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