Patient safety: Warnings from all sides

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By Paul Evans, Director, NHS Support Federation

In 2016 there was an unprecedented series of warnings raising the alarm about the pressures on the NHS. In late 2016, we collated this evidence from across the NHS in a report which makes a powerful case for prioritising the resourcing of the NHS and social care (written by Sylvia Davidson and Paul Evans). It is clear, however, that since our report (A Warning from All Sides) little if anything has changed for the better in the NHS, with even more warnings on safety and the fragile state of the NHS from every sector involved.

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The 2016 report was filled with shocking accounts from the frontline of today’s NHS. A dozen evidence-based warnings had been issued by Royal Colleges, trade unions and think tanks, all with a repeating theme - that care is not just under pressure, but is becoming unsafe. The NHS Support Federation investigation revealed how the government was gambling on the resilience of staff and patients in the face of a lack of resources.

Two years on and it is clear that nothing has changed, indeed things have got worse.  More reports, including from the Association of Child Psychiatrists, the RCN, the Royal college of Physicians and the Royal College of Psychiatrists, all reported on the damage to patient care taking place due to underfunding.

The Royal College of Physicians identified that 80% of those asked said they were worried about the ability of their service to deliver safe patient care. The Royal College of Midwives’ research revealed that almost 50% of maternity units are having to close temporarily because they cannot cope with demand and there are safety concerns.

A BMA survey found that many junior doctors with little specialist experience are having to take responsibility for entire wards of patients, such as in intensive care and on stroke and surgical units.

Five years on from the Francis report the reality is that the government are gambling with patient care. They are relying on the resilience of staff and patients in the face of huge underfunding and cuts, which they themselves have instigated.

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NHS funding rises have been the lowest since the 1950s. Government demands for £40bn of savings (2012-21) have left the NHS in a financial vice. No wonder then that survival is now based upon cuts, rationing and pushing services closer to the edge.

Both the Association of Child Psychiatrists and the Royal College of psychiatrists in recent months have warned that the long waiting times, rationing of care and the shortage of beds are so bad that people risk harming or killing themselves as their mental health deteriorates whilst they wait for treatment.

Underinvestment is worsening the chronic shortage in staff.  The Royal College of Physicians, Royal College of Anaesthetists, Royal College of Paediatrics and Child Health and the BMA have all reported widespread problems with rota gaps - where shifts start with too few staff. According to figure’s from the Government’s own NHS Digital released in July 2018, vacancies for doctors, nurses, midwives and therapists are running at the highest levels since  records began three years ago.

UNISON, The Royal College of Midwives and the RCN have all reported on staff fears about understaffing and how they view these as “unsafe”.

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In community healthcare the number of district nurses and health visitors has been falling, and a record number of patients have had to find a new GP as large numbers of surgeries close or merge. Lack of staff is also causing temporary closures of maternity and A&E units.

The declining performance figures for the NHS through 2017/18 reflect the problems only too starkly, but worryingly the most vulnerable are just as exposed to the risk. More than half a million patients are now waiting more than the recommended 18 weeks to start planned NHS treatment. In April 2018, there were warnings that the NHS is now in an “eternal winter” as hospitals cannot cope with rising patient need, as a record low was reported for A&E treatment performance.

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Reading these reports leaves no room for doubt about the scale and urgency of the problem. Unacceptable risks to patients are happening on a daily basis. Together they describe a situation that is worse than any previous crisis in the NHS. The only question they can’t answer is why is the government is not reacting.