Workforce and patient safety

Background

The workforce challenges faced by the NHS in England present a significant risk to patient safety and staff wellbeing.

These challenges include inadequate interoperable IT infrastructure, skills shortages in key areas of the NHS and a mismatch between demand for hospital care and the supply of staff and other resources to meet that demand.

National reports and research have highlighted that these challenges are influenced by a shortage of NHS staff, and that there is a need to focus on recruitment and retention and consider the most appropriate workforce models for health and care in the future. To address these previously identified challenges, we can use our unique system-level perspective to propose ways to improve working conditions for NHS staff. We anticipate this in turn can help to improve patient safety.

Summary of investigations

We’re undertaking five investigations that consider how working conditions in the NHS can be optimised to support patient safety, while maintaining and improving staff wellbeing:

Workforce and patient safety: temporary staff – involvement in patient safety investigations.
Workforce and patient safety: digital tools for online consultation in general practice.
Workforce and patient safety: temporary staff – integration into healthcare providers.
Workforce and patient safety: primary and community care co-ordination for people with long-term conditions.
Workforce and patient safety: electronic communications on patient discharge from acute hospitals.

Each individual investigation will produce an investigation report that may make safety recommendations, safety observations or identify local-level learning to inform improvements in support of patient safety and staff wellbeing. So far, we have published four of five investigation reports, with the final one to follow in 2025.

The findings from all five investigations, and additional intelligence, may then contribute to future investigations.

Closure notice

The prioritising patient care investigation, which is part of the wider programme of work on the theme of workforce and patient safety, has been closed.

Safety recommendations

NHS England

HSSIB recommends that NHS England includes guidance on engaging temporary staff in learning responses within their 'engaging and involving patients, families and staff following a patient safety incident'. This should be developed in collaboration with providers of temporary staff to the NHS to help assist healthcare providers being able to fully investigate incidents from a systems perspective, enabling learning that can improve patient care.

When we published our guidance document: Engaging and involving patients, families and staff following a patient safety incident to accompany the publication of the Patient Safety Incident Response Framework in August 2022, we made a commitment to revise the document based on feedback about implementation and emerging research findings from the Learn Together research programme. In March 2024 we reconvened our stakeholder group to commence the revision and are pleased to consider HSSIB’s recommendation as part of this work.

Response received on 2 May 2024.

NHS England

HSSIB recommends that NHS England updates the agency worker framework agreement criteria to explicitly require framework agreements to adhere to the staff support principles of the NHS England Patient Safety Incident Response Framework. This will improve patient safety as there is a recognised link between staff having wellbeing concerns and the delivery of patient care.

This has been confirmed with NHS England and both the framework operators:

- The Workforce Alliance

- Health Trust Europe

A full list of NHS England approved framework agreements for the supply of temporary staffing can be found here.

Action planned to deliver safety recommendation:

Update the framework approval application form for 2024, by September 2024.

Response received on 3 May 2024.

NHS England

HSSIB recommends that NHS England undertakes an evaluation of the risks to patient safety of online consultation tools in general practice, taking into account the findings of this investigation, recent research, and the experiences of general practices. This is to identify and implement actions to support the safe delivery of care using online consultation tools in line with best practice.

NHS England

HSSIB recommends that NHS England develops mechanisms for assuring that integrated care boards support general practices when implementing online consultation. This is to ensure online consultation tools are procured and implemented in ways that best support patient safety.

National Guardian’s Office

HSSIB recommends that the National Guardian’s Office, working with relevant stakeholders, identify the barriers that prevent temporary staff from speaking up and develops mechanisms to address those barriers. This will build on their work to explore barriers for other staff groups and enable all workers to contribute to patient safety improvements without fear of reprisal.

We will implement HSSIB’s safety recommendation that the National Guardian’s Office will work with stakeholders to identify the barriers that prevent temporary staff from speaking up and develop mechanisms to address those barriers. This builds upon our work exploring the barriers to speaking up to improve workplace cultures so that all workers – no matter what their contract terms – are confident to speak up.

Given the critical role which temporary workers play in the NHS, it is vital that we ensure that they feel confident to speak up about patient safety and not fear they will lose future opportunities to work in that organisation. Temporary workers can offer valuable insights into practices and quality of care. Freedom to Speak Up guardians are available to all workers – this includes temporary, agency and bank staff.

I echo HSSIB’s recommendation for local level learning and for leaders to ask themselves: How do you ensure that temporary staff know how to speak up and that they feel safe to raise concerns?

We are planning on taking this action forward in 2025/26, subject to funding.

Response received on 5 November 2024.

Department of Health and Social Care |

NHS England

HSSIB recommends that NHS England/Department of Health and Social Care, working with other relevant organisations, reviews and evaluates the implementation of the care co-ordinator role. This is to ensure that all patients with long-term conditions have their care co-ordinated and that they have a single point of contact 24 hours a day, 7 days a week, to help them with any queries or concerns that they may have.

Department of Health and Social Care

HSSIB recommends that the Department of Health and Social Care works with NHS England and other stakeholders, to develop a strategy that ensures that all diseases are given parity and that all people with a long-term condition in primary, secondary, tertiary and community or social care have their care effectively co-ordinated across multiple agencies. This is to ensure that people with long-term health conditions have co-ordinated care plans with effective communication between services and a single point of contact for concerns or questions.

Safety observations

Temporary staff – involvement in patient safety investigations

Agencies providing temporary staff to the NHS can improve patient safety by facilitating the involvement of temporary staff in investigation processes, including interviews. This is to enable the investigation of patient safety incidents in line with the Patient Safety Incident Response Framework.

Digital tools for online consultation in general practice

National healthcare organisations can improve patient safety by supporting general practices to report patient safety incidents associated with the use of online consultation tools.
National healthcare organisations can improve patient safety by creating the conditions within which online consultation tools can be effectively implemented, including ensuring general practice has the resources, capacity and capabilities to meet the needs of its patients.
National healthcare organisations can improve patient safety by considering how long-term condition management and proactive health promotion can be accomplished alongside the online consultation model of general practice, which may limit opportunities to provide holistic care to patients.
National healthcare organisations can improve patient safety by supporting software developers of online consultation tools to meaningfully involve patients and staff in software design to help better understand their needs.

Temporary staff – integration into healthcare providers

National bodies can support patient safety by developing credentialing systems which enable staff to verify their competencies when moving between NHS organisations.
Organisations that provide temporary staff to the NHS can improve patient safety by including information about the NHS England Learn from Patient Safety Events service to temporary staff as part of their onboarding process. This is to enable temporary staff to record patient safety risks if they do not have access to a healthcare provider’s reporting system.

Primary and community care co-ordination for people with long-term conditions

Health and care organisations can improve patient safety by allocating a point of contact for patients and/or their carers when people are discharged from services out of normal working hours. This will ensure patients and their carers are able to escalate any concerns relating to their ongoing care and drive improvements in care co-ordination.

Workforce and patient safety

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Background

Summary of investigations

Closure notice

Safety recommendations

NHS England

NHS England

NHS England

NHS England

National Guardian’s Office

Department of Health and Social Care |

NHS England

Department of Health and Social Care

Safety observations

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