Patient Safety Watch: The crisis of an understaffed NHS

Good afternoon and welcome to our first Patient Safety Newsletter of 2023, brought to you fortnightly in collaboration with HSJ.

We start 2023 with the NHS under unprecedented pressure. Senior NHS leaders have described the current situation to me as “the worst they have seen in their careers”.

Views from the frontline

This fortnight has seen many column inches dedicated to warnings from NHS workers who fear for the safety and wellbeing of their patients. Oxford-based GP Helen Salisbury told the i how she now tries to keep people at home as much as possible, because she’s aware of the lack of resource at hospital. She went on the say that, if she does have to advise a patient go to hospital, she only calls for an ambulance as a “last resort, only chosen if no other transport can be arranged”. She added: “It doesn’t feel safe for my patients right now.”

Francis speaks up

One of the starker assessments of the current situation came from Sir Robert Francis, the former chair of the Mid Staffs inquiry, and Rachel Power, CEO of the Patients Association, who last week wrote to health and social care secretary Steve Barclay calling for “immediate and long term action”. Their letter warned: “What we are witnessing across the NHS is the Mid-Staffs scandal playing out on a national level, if not worse.”

Views like these can be all too quickly viewed as subjective, but other more quantifiable indicators of NHS performance and outcomes right now provide strong evidence that they are close to the mark.

As someone who has followed progress in patient safety in the NHS over several years, it’s of great concern to see the current situation unfold and the impact on patients and staff. At Patient Safety Watch, our first research report published last year highlighted that “workforce shortages across nearly all areas of care present one of the most immediate threats to patient safety” and called for the government to “publish a workforce plan to demonstrate how the workforce gaps will be filled over the next decade through increases in training places and improvement of retention”.

As well as doing everything possible to provide support to mitigate patient safety risks in the current pressures, it is surely imperative that long-term action is taken to ensure the NHS has the staffing, resources and investment it needs to avoid future crisis. A robust workforce plan is badly needed.

Strikes and safety

In view of the current pressures, the ongoing strike action presents another huge challenge for NHS organisations and staff in how best to mitigate risks to patient safety. However, Tony Hockley, a senior visiting fellow in the London School of Economic’s department of social policy, argues the upcoming nursing strikes need to be viewed in the light of the thousands of nursing vacancies currently unfilled and the health service’s problems with retaining its skilled nursing staff – and what this means for patient safety. 

“If you cannot recruit and retain professionals (mostly nurses) then you cannot provide safe and effective care,” Dr Hockley writes, also pointing out surgical patients are more likely to die in hospitals with the lowest staffing on wards.

As I’ve said in previous newsletters, the rights and wrongs of industrial action in these circumstances can be debated – but it is surely in everyone’s interests that both sides of the dispute work harder than ever to reach a fair solution in the best interests of both the short-term and long-term safety of patients as well as staff.

Maternity care in the spotlight (again)

This week has seen maternity services return to the spotlight. The Care Quality Commission published the results of its 2022 maternity survey. The survey looked at the experiences of women and other pregnant people who had a live birth in early 2022.

The survey results show a worrying picture of decline with more women reporting they were not always able to get help during labour and birth (63 per cent  vs 72 per cent in 2019), a decline in the proportion of women who felt they could always get help after birth in hospital (57 per cent vs 62 per cent in 2019) and fewer women saying they received help and advice about their baby’s health and progress (63 per cent vs 71 per cent in 2017).

Commenting in The Independent, Angela McConville,  National Childbirth Trust CEO, said: “This is not all the impact of the covid pandemic but is directly associated with long-term underinvestment in the staffing of maternity services.” Could a theme to this fortnight’s newsletter be possibly emerging?

Before moving away from maternity, readers aware of the Montgomery ruling and the implications for informed consent and shared decision making in relation to maternity care may be interested in this blog relating to a new legal ruling that raises some important issues. 

Sharing some good stuff…

Medway Foundation Trust has launched what looks like a great new patient safety initiative. Call 4 Concern aims to encourage and empower inpatients and their friends and family to contact a member of the trust’s acute response team for help or advice if they have concerns about their care. 

Medway FT chief Jayne Black said: “While our staff work extremely hard to provide the very best of care to our patients, we also recognise that at times the patient or a close friend or loved one can see that something is wrong before we can. While we already have robust systems and processes in place to detect when a patient’s condition worsens, Call 4 Concern is another layer of reassurance for our patients and their families and shows our commitment to providing safe, compassionate and joined up care.”

The national patient safety strategy has a focus on encouraging trusts to involve patients (and their families) in their own safety. This looks like a great initiative towards this and something I hope other trusts might look to adopt.

As a final share for this edition, Laura Pickup, national investigator at the Healthcare Safety Investigation Branch, has written an insightful blog about the importance of designing medical equipment to minimise “use error”. The blog states that “limited recognition of device design and evaluation” is “a key feature of patient safety in the NHS” which can increase the risk of harm occurring.

Ms Pickup highlights how human factors professionals and staff with appropriate human factors knowledge could play a crucial role in ensuring the principles of safe design are “embedded, recognised and applied to address patient safety issues and subsequent harm”.

That brings this edition to a close with the news covered reflecting an incredibly difficult and challenging time for everyone working in the healthcare system as well as patients and families using healthcare services.

Please look out for the next newsletter in a fortnight’s time. In the meantime, please get in touch if there are items you think it would be good to cover here or if you have examples of patient safety initiatives you’d like to share.

Take care and stay safe.

James Titcombe

@JamesTitcombe