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Revealed: extent of harm to patients under NHS care

More than 20 per cent of patients suffer avoidable harm during their care at some trusts, a national survey of frontline NHS services has revealed.

The NHS Safety Thermometer reveals that nine per cent of all NHS patients have suffered an avoidable harm. This means major improvements are required if the NHS is to meet the Department of Health’s target to deliver “harm-free care” to 95 per cent of patients “by 2012”.

The safety thermometer, launched in April, gathers data submitted by all NHS providers on a set of key care quality indicators including pressure ulcers and patient falls.

It shows that, in July, 91.2 per cent of NHS patients were “harm free”. Six per cent had a pressure ulcer, although not necessarily one caused by the reporting organisation. One per cent developed a new venous thromboembolism, and 1.2 per cent had a “fall with harm” while receiving health service care.

HSJ analysis of the figures revealed that when organisations surveying fewer than 300 patients were excluded, the five trusts with highest reported rates of patients with avoidable harm from April to July were:

  • Torbay and Southern Devon Health and Care Trust (23.5 per cent of patients)
  • City Hospitals Sunderland Foundation Trust (23.1 per cent)
  • Airedale Foundation Trust (20.5 per cent)
  • Sussex Community Trust (19.3 per cent)
  • Chesterfield Royal Hospital Foundation Trust (16.9 per cent)

These compare with a median rate of 8.9 per cent. There were 24 trusts with an overall rate of harm of less than five per cent.

The Airedale and Sunderland trusts were also the only two to report that more than 10 per cent of their patients had acquired a VTE under their care.

However since this story was originally published online, Airedale Foundation Trust have clarified that the figures they submitted to the survey were wrong, and that their overall harm rate should have stood at 9.7 per cent.

Twelve trusts reported that more than six per cent of their patients had suffered falls, led by York Teaching Hospital Foundation Trust, North West London Hospitals Trust and 2gether Foundation Trust.

There were seven trusts which reported more than three per cent of their patients had developed a new pressure ulcer on their watch. Croydon Health Services Trust, City Hospitals Sunderland and Leeds Teaching Hospitals Trust had the highest rates.

Nationally, there has been modest improvement across all indicators since April 2012, when the overall harm-free figure stood at 90 per cent.

However, the results are not adjusted for seasonal variation, and the NHS Information Centre, which publishes the data, cautioned against identifying any trends from the first four months of data.

HSJ analysis shows that from April to July, the foundation trust sector outperformed non-foundation NHS trusts, with the two groups respectively recording averages of 8.4 per cent and 9.2 per cent of patients as being harmed under NHS care.

Ninety-one per cent of men were harm free in July, compared with 90.6 per cent of women. The largest difference was with urinary tract infections, which were found in 1.5 per cent of female patients and 1 per cent of men.

The data also shows how some harms are more prevalent in different care settings. Hospital wards have lower rates of harm in all areas except urinary infections and VTE. Meanwhile, community hospital patients have a much higher rate of overall harm, with pressure ulcers in particular more prevalent. Patients cared for in their own home have a lower prevalence rate of all harms except pressure ulcers.

The data has been assembled via a monthly series of snapshots, gathered by frontline clinical staff since April. The July survey included data from more than 141,000 patients across 205 organisations, including private providers of NHS funded care. NHS trusts are incentivised to take part in the survey through additional commissioning for quality and innovation payments.

JP Nolan, nurse adviser for acute and emergency care at the Royal College of Nursing, welcomed the safety thermometer as “a fantastic piece of work”, but added that local qualitative root cause analysis of harm caused to patients will be critical to driving improvements.

He added that “in the numbers, what is lost is a rich and valuable narrative on patient safety – the quantitative stuff is very important”.

Mr Nolan said that in the new NHS commissioning system, patient safety will have to be owned locally by nurses and other clinical members of clinical commissioning groups.

“We’re very keen on seeing how the patient safety function moves across to the NHS Commissioning Board, how that cascades down through the clinical commissioning groups and into the contracts for the providers, and how that is represented on the front line. We’re interested in how that will work.”

Jacqui Fletcher, fellow of the National Institute for Health and Clinical Excellence and tissue viability nurse, told HSJ that the overall figure of 91 per cent harm free was “better than expected” given that many trusts have not monitored these harms in this way before.

She said the exercise is raising the profile of patient safety at board level, and encouraging trusts to make changes that “ground level clinicians have been wanting to do for a long time”. Ms Fletcher was optimistic that the NHS could still increase the overall harm-free figure to 95 per cent by the end of the year, as many of the changes required to improve performance were relatively simple to enact.

* Additional research by George Wellby

Readers' comments (19)

  • It'll be interesting to see where this goes. It seems like a good idea to focus on a small number of serious but avoidable problems. The cynic in me feels like starting a sweepstake on how many 'harms' will be measured by the Thermometer this time next year, but I am hopeful that there'll be an improvement in the current metrics by the end of the year.

    This is a national CQUIN goal, isn't it? Perhaps by the end of the year it will be possible to calculate the reduction in costs associated with the different kinds of harm, and compare this to the amount paid out in CQUIN money?

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  • This is very welcome. There's good evidence that these outcomes are common, readily measured and cause preventable harm to patients.

    I'd rather like to see similar data for care homes.

    Sure, one could do a wider trawl, but we need to get this sort of thing right so I'm glad to see this implemented at last.

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  • Hi Stella

    The data does include some care homes, where they're providing NHS care, though coverage is more patchy than for NHS providers.

    Obviously for care homes the samples are much smaller so can't say much about them as individual organisations, but I would like to analyse them as a cohort in future.

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  • High quality care delivered Right First time with Zero Harm is the only moral, acceptable, and achievable goal for any healthcare operation. Come on folks you can deliver, you must deliver. All of these levels of harm ore unconscionable and unacceptable. Please get on with it now! Cure the NHS, Stafford.

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  • As a recent patient in hospital,I wonder why weight loss from poor quality food isn't included?

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  • Jacquie Fletcher frightens me. Zero Harm is the only moral way of delivering healthcare. Accepting harm to 5 patients in every 100 is complacent and dangerous. Zero Harm is entirely deliverable. Cure the NHS Stafford.

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  • Kenneth - the 95 per cent harm free target is the DH's, not Jacqui's. However I can't explain why, if these harms are assumed avoidable, 100 per cent harm free care isn't the target.

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  • Kenneth, David - perhaps 100% is considered unattainable because there are some situations where a harm could occur regardless of staff efforts? If a patient at risk of falling insists on using the toilet or shower on their own, or if a patient at risk of a pressure ulcer refuses to mobilise, harm can occur regardless of how prepared and vigilant the staff may be.

    In contrast, the list of Never Events do have a 100% avoidance target. With the possible exception of escape from a secure MH unit, all are entirely dependent on staff.

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  • We don't have a risk avoidance culture, but a risk minimisation culture. We do encourage patients who are at risk of falls to mobilise, or they are at risk of VTE, pressure ulcers etc.
    Also, this is data for improvement, not for judgement, and no inference can be drawn until there are at least six data points. This is a very knee-jerk article, that has no understanding of how to use data to support improvement.

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  • We don't have a risk avoidance culture, but a risk minimisation culture. We do encourage patients who are at risk of falls to mobilise, or they are at risk of VTE, pressure ulcers etc.
    Also, this is data for improvement, not for judgement, and no inference can be drawn until there are at least six data points. This is a very knee-jerk article, that has no understanding of how to use data to support improvement.

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  • A snap shot. One dot. No trend data. The game continues - one data point - benchmarks - judgement. Does the NHS understand improvement? We need better quality leadership and management.

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  • Steven Burnell

    For the Public, this is shocking if over a 3 month period, some Trusts allowed / caused some avoidable harm to more than 1-in-5 of their Patients.
    Other industries could not survive this - we must drive up the expectations & the quality of services delivered to well beyond the 95% DH /NHS Standard. And, it should perhaps include Unhealthy Weight Loss.

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  • What about the Trusts who have submitted no data at all? Isn't absence of reporting more significant than one data point? More of a story there I think.

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  • Aug 31st 8.13 is spot on.
    It is not possible to draw many conclusions from a single survey. Sure there is a range around a mean, but so what?
    Some patient groups are far more likely to fall or get pressure sores than others. Unless the results are standardised to account for the demographics of the in-patient population in each organisation, the percentages are not comparable cross-sectionally, and it was unwise of the HSJ to attempt it. Maybe the longitudinal trends over time in individual establishments will be useful to compare.

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  • Gosh, I trust this isn't going to be a single report! We need to know which NHS organisations haven't contributed data because they have some questions to answer for the public they serve and whatever vestigial oversight bodies still exist locally. There should be no reasons to exclude any provider.

    I appreciate how hard it's going to be to extend such a survey to care homes and make sure that data isn't 'sanitised' before submission. But the closed nature of such institutions means that patients/clients are very vulnerable.

    Agree about excessive weight loss & malnutrition as a second phase addition. Start with older people & those who stay in hospital more than 4 weeks? But for most inpatients, it doesn't become a sentinel event and as a wider health problem, it's less common than obesity.

    Planned risk taking with best possible safeguards and consent of relevant parties is OK, but I've seen it misused to justify poor practices, poor staffing & inadequate safety equipment levels.

    This is a valuable report and I will watch progress with great interest.

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  • But Torbay seem to accept that having a higher proportion of >65s means they'll have more incidents, according to their press release. Just because the data's not age standardised adjusted makes it acceptable for one in five people not to be safe? And only one data point means it's not relevant? Shocking complacency. Typical NHS attacking the figures. Shows nothing's changed. Let's hope the Francis report makes a difference.

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  • I strongly object to the attitude that more older patients = risks you can't control.

    Yes, older people need more care and their needs are wider than those of more resilient younger patients, but too many units are leaving them in wet beds developing pressure ulcers, dehydration, malnutrition & thromboses.

    There simply is NO EXCUSE for some of the poor care I've seen. I know from my own clinical experience that these sentinel events are preventable if you staff your wards and community teams with well qualified and motivated nursing staff.

    The units that fail in this end up with the poor outcomes because they have too many unregistered care assistants and sometimes they have incompetent & unmotivated registered nurses too. Staffing levels and skill mix needs to reflect real patient needs, not arbitrary budget levels.

    We shouldn't be afraid to speak these truths and criticise bad care for what it is.

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  • Steven Burnell

    Stella Welsh:
    Well said - keep telling as it is when others might not feel able. Very best regards.

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  • http://www.gosh.nhs.uk/about-us/our-priorities/quality-and-safety/zero-harm/?__utma=1.833081914.1347638799.1347638799.1347638799.1&__utmb=1.6.9.1347640240420&__utmc=1&__utmx=-&__utmz=1.1347638799.1.1.utmcsr=google|utmccn=(organic)|utmcmd=organic|utmctr=the%20zero%20harm%20hospital&__utmv=-&__utmk=134402033

    or search for 'zero harm' on the GOSH website. good enough for me! Time it was for everone. Everyone at NHS Live 2004 listened to Don Berwick explaining the philosophy beautifully - how many harmed since then?
    Cure the NHS - Stafford

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