Today the results of the NHS Staff Survey 2019 were released with responses from 569,440 staff across 300 NHS organisations in England.[1] This is one of the largest workforce surveys in the world and asks staff a range of questions about their experience of working in the NHS across several different themes.[2] In this blog we will focus on the responses that relate to the ‘Safety culture’ theme in the survey.
Witnessing errors, near misses or incidents
- 27.6% of staff reported that in the last month they had seen an error, near miss or incident that could have hurt patients.
In the UK avoidable unsafe care kills and harms thousands of people each year, with the number of deaths resulting from patient safety incidents annually estimated at 11,000.[3] These results seem to bear out the scale of the problem, with the number of survey respondents meaning that the 27.6% figure equates to over 150,000 staff witnessing an error, near miss or incident within the last month when they completed the survey.
Patient safety remains a systemic challenge for the NHS and unsafe care has a complex set of causes. This can only be addressed by taking systemic approach addressing the six reasons for patient safety failure that Patient Safety Learning have highlighted in our report A Blueprint for Action.[4] Patient Safety must be recognised and treated is a core purpose of healthcare if we are going to get to grips with this scale of this issue.
Reporting incidents and blame culture
- When asked if last time they saw an error, near miss or incident that could have hurt staff or patients/service users whether they had reported this, 95% stated they or a colleague had done so.
- 59.7% said their organisation treats staff who are involved in an error, near miss or incident fairly.
- 61.1% said their organisation gives them feedback about changes made in response to reported errors, near misses and incidents.
- 71.7% would feel secure raising concerns about unsafe clinical practice.
The briefing published along with the survey results indicates that the figures for organisations treating staff who are involved in an error or incident fairly and the feedback staff received on reported errors both mark a several percentage point rise from 2015.[5] Despite this improvement though there is clearly still a significant proportion of staff who do not have confidence that they would be treated fairly if they raised incident or are fearful of speaking up about unsafe clinical practice.
This is concerning but perhaps not surprising given the persistence of a blame culture in parts of the NHS. Such a culture discourages staff from speaking up. Recent reports such as the Paterson Inquiry highlight issues of healthcare professionals being fearful of raising concerns and the potential consequences to them of doing so.[6] It is vital and urgent that we move towards a culture in healthcare where staff can feel safe and secure in reporting patient safety concerns, knowing theses will be actively welcomed, listened to and acted on. Without this change, patients will continue to be harmed. We call on NHS leadership to now act on the many reports that make recommendations for culture change.
Taking action and addressing patient concerns
- 71.1% said their organisation takes action to ensure that reported errors, near misses or incidents do not happen again.
- 73.8% said their organisation acts on concerns raised by patients and service users.
Both these figures mark an increase on the results in the 2018 survey. However due to the number of respondents this also means that alarmingly more than 140,000 staff that responded to the survey do not have confidence that their organisation takes action to prevent harm or address patient concerns. Commercial organisations and other safety critical industries who had such alarming safety records would go out of business or be hauled up by their regulators. It is just not acceptable that a publicly funded healthcare system tolerates this level of performance.
Patients tell us that they are often not engaged properly in their care, instead treated as passive participants in the process. There is also clear research evidence that active patient engagement helps to reduce unsafe care. Working with Joanne Hughes from Mother’s Instinct we have recently launched a new blog series on this to develop our understanding of the needs of patients, families and staff if things go wrong and how we can best meet these.
We also share examples of good practice so that learning is shared for improvement. To help facilitate this Patient Safety Learning have launched the world’s first knowledge sharing platform for patient safety, free for all to use, the hub.
[1] NHS Staff Survey Results, Results Summary 2019, Last Accessed 18 February 2020. http://www.nhsstaffsurveyresults.com/homepage/results-2019/
[2]NHS Survey Coordinator Centre, NHS Staff Survey 2019: National results briefing, February 2020. https://www.nhsstaffsurveys.com/Caches/Files/ST19_National%20briefing_FINAL%20V2.pdf
[3] NHS England and NHS Improvement, The NHS Patient Safety Strategy: Safer culture, safe systems, safer patients, July 2019. https://improvement.nhs.uk/documents/5472/190708_Patient_Safety_Strategy_for_website_v4.pdf.
[4] Patient Safety Learning, The Patient-Safe Future: A Blueprint For Action, 2019. https://s3-eu-west-1.amazonaws.com/ddme-psl/content/A-Blueprint-for-Action-240619.pdf?mtime=20190701143409.
[5] NHS Survey Coordinator Centre, NHS Staff Survey 2019: National results briefing, February 2020. https://www.nhsstaffsurveys.com/Caches/Files/ST19_National%20briefing_FINAL%20V2.pdf
[6] Patient Safety Learning, Patient Safety Learning’s response to the Paterson Inquiry, February 2020. https://s3-eu-west-1.amazonaws.com/ddme-psl/PatientSafetyLearningsresponsetothePatersonInquiry.pdf?mtime=20200211091948
