Patients have the right to be treated in a safe and secure environment, and the NHS is aiming to continuously improve patient safety. However, healthcare 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 which 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 safety culture, violence in the NHS, hospital cleanliness and suicide in mental health service users. A summary of our safety indicators is shown below. Click on the links for more detailed content and analysis.
Healthcare-associated infections
- Outbreaks of acute respiratory infections in hospitals and care homes decreased during the spring of 2021, but increased again during the summer.
- In the week beginning 13 September 2021, there were 154 new outbreaks in care homes and 17 new outbreaks in hospitals. This compares to maximum values of 1,010 outbreaks in care homes and 91 outbreaks in hospitals in previous waves of the pandemic.
- In 2020/21, levels of healthcare-associated infections including C. difficile, MRSA and E. coli cases decreased on the previous year. In particular, the number of E. coli infections were the lowest they have been since 2014/15.
Safety culture
- Between 2016 and 2020, the national average 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 69% to 73%.
- NHS staff working in ambulance trusts least often reported that their organisation takes action to ensure that incidents do not happen again; in 2020, 61% of respondents from ambulance trusts said that their organisation takes 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 2015 to 73% in 2020.
- In 2020, nurses and midwives felt the most secure raising concerns about unsafe clinical practice and ambulance staff and medical/dental trainees felt the least secure.
Violence in the NHS
- Staff in ambulance trusts are consistently the most likely to experience violence from patients and the public, with 33% of respondents in 2020 saying that they had experienced at least one incident in the past 12 months. This compares to 5% of staff in acute specialist trusts.
- In 2020, 2% 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 – higher than the 1% national average.
- Staff in mental health and learning disability trusts are the most likely to have reported the last incident of violence they experienced. In 2020, 91% of respondents from mental health and learning disability trusts said they or a colleague reported it compared to 68% of staff from acute trusts.
- Between 2016 and 2020, there was a statistically significant decrease in Urgent and Emergency Care Survey respondents who ‘definitely’ felt threatened by other patients or visitors while in A&E, from 2.4% to 2.1%.
Hospital cleanliness
- The Coronavirus Inpatient Experience Survey found that four in five patients rated their hospital room or ward as ‘very clean’, which may reflect the enhanced infection prevention and control procedures that were introduced.
- Covid-19 patients were slightly less positive, with 75% rating their room as ‘very clean’ compared to 80% of patients without a Covid-19 diagnosis.
Are patients told about medication side effects?
- In 2020, 42% of Urgent and Emergency Care Survey respondents and 43% of Community Mental Health Survey respondents said that a member of staff ‘completely’/’definitely’ told them about medication side effects to watch for.
- In 2019, only 37% of Adult Inpatient Survey respondents were ‘completely’ told about medication side effects to watch for.
Injuries due to falls
- In England, the percentage of hip fractures that happened in hospital decreased from a high of 5.4% in February 2013 to a low of 2.9% in August 2021. The percentage is higher in Wales but lower in Northern Ireland.
- On average, 73% of hip fracture patients in England receive prompt surgery (within 36 hours), compared with 64% 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 2013/14 Q1.
- Between 2007/08 and 2019/20, the rate of patients who were admitted to hospital with any condition and died within 90 days of their discharge from a VTE-related event decreased from 72 to 60 deaths per 100,000 adult hospital admissions.
Social care users and safety
- The Personal Social Services Adult Social Care Survey asks service users whether care and support services help them in feeling safe. Between 2014-15 and 2020-21, the proportion of service users who responded ‘Yes’, they do help them in feeling safe, increased from 85% to 88%.
Suicide in mental health service users
- In 2018, there were 1,306 suicides in England by people who had been in contact with mental health services in the previous 12 months. In Scotland there were 222 patient suicides and in Wales there were 73.
- Between 2006 and 2018, the rate of patient suicide, taking into account the rising number of people receiving mental health care, decreased from 98 per 100,000 mental health service users to a projected 49 per 100,000 service users.
Emergency readmissions
- Between 2013/14 and 2019/20, the number of 30-day emergency readmissions to hospital in England increased by 26%. The emergency readmissions rate, taking into account increases in the total number of emergency admissions, increased from 12.5% to 14.4% 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.
For more information and analysis of safety in health care, see these Nuffield Trust blogs: