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Healthcare must be redefined as a safety critical industry, says RCN

Healthcare should be reframed as a safety critical industry in order to avoid errors and improve patient outcomes.

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The Royal College of Nursing has called for the healthcare sector to be refined as a safety critical industry.

Healthcare should be reframed as a safety critical industry in order to avoid errors and improve patient outcomes, according to written and oral evidence submitted to the Draft Health Services Safety Investigation Bill Committee by the Royal College of Nursing.

Speaking at the Committee hearing earlier today, Dame Professor Donna Kinnair, Director of Nursing, Policy and Practice at the RCN, told MPs and Peers that while the College supports the creation of an independent body to investigate serious patient safety incidents in England, this could only work effectively if healthcare is redefined as a safety critical industry.

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Donna said the Bill in its current form places disproportionate emphasis on blaming individuals, and ignores examining the wider context in which mistakes can happen. As well as blaming frontline professionals for system issues beyond their control, this risks investigations failing to root out the true cause of errors, further compromising patient safety.

In light of the 40,000 nurse vacancies in England alone, the RCN has called for nurse staffing levels at the time of an incident to be reported by the HSSIB for every investigation.

In addition the College has called for concerns raised about staff shortages on shift before the incident to be noted by the investigation.

Safe staffing levels should be enshrined in law.

In England, 71 per cent of NHS day shifts in adult acute wards fell outside the recommended nurse to patient ratio (1:8) standard set out in the NICE guidelines. Of those, 26 per cent shifts had more than 14 patients to one nurse. The RCN has previously called for safe staffing levels to be enshrined in law.

The College also raised concerns that healthcare staff who speak out in HSSIB investigations must be guaranteed a genuine safe space in which to discuss errors. It further recommended that findings of investigations be shared with health and care providers both within the NHS and independent sector, in an anonymised and appropriate way.

Speaking at the hearing, Donna Kinnair, Director of Nursing, Policy and Practice at the RCN, said: “The HSSIB will have to tackle those thorny cultural issues such as lack of staff, which people so often say we can do nothing about. It becomes more and more perverse that we tend not to look at the issues that are right in front of us.

“One of the things we are very clear about is we have an understaffed health service. The fewer nurses you have on duty, the worse patient outcomes you have. Nurses deliver 70 per cent of care. We would be working with HSSIB to make sure safe staffing levels are enshrined in law.

“It’s cheaper and easier to deal with the individual, and place the blame on the individual’s head, but this is not the solution. We can make the system safer.”

Nurses are forced to deliver care in unsafe circumstances.

Speaking outside the hearing, Donna said: “To improve patient safety, HSSIB investigations must root out the true cause of errors including systemic failures by Government and agencies. With staffing levels on many shifts below recommended safety guidelines, it is unjust, and potentially misleading to emphasise individual blame when systems and procedures are at fault. 

“Many nurses already struggle in the knowledge they are forced to deliver care in unsafe circumstances, yet their concerns are often ignored. Investigations should note concerns raised prior to incidents, and must take into account inadequate staffing levels.

“Staff should not be held to account for all care that is delivered, irrespective of resources and funding. Appropriate levels of accountability have to exist at all levels, including Government.”

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Nursing vacancies hit record high leaving patient care at risk

It can be “dangerous” when there aren’t enough nurses to provide care.

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Patient Falls Risk with IV

There are now a record 43,671 empty nursing posts in the NHS in England alone.

NHS figures show that there are now a record 43,671 empty nursing posts in the NHS in England alone, according to the Royal College of Nursing (RCN).

The College says a global shortage of nurses alongside the removal of the nursing bursary has compounded this figure which now sees 12% of posts through the NHS in England without a full-time Registered Nurse.

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Figures from the University and College Admissions Service (UCAS) show a 29% overall decline in applications to undergraduate courses since 2015, when the bursary was cut by the Government.

In a report released today titled ‘Standing up for patient and public safety’, the Royal College of Nursing outlines the evidence of the need for a new law that allocates specific legal responsibilities for workforce planning and supply.

A new law is needed.

The report states that in order to address the record number of vacancies, and the gap between the numbers of health and care staff needed to deliver patient care vs. how many are in the system.

Figures included in the report reveal that the number of nursing staff has consistently failed to keep up with the dramatic rise in demand for services and the number of emergency admissions.

The report finally makes a further call for legal clarity on the roles, responsibilities, as well as accountabilities, for workforce planning and supply.

In September, after pressure from RCN members, NHS England and NHS Improvement asked the Government for clarity over who is accountable for the nursing workforce.

‘Nurses are working harder than ever’.

Dame Donna Kinnair, Chief Executive and General Secretary of the Royal College of Nursing said: “Nurses are working harder than ever to deliver safe patient care but are being held back by a system that is legally lacking teeth. Despite the public, patients and nurses all agreeing that clarity is needed on responsibilities for delivering enough nurses, we have yet to see any government pledge anything of the like, and as a result are staring down the barrel at a record 43k empty nursing posts.

“We know how dangerous it can be when there aren’t enough nurses to provide care, but at present, almost all accountability rests with the frontline nurse working on the understaffed ward, rather than those responsible for the system they work in.

“We believe the time has come for change and that patient care was future-proofed by law, and that from the government down, decision makers are held to account.

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NHS calls for clarity on who is accountable for the nursing workforce

Figures suggest there are around 40,000 unfilled nursing vacancies throughout the NHS in England.

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Working nurses in the CCU

Healthcare leaders are calling for legislation to be included in the forthcoming Queen’s Speech.

NHS England and NHS Improvement have called on the Government to clarify who is accountable for the nursing workforce and the chronic problems it’s currently facing.

Following ongoing pressure from nursing unions, the two organisations met today and recommend that the government should “revisit with partners whether national responsibilities and duties in relation to workforce functions are sufficiently clear.”

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With around 40,000 unfilled nursing vacancies in the NHS in England and thousands more throughout social care, the Royal College of Nursing (RCN) believes the Secretary of State for Health and Social Care should be legally accountable for the workforce.

Along with other health care leaders, Dame Donna Kinnair, Chief Executive & General Secretary of the RCN, written to the Government calling for the legislation proposed by NHS England and NHS Improvement to be included in the forthcoming Queen’s Speech.

Staff shortages have reached ‘alarming levels’.

Responding to the news, Dame Donna Kinnair said: “We are pleased that NHS England and NHS Improvement has recognised the concerns of RCN members and the public and has stated that the issue of accountability for workforce planning and supply remains an area that needs be resolved.”

“In the week after we have launched a major public facing campaign calling for investment in the nursing workforce as well as for accountability to be clarified in the law, yet again, the case is made for this to be taken seriously.

“We are clear that government is well placed to determine how accountability can be clarified in law.

Adding; “Staff shortages have reached alarming levels with at least 40,000 vacant registered nurse posts in the NHS in England alone with thousands more vacancies in public health and social care.

“We now hope government will listen to this message, as well as the voices of the thousands of members that responded to the NHS England engagement process, and bring forward this legislation, taking the opportunity to include accountability in government and throughout the health and care system, for workforce planning and supply.”

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