Concerns over patient safety in NHS ambulance services are growing

Keegan Shepard, Edge Hill University

Even with all the wonders that modern medicine has to offer, it is clear that patients remain at significant risk while receiving care. And no more so than when in the care of the ambulance service.

Patient safety has been a principle in healthcare ever since the 1950s but has been of worldwide attention after the Institute of Medicine released the report “To err is human: building a safer health system” in 1999. This report prompted a great deal of concern after it highlighted that 44,000 to 98,000 patients died each year due to medical error in the US. These threats to patient safety are present in Britain’s NHS as well. In 2013, the Francis Report concluded that an estimated 400 to 1,200 patients of the Stafford Hospital died due to poor quality of care.

While most research on patient safety has been done on hospitals, major concerns exist in the NHS ambulance services, where quick responses to emergency situations are key.

The NHS ambulance services have seen a rapid growth in the number of 999 calls in England over recent years. From 2014 to 2015, they recorded a 6.1% increase from 8.49m to 9m calls, averaging 24,661 calls received every day. The Department of Health released a report detailing how the 999 demand for ambulance services is increasing at a higher rate than the growth in demand for other emergency and urgent-care settings, as well as faster than the growth in population.

An increase in demand has also led to an increase in waiting times. In November, a total of 2,955 patients had to wait over 12 hours to be either admitted, transferred or discharged following their arrival at A&E, a 22% increase from a year ago. The steep rise in demand against a backdrop of budgetary cuts and paramedic shortages presents serious concerns to the safety of patients using these services.

An increase in demand has led to an increase in waiting times. Robert Kneschke/

Staggering rise in patient safety incidents

The National Reporting and Learning System (NRLS) has been collecting data on patient safety incidents in the NHS since 2003. A patient safety incident is defined as “any unintended or unexpected incident which could have or did lead to harm for one or more patients receiving NHS care”. In the ambulance services, the number of reported patient safety incidents in England rose by 4,132 between July 2009 and June 2010, and by 10,375 between July 2014 and June 2015.

In only five years, the annual rate of patient safety incidents has more than doubled. Over the same period, all care settings in the NHS in England also saw a rise of patient safety incidents from 1.1m to 1.7m. To put this into perspective, the rate of reported patient safety incidents rose by 151% in the ambulance services, while the NHS as a whole experienced a more modest growth of 51%. The sheer level of the recent growth of incidents reported by ambulance services compared with other care settings or the NHS as a whole is very troubling.

Some research indicates that the ambulance services are less prone to reporting incidents than other care settings in the NHS. This suggests that more patient safety incidents are occurring in the ambulance services than are being reported. Even if the data from the NRLS is under-reporting the scale of the problem, it’s clear that this staggering rise in incidents does not appear to be slowing down. In all likelihood, patient safety incidents may continue to grow at a faster rate due to the increased demand and other pressures.

In addition to the number of incidents, the NRLS also details the level of severity of reported patient safety incidents, ranging from no harm to death. About 30% of the incidents in the ambulance services from October 2014 to September 2015 caused harm to a patient while receiving NHS care. If the demand continues to rise, an increase in the risks for patient safety incidents is also likely.

It has been almost 18 years since the release of the Institute of Medicine’s To err is human, and four years since the Francis Inquiry. Reports like these act as reminders of the grave consequences of low quality of care, and they put pressure on the services to improve. It is hoped that future research can identify the causes of incidents as well as develop strategies to make care safer for the patients. It is clear that NHS ambulance services have a long way to go.The Conversation

Keegan Shepard, PhD Student and Graduate Teaching Assistant, Edge Hill University

This article was originally published on The Conversation. Read the original article.

What about the issues that don’t figure in the election campaign, but matter ?

The ways in which the formal election campaign and its associated conversations miss out the issues that touch most people, are ones I will come back to over the coming weeks.

It’s important to start though by recognising that the shared conversations between the politicians and the media rule out a whole series of voices and experiences.

The impact of welfare reform, which will be a centre piece of the next five years if the present Tory-led Government retain power, is ruled out of discussion by ministers.

And yet whilst the media may press them on the issue, the headlines focus not on an absence of an answer, but on the skill of avoidance.

All three of the major UK based parties are in favour of education and all three have a shared commitment to maintaining the new status quo on the roles of academies and trusts rather than local schools.

Indeed all three are also in favour of the status quo on how the NHS is organised.

However, they do differ on some things. But it is the shared consensus which is rarely up for discussion. Why? And why aren’t the voices of  those that rely on the services (not those who work in them) heard?

On May 7th local elections will take place too. Here, the absence of a rich and diverse debate is very evident. But does this matter? I think it does. Whoever wins nationally on May 7th will be putting in place spending plans which directly impact on local communities.

It will be City Hall making many of the cuts and therefore we do need to try and make the connections between the local and the national. Accountability only works if those that make decisions are open to challenge and are willing to engage with that challenge.


Why changing how public services are run and financed is off the agenda

How public services are funded and how they are run have been two central questions to dominate news and political conversations.

The scale of problems associated with the NHS, from the crisis in A&E to the scandals revealed in the Francis Report in Staffordshire, have all been about money and staffing.

And yet, as the General Election gets closer these two questions are moving into the background. It seems to me that whilst the headlines are all about poor funding and inadequate staffing levels, both of the major parties are not quite sure what the answers are. They would rather the discussion was focussed on the personalities and the gaffes (as much as they say they would rather concentrate on the issues).

We saw last week with the news that the new Greater Manchester body is to be given responsibility (or share it with existing NHS organisations) for all health spending that the major parties were not sure how to react. In a sense it was a counter intuitive response : the Conservatives who are supposed to be sceptical about the way Labour Councils are run, is in fact, transferring millions of pounds and responsibility for a range of services to an overwhelmingly Labour dominated new authority. And Labour, who are supposed to favour greater devolution, found themselves with their national spokesperson on Health being critical of the proposal. And (predictably) the news followed these two apparent contradictions.

I want to suggest that what they tell us is that neither party is clear (or confident) about what to do next.

The funding crises in the public sector is built in for the next five years. Austerity is not over we are about to move into the next phase – Austerity 2.0. The real discussion needs to be about what we are prepared to fund (both the level and the scale of service) and that avoiding either of those two questions does not help the public conversation.

Why policy matters and why we need to talk about it more

The General Election campaign, not formally announced but underway,is being dominated by the personalities (or lack of).

So it matters that the Green Leader had a difficult interview or that senior MPs can offer to trade their services for £5,000 a day but that other (potentially more significant things) issues can be ignored or missed altogether.

An important announcement by the Government some time ago (and backed by the other major parties) was the decentralisation of decision making and budgets to something called the City Region of Greater Manchester.

The language is not as important as the act and the decision that have been made.

All the decisions on policing, fire and rescue, transport, planning and infrastructure will be made by the leaders of the 10 authorities in Greater Manchester. Alongside some decisions on education and training (probably related to skills and apprenticeships).

At some point, possibly 2017 or 2018, an elected mayor will be responsible – a kind of Boris Johnson mark two. And now the Government are saying that all health spending will be devolved too. So goodbye Clinical Commissioning Groups (CCGs). And what about the NHS restructure introduced in 2010? The new addition has major implications for the kind of health service we have, we might want and we might hope for. But that wont be part of the General Election campaign.

The decision to decentralise is a really important and significant one. There is a whole set of arguments which support it and , indeed, it can be seen that it brings decisions closer to where we live.

But not to include it as part of the May 2015 conversation is a big error and misses the trick of connecting policy decisions to the wishes of local communities and thus brings the national (or in this case a kind of regional) to the local.

Its part of the accountability and transparency that makes civic society healthy (or healthier than it is) and we should be asking questions about what this new announcement means. It could be a way of reviving our public and policy conversations.