Patient safety is frequently at risk in NHS hospital trusts in England, with 70% of them failing to meet national safety standards, according to an Observer analysis of inspection reports, with staff shortages the biggest problem.
Reports by the regulator the Care Quality Commission (CQC) reveal that managers at one trust failed to act on staff reports of abuse and violence, while a shortage of critical beds at another trust led to three serious incidents resulting in patient harm.
Of 148 acute and general hospital trusts, safety standards at 96 are rated as “requires improvement” by the CQC; six are rated inadequate, the lowest category. The others are rated good, with none outstanding.
Of the 14 inspection reports published since the start of June, half raised concerns over inadequate staffing levels. One trust, Imperial College Healthcare in London, “did not always have enough staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and abuse and to provide the right care and treatment”.
Shrewsbury and Telford hospital trust was rated inadequate for safety last year. The number of nurses in its urgent and emergency services was “not sufficient to manage the department safely”, and the inspectors “saw these low staffing levels directly impact on patients’ safe care and treatment”. Nurses who had not received the right support or training had to co-ordinate the department for two months before the inspection because of staff shortages. A trust spokesman told the Observer improvements were being made.
Rob Harwood, chair of the consultants committee at the British Medical Association, said: “With the NHS chronically underfunded and understaffed for many years, those working there are increasingly expected to deliver care in an unsafe, unsupportive environment, putting the safety of our patients at risk.
“As well as delivering the urgent investment needed on the frontline, the government must get a grip on the workforce crisis to ensure safe staffing levels in the NHS and change the current pension rules in order to retain and motivate its workers rather than pushing them to vote with their feet.”
Helga Pile, deputy head of health at the trade union Unison, said: “One in every 10 posts in the NHS is vacant because of a shameful failure of workforce planning, and it’s staff and patients who are paying the price.
“Patients aren’t getting the care they deserve while exhausted health staff are routinely being asked to do more with fewer resources.
“Sustained government investment is needed across the NHS and health professions need to become more attractive career options. Funding for large-scale degree apprenticeship programmes would be a game changer.”
Imperial College Healthcare did not respond to a request for comment.
Aside from staff shortages and inadequate training, other failings identified in recent CQC reports include:
• Three serious incidents resulted in patient harm as a consequence of critical care beds not being available at South Tees hospital trust
• Managers at Walsall Healthcare trust failed to act on staff reports of abuse and violence
• Overcrowding at the Princess Royal University Hospital in London, with patients cared for on trolleys in corridors and at times two patients being nursed in single-person cubicles
• Significant handover delays for patients arriving by ambulance, also at Princess Royal
• The design and use of facilities in the emergency department at the Queen Elizabeth Hospital in King’s Lynn did not always keep patients with mental health concerns safe, while patients did not always receive medication at the right time.
A spokesperson for King’s College Hospital NHS Foundation Trust, which runs the Princess Royal, said: “We are fully committed to improving the safety, quality and experience of patient care within the urgent and emergency care services at the Princess Royal University Hospital. Since before the publication of the CQC’s report, the trust had begun to implement a programme of improvements within the department to address the concerns that were raised.”
Despite the dire national picture, safety standards are slowly improving over time – around 85% of NHS acute and general hospital trusts have been rated substandard for safety at some point during the last five years, and the number rated Inadequate has fallen sharply.
Brighton and Sussex University Hospitals trust’s safety rating was upgraded from Inadequate to Good in January after inspectors found numerous improvements had been made, with the trust maintaining adequate staffing levels – though even then, the lack of registered nurses remained a “significant challenge”.
A Department of Health and Social Care spokesperson said: “The safety of patients is paramount and all hospitals are required by law to have the right staff in the right place at the right time.
“There are 16,800 more nurses on our wards than in 2010 with 52,000 more in training and to help retain our dedicated staff we are providing more flexibility and career development alongside multi-year pay rises for junior doctors and over a million other NHS workers, including nurses.”
