The NHS is aspiring to be “one of the safest healthcare systems in the world”. But healthcare is a high-risk activity, and improving safety requires us to address the environment in which care is delivered, and to look beyond individual incidents or mistakes. An open and transparent safety culture is needed, where staff are encouraged to report risks and incidents, and action is taken to learn from them and ensure they do not reoccur.
Measuring how the safety of healthcare is changing over time is challenging and complex. There is more information available about harm to patients than there is about whether or not services are safe. Further to this, adverse events and near-misses tend to be under-reported, so an increased reporting of such events may reflect an improved awareness of safety issues rather than a less safe environment. And safety in healthcare is a moving target – as standards improve we come to regard an increasing number of events as patient safety issues, for example, the increased focus on healthcare-associated infections in recent years.
Here at QualityWatch, we’ve reviewed and updated our indicators looking at how the safety of NHS care has changed over time. Although there are some gaps in the data, due to limited information in areas such as primary care and community settings, we have been able to identify indicators at a national level across many aspects of safety. While some measures show an improvement, such as the management of venous thromboembolism and hospital cleanliness, other measures, such as the proportion of hip fracture cases that have prompt surgery, have not improved. Please find below a summary of our safety indicators, and click on the links for more content and analysis.
Safety culture
- A good safety culture in healthcare is one where staff have positive perceptions of psychological safety, teamwork and leadership, and feel comfortable discussing errors.
- The proportion of NHS Staff Survey respondents who “strongly agreed” or “agreed” that when errors, near misses or incidents are reported their organisation takes action to ensure that they do not happen again increased slightly from 67% in 2015 to 69% in 2017.
- NHS staff working in Acute Specialist Trusts report that their organisation takes the most action to ensure that incidents do not happen again, and Ambulance Trust staff report that their organisation takes the least action.
- In 2017, seven out of ten NHS Staff Survey respondents “strongly agreed” or “agreed” that they would feel secure raising concerns about unsafe clinical practice, up from 68% in 2014.
- General managers, nurses and midwives, and medical/dental consultants feel more secure raising concerns than medical/dental trainees and ambulance staff.
Are patients told about medication side effects?
- Effective communication to patients of medication and side effects to watch for is an important aspect of patient safety.
- Less than half of survey respondents said that they were “completely” told about medication side effects to watch for. Over a third of survey respondents were not told about side effects to watch for.
- Between 2009 and 2017, the proportion of Adult Inpatient Survey respondents who were “completely” or “to some extent” told about medication side effects to watch for increased from 54% to 57%.
Hospital cleanliness
- Across the NHS, cleanliness is a vital part of ensuring safe, high-quality care. Failure to meet the required standards could lead to the spread of infections, ward closures and potentially impact the health of patients and staff.
- The proportion of Adult Inpatient Survey respondents who said that their room or ward was “very clean” increased from 63% in 2009 to 70% in 2017.
Healthcare-associated infections
- Clostridium difficile (C. difficile), methicillin-resistant Staphylococcus aureus (MRSA) and Escherichia coli (E. coli) are bacterial infections which commonly occur as a direct result of healthcare interventions, or from being in contact with a healthcare setting.
- In 2007, the levels of C. difficile and MRSA became a major national concern, and action to address these problems was far reaching. Between 2007 and 2014, there was a 76% reduction in C. difficile cases and an 81% reduction in MRSA cases. Since then, the annual counts of these bacterial infections has fluctuated.
- Enhanced surveillance of E. coli has been mandatory for NHS acute trusts since 2011. Between 2012 and 2017, the total number of E. coli infections increased by 27%, prompting the launch of a government initiative to reduce Gram-negative bloodstream infections. However, some of the increase may reflect higher rates of blood culture testing as awareness of sepsis has increased.
Injuries due to falls
- Patients in hospital should receive the help and support they need to prevent falls and injuries such as hip fractures. And all patients with a hip fracture should be operated on promptly, to improve the outcome.
- In England, the percentage of hip fractures that happened in hospital (rather than in homes, care homes and outside) decreased from 4.9% in March 2012 to 3.7% in September 2018. The proportion is higher in Wales but lower in Northern Ireland.
- The percentage of hip fractures cases having prompt surgery (within 36 hours) is higher in winter than summer, and has been declining over time in England since 2014. On average, 75% of hip fracture patients in England have surgery within 36 hours, compared with 63% of patients in Wales and only 25% of patients in Northern Ireland.
Venous thromboembolism
- Venous thromboembolism (VTE) is a serious medical condition which can affect patients after surgery or other medical care.
- Since 2010/11, there has been an increase in the proportion of adult inpatients whose risk of VTE was assessed. The 95% target was introduced in 2013/14 as part of the national VTE CQUIN goal, and the 95% threshold has been exceeded since 2013/14 Q1.
- Between 2007 and 2016, the rate of patients who were admitted to hospital with any cause and died within 90 days of their last discharge from a VTE related event decreased from 72 to 62 deaths per 100,000 adult hospital admissions.
Emergency readmissions
- Between 2010/11 and 2016/17, the number of 30-day emergency readmissions to hospital in England increased by 19%, and the emergency readmissions rate increased from 7.5% to 8%.
- Patients who are readmitted to hospital with pressure sores or VTE, when these conditions were not diagnosed in their previous admission, may have received suboptimal care. The emergency readmissions rate for pressure sores increased from 0.05% of admissions in 2010/11 to 0.13% of admissions in 2016/17. The emergency readmissions rate for VTE increased from 0.11% to 0.13% over the same time period.
Suicide in mental health service users
- Suicides by people in contact with mental health services are arguably the most preventable. In the UK, there were 1,612 suicides by people who had been in contact with mental health services in the previous 12 months in 2016. This accounts for 27% of all suicides in the general population.
- Between 2006 and 2016, the number of suicides by people in contact with mental health services in the UK increased by 11%. However, this is overshadowed by a substantial decrease in the rate of patient suicide, when you take account of the rising number of people receiving mental health care.
Social care users and safety
- The Personal Social Services Adult Social Care Survey (ASCS) asks service users if care and support services help them in feeling safe. Between 2014-15 and 2017-18, the proportion of services users who responded “Yes” they do help them in feeling safe increased slightly from 85% to 86%.