Patients have the right to be treated in a safe and secure environment, and the NHS aims to continuously improve patient safety. However, health care is a high-risk activity and standards continue to be redefined as more types of harm are considered to be preventable and unacceptable. New risks to patient safety can arise, such as the coronavirus (Covid-19) pandemic, creating significant challenges for health and care services to deliver safe care. Improving safety requires an understanding of the environment in which health care is provided, as well as a culture that prioritises safety – where staff feel able to raise concerns and action is taken to learn from adverse events.
Measuring safety is complex, and there is a lack of available information on safety in some areas, such as primary care and social care. Here at QualityWatch, we’ve updated our indicators across many aspects of safety, including trends in emergency readmissions, safety culture and hospital cleanliness. And with this year’s World Patient Safety Day focusing on the safety of health care workers, we’ve also updated our indicator on NHS staff’s experiences of violence.
The latest data presented here covers the Covid-19 outbreak period for injuries due to falls and our new indicator on outbreaks of respiratory infections in hospitals and care homes. Data for all other indicators are from before the onset of the pandemic. A summary of our safety indicators is shown below. Click on the links for more detailed content and analysis.
Healthcare-associated infections
- In March 2020, the number of outbreaks of acute respiratory infections in hospitals and care homes increased dramatically, driven by the Covid-19 pandemic. In care homes, the number of outbreaks increased from 17 in the week starting 2 March 2020 to 1,010 in the week starting 6 April 2020. In hospitals, there was a peak of 52 outbreaks in the week starting 30 March 2020.
- Between 2007/08 and 2013/14, C. difficile cases decreased by 76% and MRSA cases decreased by 81%. Since then, levels of both have fluctuated.
- Since 2011, the total number of E. coli infections has increased by 34%. This may reflect higher rates of blood culture testing as awareness of sepsis risk has increased.
Safety culture
- Between 2016 and 2019, 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 slightly from 69% to 71%.
- NHS staff working in acute specialist trusts most often reported that their organisation takes action to ensure that incidents do not happen again; in 2019, 78% of respondents from acute specialist trusts said that their organisation takes action. This compares to 58% of respondents from ambulance trusts.
- 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 2015 to 72% in 2019.
- In 2019, nurses and midwives felt the most secure raising concerns about unsafe clinical practice and ambulance staff felt the least secure. Between 2015 and 2019, the percentage of respondents who said that they felt secure raising concerns increased for all staff groups except for medical and dental trainees.
Violence in the NHS
- Staff in ambulance trusts are the most likely to face violence from patients, their relatives, and the public, with 34% of respondents in 2019 saying that they had experienced at least one incident in the past 12 months. This compares to 5.5% of staff in acute specialist trusts.
- Between 2015 and 2019, the percentage of respondents who had experienced physical violence from managers or other colleagues in the past 12 months decreased from 2.5% to 2.1%.
- In 2019, 3.8% of respondents from mental health and learning disability trusts had experienced violence from patients and the public more than 10 times in the past 12 months – over 2.5 times the national average.
- Staff in mental health and learning disability trusts are the most likely to have formally reported the last incident of violence they experienced; in 2019, 92% of respondents from mental health and learning disability trusts said that the last incident was reported either by themselves or a colleague. This compares to 68% of staff in acute trusts.
- 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%.
Hospital cleanliness
- 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 2015, then remained constant until 2017. Since then, it has decreased slightly to 69% in 2019.
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. And in 2019, less than half of Community Mental Health Survey respondents said that they were ‘definitely’ told about possible medication side effects.
- Between 2009 and 2015, the percentage of Adult Inpatient Survey respondents who were ‘completely’ told about medication side effects to watch for increased from 36% to 39%, but has since decreased to 37% in 2019.
Emergency readmissions
- Between 2013/14 and 2018/19, the number of 30-day emergency readmissions to hospital in England increased by 25%. The emergency readmissions rate, taking into account increases in the total number of emergency admissions, increased from 12.5% to 14.3% over the same time period.
Injuries due to falls
- In England, the percentage of hip fractures that happened in hospital decreased from 5.4% in 2013 to 3.8% in 2015, and has remained fairly constant since then. The percentage is higher in Wales but lower in Northern Ireland.
- On average, 74% 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.
Venous thromboembolism
- Since 2010/11, there has been an increase in the proportion of adult inpatients whose risk of venous thromboembolism (VTE) was assessed. In 2013/14, a target was introduced for 95% of adult inpatients to be risk assessed, and this threshold has been exceeded since Q1 2013/14.
- Between 2007/08 and 2018/19, 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 57 deaths per 100,000 adult hospital admissions.
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
- 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. The rate of patient suicide, taking into account the rising number of people receiving mental health care, decreased from 98 to 48 suicides per 100,000 mental health service users over the same time period.
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: