NHS pressures causing avoidable harm to 500 patients a year – report

This article was taken from: https://www.theguardian.com/society/2018/dec/19/nhs-pressures-causing-avoidable-harm-to-500-patients-a-year-report

By Denis Campbell Health policy editor

Unmanageable hospital workloads exposing people to increased risks, regulator finds

Patients in England are being harmed because doctors and nurses are too busy to enforce directives designed to improve safety, a scathing report by the NHS regulator has found.

People in hospital are exposed to increased risk, including during surgery, because safety alerts are not being implemented by staff struggling with “unmanageable” workloads, the Care Quality Commission said.

The findings come from a review of patient safety in England ordered last year by the then health secretary, Jeremy Hunt, and undertaken by the CQC.

About 500 people a year are suffering avoidable harm as a result of “never events” – serious lapses in patient safety that can cause injuries or even death and should be completely avoidable. They include surgeons operating on the wrong part of a patient’s body and swabs being left inside someone during their procedure.

Staff shortages, a high turnover of personnel and confusion over which of an array of NHS bodies is responsible for patient safety are also contributing to a stubbornly high incidence of “never events”, the CQC found.

Its findings raise serious questions about how much safer NHS care has become despite a flurry of initiatives introduced after the official report in 2013 into the Mid Staffordshire hospital scandal.

The latest figures show that “never events” in the NHS in England rose from 290 in 2012-13 to 468 last year, although the increase is partly explained by changes in how incidents are recorded.

The CQC praises the desire of NHS staff to keep patients safe, but warns that “never events continue to happen despite [their] hard work and efforts”.

It adds: “Staff at both leadership and frontline levels told us that they felt overwhelmed by the volume and nature of the demands currently placed on them.

“The number of alerts and amount of other information from multiple organisations, for example about different targets and initiatives, can be unmanageable.”

While “never events” are rare they should not occur at all if safety protocols are implemented properly.

The CQC based its findings on inspections of 18 acute and mental health trusts, workshops with staff and the views of safety experts from other industries. It also found that:

• NHS trusts “receive too many safety-related messages from too many different sources”.

• The NHS needs to “radically transform” its approach to safety because there is a worrying gap between how safe the NHS thinks it is and the reality for patients.

• The NHS wrongly believes it is an “essentially safe” system, in which things only go wrong exceptionally, even though about 2m patient safety incidents happen every year, 21,500 of which are serious.

• Staff are often unable or unwilling to disclose concerns about patient safety, despite many recent attempts to make it easier for them to do so.

• “With the competing pressures on staff due to high workloads, implementing patient safety alerts can be seen as just one more thing to do”.

• Staff are too busy to undergo proper education and training to update themselves on patient safety.

• Rigid hierarchical structures in the NHS are “inimical to safety” and need to be eradicated.

Jonathan Ashworth, the shadow health secretary, said: “This is a damning report confirming chronic understaffing across the NHS is now putting patient safety seriously at risk.”

NHS Improvement, which oversees patient safety, said it intended to halve the number of “never events” and drug errors, in a drive to make the NHS the world’s safest healthcare system.

Caroline Dinenage, the care minister, said the report “recognises that NHS staff’s commitment to patient safety is unwavering, but this needs to be matched by systems and a working culture which give safety the priority it deserves.

“We have made great progress towards creating a better learning culture within the NHS. We know we can do more to ensure no patient has to suffer avoidable harm.”