Hospitals failing to tackle safety crisis
Chaotic organisation of health service is putting patients’ lives at risk, warns NHS medical director
HOSPITALS are failing to tackle “significant safety problems” that can cause death or disability, the NHS medical director has warned.
In a major intervention, Prof Sir Bruce Keogh said patients were being left in danger because of the absence of any central NHS system ordering changes in medical practice on safety grounds. Patients were being left at risk of suffering needless harm – including amputations, devastating maternity complications and deaths – because of the lack of action to protect them, the former heart surgeon said. In an interview with The Sunday Tel
egraph, Sir Bruce said there were too many organisations vying for attention and, instead, one simple system was needed to issue safety directives.
He also said too many hospitals were putting cost-cutting ahead of patient safety.
“People accept that their disease has risks, they accept that the treatment may carry some risks. What they should never have to accept is that the way we design and deliver our services adds to that risk,” he said.
“Where there are solutions to significant safety problems, I would like to see a system that mandates the use of those solutions through the NHS.
“The difficulty that we have is that the NHS is a conglomerate of hundreds of organisations, all of whom have their own boards and people in them with their own views.”
When action was required on safety grounds, “there should be a simpler way”, he said.
The public warning – a clear signal of frustration with NHS bureaucracy – is unprecedented from a man who has been the most senior doctor in the health service for a decade.
His comments come ahead of a report that is due to highlight a series of medical innovations which have slashed rates of death, injury and complications in the NHS hospitals that have introduced them.
Sir Bruce said patients were being let down by the absence of any mandatory system to ensure all hospitals introduced devices such as £2 valves that stop doctors and nurses mixing up drips, which can result in amputations, and angled surgical scissors that can spare mothers from childbirth injury.
Another example is PneuX, a ventilation tube that prevents pneumonia in intensive care units by electronically monitoring patients and preventing bacteria leaking into the lungs.
Some studies suggest the device, which costs around £330, could halve the rates of ventilator-acquired pneumonia, with the overall savings amounting to £700 each time it is used.
Sir Bruce suggested messages on safety were being compromised by the number of NHS central bodies and watchdogs issuing advice, and said such organisations were too numerous. He said one national director for patient safety – a job which used to fall under NHS England, but now falls under the auspices of watchdog NHS Improvement – should be given the power to issue safety directives, ensuring wider take-up of devices which could save lives, or prevent devastating complications.
“The decision to take up some of these devices or solutions is influenced by financial pressures and I think we need some way of being clear about when a recommendation such as this should override the financial considerations,” he said.
The NHS should take its lead from
the airline and nuclear industries, Sir Bruce suggested. “When a safety improvement is made, a way is found to ensure that it is taken up not just by individual airlines or countries, but across the industry,” he said.
An forthcoming independent evaluation of innovation in the NHS is expected to highlight the economic benefits of new medical inventions which have improved safety, quality of care or reduced pressures in the hospitals which have tried them.
Sir Bruce said many changes which improved safety would reduce costs in the long-run, particularly in negligence bills and in the length of hospital stays.
But he said NHS trusts needed to be prepared to pay “up front”.
The devices he backed are part of the NHS Innovation Accelerator, run by NHS England and 15 Academic Health Science Networks, which aims to ensure that effective gadgets and scientific breakthroughs spread more quickly. Some are put on a special tariff, which means hospitals can adopt them knowing they will automatically be funded by the NHS.
Sir Bruce said that many good ideas spread best without central orders, allowing clinicians to adopt the practices best suited to their requirements.
But he said safety should trump all other concerns, even at a time of tough financial pressures for hospital trusts.
“We need freedom to enable people to innovate and we need to have mechanisms to force the uptake of things where safety is a key issue,” he said.
Sir Bruce acknowledged hospitals were under a great amount of strain, as winter approaches.
“I think it’s really difficult for chief executives at the moment,” he said.
“They are having to spin a lot of plates and I think that becomes increasingly difficult as we get into winter, as the demand goes up, as illness affects both patients and staff, and a time when social services are under pressure.”