England’s Healthcare Staff Increasingly Afraid To Raise Safety Concerns

Healthcare workers in England’s public health system are more afraid to report concerns about patient safety than they were last year, results from a national staff survey show.

In 2021, some 75% of staff felt comfortable raising concerns about unsafe clinical practices. But that figure fell to just under 71.9% in 2022: a marked decline for a metric which had been improving in recent years.

Staff at ambulance services reported the largest fall, from just over 70% in 2021 to 65.2% last year.

The results reflect staff experiences during an extended period of intense pressure, as demand for emergency care has outstripped capacity. Short staffing, sicker patients and a lack of adequate social care are all factors in a crisis that has seen ambulance and emergency room wait times balloon.

Exactly how many patients have come to harm as a result of emergency delays isn’t yet clear, but a Guardian investigation published Friday shows that more than 500 seriously ill people died last year waiting for an ambulance to take them to hospital.

This is more than double the number of people who died in similar circumstances in 2021, the report found. It’s also likely to be an understimate, the newspaper cautioned, as not all organisations provided results for all of 2021 and 2022.

Royal College of Emergency Medicine president Dr Adrian Boyle told the newspaper: “These 500-plus deaths a year when an ambulance hasn’t got there in time are tragic and avoidable... These numbers are deeply concerning. This is the equivalent of multiple airliners crashing.”

Working in highly pressurised environments continues to take a toll on ambulance staff, who like many other members of the public healthcare sector have staged several strikes in a long-running dispute over pay and working conditions.

A recent report from the Healthcare Safety Investigation Branch found ambulance staff experienced “extreme” emotions when discussing their work, with many feeling “moral injury” over the barriers they faced in providing care.

Neil Alexander, who led the report, said in a statement at the time that staff “have shared with us the distress over delays and the harm that it is causing to patients and how this has affected their personal wellbeing.”

“We heard words like ‘demoralising,’ ‘powerless’, ‘hurt’, ‘relentless’ during our interviews with them, and many expressed they are feeling the burden and experiencing moral injury.”

The link between safety and staff wellbeing, the HSIB argues, should be a key factor in patient safety planning.

The latest NHS Staff Survey results show a concerted effort is needed to make “positive movement” on “speaking up” measures, charity Patient Safety Learning tweeted on Thursday.

“If we are to effectively learn from and prevent future incidents of avoidable harm, staff need to feel safe to raise and discuss patient safety incidents. This year’s staff survey results are a clear indication that too often this is still not the case,” wrote the organization, which is led by chief executive Helen Hughes.

“Now must be the time when NHS England brings forward as a matter of urgency robust and specific commitments to drive forward the work of improving the safety culture in the NHS.”