Seasonal weather causes pressures on healthcare systems across the world. Just as high temperatures and humidity can have a large impact on health, when the temperature falls during the winter months there are increased hospital admissions from cold-related illnesses.
High demand for beds is often compounded by difficulties in discharging patients from the wards back to their homes as well as staff shortages caused by illness or bad weather. In addition to this, extreme weather, be it tropical storms or snow blizzards, may also contribute to the pressure on healthcare organisations by impacting on the number of ambulance call outs and subsequent response times as well as possibly preventing people from accessing primary care services. All elements of the healthcare environment from intensive care units to district nursing are affected.
Winter pressures tantamount to a humanitarian crisis
The demand on healthcare organisations during the winter season in the U.K. has been widely documented. In January 2017 the head of the British Red Cross claimed that, “a humanitarian crisis” was gripping the NHS as it struggled to keep up with rising demand. The so called “winter pressures” have been increasing steadily year after year and in 2017/18 the NHS experienced what has been considered to be one of the toughest winters on record1. It was not uncommon to see 12 hour trolley waits in A&E, for ambulances to be diverted as hospitals were unable to cope and for some wards to be operating for a number of weeks whilst having declared unsafe levels of bed occupancy.
After winter is over there are frequently calls from politicians, the media and healthcare organisations themselves for lessons to be learnt and yet, as 2018 progressed there was no sign of demand going down or the crisis abating. Urgent and emergency services were as busy as ever, caused overwhelmingly by the complex needs of the aging population. Fears have been raised that the winter of 2018/19 will prove no exception. Winter pressures are not confined to hospitals though as GPs are working flat out to try and cope with demand. In a survey carried out by GPonline, 74% of GPs said they were concerned that their practice would be unable to cope this winter due to workforce problems, heavy workload and underfunding.
Patient safety can be severely compromised
The knock on effect of winter pressures on patient safety is clear. The Royal College of Physicians ran a poll which showed that 58% of doctors were “worried” or “very worried” about the ability of their hospital to deliver safe patient care due to winter pressures. When clinicians work under intense strain and the whole system is under immense pressure, as it is during winter, there is an increased risk that patient care and safety will be compromised. This has been evidenced repeatedly. The East of England Ambulance Service declared 22 Serious Incidents in just one month of winter 2017/18 and although no patient died, three patients were caused serious harm by the ambulance delays caused by winter pressures2. A large and increasing number of studies have reported a relationship between low nurse staffing levels and adverse outcomes, including higher mortality rates3.
There is widespread agreement that workforce issues are one of the largest contributing factors to winter pressures. NHS England reported that workforce pressures present the highest internal risk for NHS trusts this winter and a report by The King’s Fund published in November 2018 claimed that workforce challenges in the NHS now present a greater threat to health services than the funding challenges4. The Government has created a winter fund of £420 million which has been divided amongst hospitals, adult social care and ambulance services to improve resilience5. It isn’t solely for workforce issues but the hope is that it will help prepare for the winter demand.
Transparency and learning are crucial to stamping out a blame culture
The workforce challenge which is exacerbated during winter will not be solved easily but there are ways in which patient safety can be championed. Transparency, learning and improvement are as important as ever in a high pressure environment as a blame culture and fear of punishment for not meeting targets can make it more likely for problems to be hidden. As the chief executive of NHS Improvement wrote in December 2018, “During challenging periods, it is particularly important that we collectively build and maintain a culture where teams can transparently raise concerns, talk about problems with care delivery, expose risks and confront head on the very real challenges of managing and delivering healthcare when resources are tight and demand is continuously increasing.”
A poll taken by the British Medical Association in September, 2018 found that 55% of all doctors questioned (almost 8000) feared being blamed unfairly for errors caused by pressures or system failures in their workplace, a perception no doubt reinforced by the case of Dr Bawa-Garba who many believed was scapegoated for wider systemic failings6. A more honest and open culture could prevent this from happening again and striving for such an environment should not be put on the back burner during times when the pressure is at its maximum. Patient safety and an open, honest and supportive learning culture should not be seasonal.
Caroline White is a specialist Healthcare Risk Control Director at CNA Hardy and works closely with our healthcare customers to integrate risk awareness and prevention into their corporate strategy and decision making.
Email – [email protected]
1 https://nhsproviders.org/media/3218/winter-warning-managing-risk-in-health-and-care-this-winter.pdf
2https://www.eastamb.nhs.uk/about-us/papers-2018/EEAST-Thematic-Analysis-of-SIs-May-2018.pdf
3https://www.clahrc-wessex.nihr.ac.uk/img/projects/8.%20Nurse%20staffing%20and%20patient%20outcomes.pdf
4https://www.kingsfund.org.uk/publications/health-care-workforce-england
5https://www.gov.uk/government/news/nhs-better-equipped-for-winter-with-420-million-funding?utm_source=5bd9cb77-55cb-45f9-bf51-0c1958c89a62&utm_medium=email&utm_campaign=govuk-notifications&utm_content=immediate
6https://www.bma.org.uk/collective-voice/policy-and-research/nhs-structure-and-delivery/future-vision-for-the-nhs/future-vision-for-the-nhs-survey