The NHS aims to continuously improve patient safety and become the best healthcare system in the world at learning from safety information. However, healthcare is a high-risk industry and no single intervention will fully address the issue. To improve safety, the many factors behind adverse events, and the wider environment in which health care is provided, need to be understood. A good safety culture is also needed where organisations prioritise safety, staff feel able to raise concerns, and action is taken to learn from errors and near misses.
Monitoring and measuring safety is complex and it cannot be captured in a single measure. Standards for safety continue to be redefined as more types of harm are considered to be preventable and unacceptable. Additionally, adverse events and near misses tend to be under-reported, so an increase in the number of incidents may reflect an improved reporting culture rather than a decrease in safety.
Here at QualityWatch, we’ve been monitoring how the safety of health and social care has been changing over time. While some measures, such as safety culture and management of venous thromboembolism, show an improvement, other measures, such as violence against NHS staff, have not improved. A summary of our safety indicators is shown below. Click on the links for more detailed content and analysis.
- Between 2015 and 2018, the proportion of NHS Staff Survey respondents who ‘agreed’ or ‘strongly agreed’ that their organisation takes action when errors, near misses or incidents are reported to ensure that they do not happen again increased from 67% to 70%.
- NHS staff 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.
- The proportion of NHS Staff Survey respondents who ‘agreed’ or ’strongly agreed’ that they would feel secure raising concerns about unsafe clinical practice increased from 68% in 2014 to 71% in 2018.
- In 2018, nurses and midwives reported feeling the most secure in raising concerns about unsafe clinical practice. Between 2014 and 2018, the percentage of respondents who said that they would feel secure increased for all staff groups except for general managers and medical and dental trainees.
Violence in the NHS
- According to the NHS Staff Survey, staff in ambulance trusts are the most likely to face violence from patients and the public, with a third of respondents in 2018 reporting that they had experienced at least one violent incident in the past 12 months.
- Between 2015 and 2018, the percentage of NHS Staff Survey respondents who said they had experienced physical violence from managers or other colleagues in the past 12 months decreased from 2.5% to 2.2%.
- In 2018, 3.4% of NHS Staff Survey respondents from mental health and learning disability trusts said they had experienced violence from patients and the public more than 10 times in the past 12 months – over 2.5 times the national average.
- Patients have the right to be treated in a safe and secure environment. Between 2016 and 2018, the percentage of Urgent and Emergency Care Survey respondents who ‘definitely’ or ‘to some extent’ felt threatened by other patients or visitors while in A&E remained constant at 8%.
Are patients told about medication side effects?
- In 2018, less than half of Urgent and Emergency Care Survey respondents said that a member of staff ‘completely’ told them about medication side effects to watch for.
- Between 2009 and 2015, the percentage of Adult Inpatient Survey respondents who were ‘completely’ told about side effects increased from 36% to 39%, but this decreased to 37% in 2018.
- The percentage of Adult Inpatient Survey respondents who said that their room or ward was ‘very clean’ increased from 63% in 2009 to 70% in 2017, but decreased slightly to 69% in 2018.
- In 2007, levels of C. difficile and MRSA became a major national concern. Between 2007/8 and 2013/14, C. difficile cases decreased by 76% and MRSA cases decreased by 81%. Since then, levels of both have fluctuated.
- Enhanced surveillance of E. coli bacteria has been mandatory for NHS acute trusts since June 2011. Since then, the total number of infections has increased by 34%. This increase may reflect higher rates of blood culture testing as awareness of sepsis risk has increased.
Injuries due to falls
- The percentage of hip fractures that happen in hospital is a measure of safety and the quality of care that older people are receiving. All hip fracture cases should have prompt surgery to improve outcomes.
- In England, the percentage of hip fractures that happened in hospital decreased from 5.4% in 2013 to 3.8% in 2018, and has remained fairly constant since then. The percentage is higher in Wales but lower in Northern Ireland.
- On average, 75% of hip fracture patients in England receive prompt surgery (within 36 hours), compared to 63% of patients in Wales and only 24% in Northern Ireland.
- In 2013/14, a target was introduced for 95% of adult inpatients to be risk assessed for VTE, which has been met since then.
- Between 2007/8 and 2017/18, 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 61 deaths per 100,000 adult hospital admissions.
- In the UK, the rate of post-operative deep vein thrombosis (DVT) after hip or knee replacement surgery is relatively low compared to other countries. Between 2011 and 2017, the post-operative DVT rate in the UK decreased by 18%.
- Between 2013/14 and 2017/18 the number of 30-day emergency readmissions to hospital in England increased by 15%. The emergency readmissions rate, taking into account increases in the total number of emergency admissions, increased from 12% to 14% over the same time period.
Safety of maternity services
- While babies may be admitted to neonatal care for many different reasons, some admissions could be due to failures in care provided at different stages of the maternity pathway. In 2016/17, 5.7% of full-term babies were admitted to a neonatal unit.
- Between 2015/16 and 2016/17, the percentage of mothers who had an unplanned overnight readmission within 42 days of giving birth increased from 2.4% to 3.3% in England and 2.9% to 3.3% in Scotland.
Suicide in mental health service users
- Suicides by people in contact with mental health services are arguably the most preventable. In 2017, there were 1,216 suicides in England by people who had been in contact with mental health services in the previous 12 months. In Scotland there were 223 patient suicides and in Wales there were 78.
- Between 2006 and 2017, the number of suicides by people in contact with mental health services in the previous 12 months increased by 8% in England. However, this is overshadowed by the substantial decrease in the rate of patient suicide, taking into account the rising number of people receiving mental health care. The patient suicide rate decreased from 98 per 100,000 mental health services users in 2006 to 48 per 100,000 service users in 2017.
Social care users and safety
- The Personal Social Services Adult Social Care Survey (ASCS) asks service users whether care and support services help them in feeling safe. Between 2014-15 and 2018-19, the proportion of service users who responded ‘Yes’, they do help them in feeling safe, increased from 85% to 87%.
For more information and analysis of safety in health care, see these Nuffield Trust blogs: