund article looks at the different ways in which strikes can impact the NHS and the people it serves.
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Content ArticleThis blog identifies important features of the NHS Long Term Workforce Plan and looks at how focussing on these areas might help systems and providers develop their own plans and take agency to solve local challenges. The author, Nick Richmond, spotlights the following aspects of the plan: ‘All levers at all levels’ approach Diverse time frames for different levers The ‘train’ actions are the most significant investment in domestic supply ever The plan is integrated with service and financial planning – future demand is ‘owned’ by the government and the NHS.
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News ArticleStaff whistleblowers have raised concerns over patient safety at one of Northern Ireland's biggest health trusts. Information received by UTV under Freedom of Information shows that most of the worries from health workers at the Belfast Health Trust relate to the Royal Victoria Hospital. Belfast Health Trust said any concerns raised by staff are investigated. The Royal College of Nursing NI was due to hold a webinar with members on Tuesday evening to discuss concerns members have about safety of patients being treated on corridors. The RCN's Rita Devlin said that the number of concerns raised with health trusts through the whistleblowing policy is only the tip of the iceberg. The concerns included unsafe staffing levels, bed shortages, boarding of patients, ED overcrowding, alleged drug dealing on a hospital site, staff sleeping on night duty, lack of mental health beds and the quality of staff training. The Belfast Trust said all staff are encouraged to make management aware of issues giving them concern through the whistleblowing process. The Trust added: "Any concern we receive is subject to a fair and proportionate process of investigation. "Whistleblowing investigations are of a fact finding nature and all relevant learning is shared as appropriate and taken forward by the Trust." Read full story Source: ITVX. 12 March 2024
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News Article
Ombudsman warns over-stretched doctors could put cancer patients at risk
Patient Safety Learning posted a news article in News
England’s NHS Ombudsman has warned that cancer patients could be put at risk because of over-stretched and exhausted health staff working in a system at breaking point and delays in diagnosis and treatment. The Parliamentary and Health Service Ombudsman (PHSO) revealed that between April 2020 and December 2023, his Office carried out 1,019 investigations related to cancer. Of those 185 were upheld or partly upheld. Issues with diagnosis and treatment were the most common cancer-related issues investigated by PHSO. These issues included treatment delays, misdiagnosis, failure to identify cancer, the mismanagement of conditions, and pain management. Complaints about cancer care also included concerns about poor communication, complaint handling, referrals, and end-of-life care. Most investigations were about lung cancer, followed by breast cancer and colorectal cancer. The Ombudsman recently closed an investigation around the death of Sandra Eastwood whose cancer was not diagnosed for almost a year after scans were not read correctly. The delay meant she missed out on the chance of treatment which has a 95% survival rate. In 2021, PHSO published a report about recurrent failings in the way X-rays and scans are reported on and followed up across the NHS service. Mr Behrens said, “What happened to Mrs Eastwood was unacceptable and her family’s grief will no doubt have been compounded by knowing that mistakes were made in her care. “Her case also shows, in the most tragic of ways, that while some progress has been made on my recommendations to improve imaging services, it is not enough and more must be done. “Government must act now to prioritise this issue and protect more patients from harm.” Read full story Source: Parliamentary Health and Health Service Ombudsman, 9 March 2024 -
News Article
Hospital patient given 'corridor care' for 14 hours
Patient Safety Learning posted a news article in News
A patient says he felt ignored and that NHS care was lacking after he spent 14 hours on a bed in a hospital corridor. Ivan Philpotts, 77, from Norwich, was transferred between wards at the Norfolk & Norwich University Hospital (NNUH), having contracted pneumonia. He said he was left in a bed in a corridor with no access to water, was unable to eat and that his wife was unable to visit. The hospital said it had experienced a high number of patients last week. "I felt very vulnerable," Mr Philpotts said. "Nobody seemed to be taking any notice of you and you were sitting there, people walking by you. "I was there from 8.30 in the morning until 9.10 at night before I actually got into a bay. We got no communication whatsoever." The hospital trust is one of just two in England that has been carrying out a trial of a "corridor care" scheme. The Royal College of Nursing's eastern regional director Teresa Budrey said: "We're starting to normalise it and that's not OK. "There are patients who are suffering for hours, without proper privacy or equipment and you've also got nurses dealing with an expanded number of patients. "We need government minsters and employers to come together for some bigger solutions across the system." Read full story Source: BBC News, 6 March 2024 Further reading on the hub: A silent safety scandal: A nurse’s first-hand account of a corridor nursing shift -
Content ArticleHospital nurse staffing, and the proportion of nurses with bachelor’s education, are associated with significantly fewer deaths after routine surgery, according to research published in the Lancet. A team of researchers conducted the study across nine European countries and found that a better educated nursing workforce reduced unnecessary deaths. Every 10%increase in the number of bachelor’s degree educated nurses within a hospital is associated with a 7% decline in patient mortality. Patients in hospitals, in which 60% of nurses had bachelor’s degrees and nurses cared for an average of six patients, had almost 30% lower mortality than patients in hospitals in which only 30% of nurses had bachelor’s degrees and nurses cared for an average of eight patients. The study shows that, in hospitals in England, an average only of 28% of bedside care nurses had bachelor’s degrees, among the lowest in Europe, which averaged 45%. The study shows that increasing the production of graduate nurses is necessary if the NHS is to realise the potential of lower patient mortality and fewer adverse patient outcomes.
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Content ArticleHospital staff members experience 1.17 aggressive events — verbal and/or physical — for every 40 hours worked, with more aggression events occurring when staff have significantly greater numbers of patients assigned to them this study from DeSanto Iennaco et al. found. The study, published in The Joint Commission Journal on Quality and Patient Safety, examined incidence of patient and visitor aggressive events toward staff at five inpatient medical units in community hospitals and academic hospitals in the Northeastern U.S. The data was collected using even counters, aggressive incident and management logs and demographic forms over a 14-day period in early 2017.
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News Article
'I was left lying in my own urine'
Patient Safety Learning posted a news article in News
A 73-year-old patient has said he was neglected at an NHS hospital and left to cry for help in "excruciating pain" during an ordeal that lasted months. Martin Wild was admitted to Salford Royal last year due to a spinal infection and claims he was denied pain relief and left lying in his own urine. Consultant Glyn Smurthwaite said Martin was "the most neglected acute patient I have ever seen". The trust that runs the hospital has apologised for failings in his care. Mr Wild came home from Salford Royal Hospital in January after an eight-month stay because of an infection following a private spinal operation. He said he was forced to phone 999 from his hospital bed when first admitted to the acute medical ward in May 2023 after struggling to get staff to give him pain relief and his Parkinson's medication. "I was left on my own in excruciating pain, with little pain relief, and I was laying on this bed for over a week before I saw a consultant." Mr Wild was discharged despite warning staff he was not well enough and no one could look after him at home, and ended up being readmitted days later via A&E. He said his poor care continued during his second stay, and Mr Wild recalled that he was shaking so much in pain that he knocked bottles of urine on to his bed after they had been left on the table with his food. Mr Wild was left lying in the urine-soaked sheets for hours before they were changed. Read full story Source: BBC News, 3 March 2023 -
Content ArticleIt is well known that the NHS is suffering from staff shortages, with 121,000 full-time equivalent (FTE) vacancies and only 26% of the workforce stating there are enough staff at their organisation. The reasons why staff are leaving are well documented (burnout, lack of work–life balance, low pay etc), and the direct impact on patients is obvious – staff shortages are one of the main reasons why there is a backlog of care. But these headlines mask nuance. They hide the areas where staff shortages are even more acute than the average, and they obscure the indirect impact on patients. Where are these areas, what are the impacts, and will the NHS Long Term Workforce Plan help?
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News Article
RCPsych calls for an end to children’s eating disorders crisis
Patient Safety Learning posted a news article in News
Child and adolescent eating disorder services have never achieved NHS waiting time targets, and are not able to meet significant demand, according to analysis by the Royal College of Psychiatrists. Psychiatrists can identify and address many of the root causes of eating disorders, including neurodevelopmental conditions such as autism and ADHD. However, a current lack of capacity prevents this from happening. Due to a lack of resources, even children who meet the threshold for specialist eating disorder services are often in physical and mental health crisis by the time they are seen. Delays in treatment cause children with eating disorders physical and mental harm. NHS England set a target for 95% of children and young people with an urgent eating disorder referral to be seen within a week, and for 95% of routine referrals to be seen within four weeks. These standards have not been achieved nationwide, since they were introduced in 2021. RCPsych analysis of the latest data shows that just 63.8% of children and young people needing urgent treatment from eating disorder services were seen within one week. Only 79.4% of children and young people with a routine referral were seen within four weeks. The College also warns that there is an unacceptable gap between the number of children being referred to specialist eating disorders services, and those being seen. This is driven by a shortfall in the number of trained therapists and eating disorders psychiatrists. For Eating Disorders Awareness Week, the Royal College of Psychiatrists is calling on Government and Integrated Care Boards to invest in targeted support for children and young people to reverse this eating disorders crisis. The call is backed by the UK’s eating disorder charity Beat. Read full story Source: Royal College of Psychiatrists, 29 February 2024 Further reading on the hub: For Eating Disorders Awareness Week, Patient Safety Learning has pulled together 10 useful resources shared on the hub to help healthcare professionals, friends and family support people with eating disorders. -
Content ArticleNicholas Gerasimidis had a history of mental illness manifesting as obsessive compulsive disorder (OCD) and anxiety. In 2022, his condition deteriorated. His GP referred him twice to the Community Mental Health Team but the referrals were rejected with medication being prescribed instead, together with advice to contact Talking Therapies. He was taken on to CMHT workload after being assessed by the Psychiatric Liaison Team in Royal Cornwall Hospital in November 2022. The preferred course of treatment was psychological treatment in the form of Cognitive Behavioural Therapy with Exposure Response Prevention. There was a waiting list of a year. In May 2023, Mr Gerasimidis became worse. It was felt an informal admission to hospital was required but a bed was not available. He was found hanged at his home address on 3 June 2023.
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News ArticleLeft in agonising pain, with staff ignoring his cries for help, Martin Wild called 999 from his hospital bed, desperate for someone to get him the medication he needed. This was just the beginning of the 73-year-old’s “nightmare” experience at the hands of Salford Royal Hospital. Over nearly five months, the former car salesman says he was subjected to prolonged periods of neglect, including being left to lie in urine-soaked sheets, pleading for medication. He lost so much weight that, according to his wife, he became skin and bone. One staff member involved in his care said they’d never seen a hospital patient neglected to such a serious degree. Mr Wild told The Independent that his time at Salford Royal Hospital has shattered his belief in the NHS and that he believes it is not fit for purpose. “It was a nightmare in that ward. I didn’t feel like there was much caring going on,” he said. “I used to lie there at night; I could hear people shouting and screaming for help. It was like being in the third world.” Read full story Source: The Independent, 24 February 2024
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Content Article
Audit Scotland: NHS in Scotland 2023 (22 February 2024)
Patient Safety Learning posted an article in NHS Scotland
The Scottish Government needs to develop a clear national strategy for health and social care to address the pressures on services, says a review by Audit Scotland. Significant changes are needed to ensure the financial sustainability of Scotland's health service. Growing demand, operational challenges and increasing costs have added to the financial pressures the NHS was already facing. Its longer-term affordability is at risk without reform.
