What has gone wrong in the NHS? Part two: patient safety

RCP president Professor Jane Dacre continues her series of articles on the current state of the NHS.

Last week I wrote about the crisis in the NHS and highlighted real examples of the pressures that medical professionals are working under. Now it's time for the investigation, from which I can share some findings taken from our latest report NHS reality check: Delivering care under pressure.

Over the past 12 months:

  • 78% say demand for their service is rising
  • over half of physicians believe patient safety has deteriorated
  • over a third say the quality of care has lowered
  • 84% have experienced staffing shortages in their team, and
  • 82% believe the workforce is demoralised.

Nearly three quarters of those surveyed are worried about the ability of their service to deliver safe patient care in the next 12 months.

Professor Jane Dacre, RCP president

I am sure these figures will not come as a surprise to anyone in the medical profession. The physicians I know – and I include myself – are optimistic, positive people who produce workaround solutions to intransigent problems who are being pushed to their limits and are no longer optimistic about the future. And this last statistic is the most sobering: nearly three quarters of those surveyed are worried about the ability of their service to deliver safe patient care in the next 12 months.

I believe one of the reasons for the concern is the uncertain future facing us due to the latest idea designed to help with the pressures: sustainability and transformation plans (STPs). There are 44 proposals, developed across the country, with the laudable aim of addressing:

  • health and wellbeing
  • care and quality
  • and finance and efficiency.

But from those we have seen so far – and please watch RCP registrar Dr Andrew Goddard’s video on the subject – many are planning to cut beds by up to 30%. In the past two decades the number of NHS beds has already been reduced by 25%, and the only way we have been able to cope with increasing numbers of patients is by reducing length of stay. 

We cannot reduce the number of beds by 30% unless they are provided elsewhere.

We cannot do that anymore. We cannot reduce the number of beds by 30% unless they are provided elsewhere. We have seen that even a mild winter with no major epidemics has not stemmed the constant flow of patients.

I am extremely pleased that the chief executive of NHS England, Simon Stevens, intervened 2 weeks ago to make it clear that mass bed closures will not be permitted unless alternative arrangements for patients are put in place first. We need that reassurance.

In the NHS reality check survey we also asked physicians if they were aware of the freedom to speak up guardian at their trust. In case you didn’t know, the guardians are there to ensure that processes are in place to support staff to raise concerns about patient safety.

Only one in five doctors know who their freedom to speak up guardian is, our survey found; of those who do, less than a third believe the guardians have helped improve the culture of transparency and raising concerns in their organisation.

We also asked, more broadly, whether doctors in their organisation feel confident in raising concerns and issues, and we found that doctors are almost split down the middle on this: nearly half feeling confident to raise issues and nearly half not. Some didn’t answer the question.

Doctors and other staff need to know how to raise and escalate safety concerns.

I worry that there are inherent safety risks in a hospital running at full or over capacity – from an increase in hospital-acquired infections to the impact of burnout from overworked staff. Doctors and other staff need to know how to raise and escalate safety concerns.

NHS staff should feel empowered to bring legitimate concerns over patient safety – the evidence shows that where this happens, patient safety incidents decrease.

Professor Jane Dacre, RCP president
@DacreJane

This text has been adapted from Jane's address to RCP members and fellows on 16 March at Medicine 2017: RCP annual conference

The following RCP Mission: Health reports are available to download:

What has gone wrong in the NHS? Part three is available to read now; part one was published on 20 March.