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First 100 days of Labour to pull NHS back from the brink

Labour pledges a relentless focus on the NHS in its first 100 days in government as new research reveals hundreds of “extreme” risks to patient and staff safety in hospitals across England. The long-term impact that Tory and Liberal Democrat underfunding is having on our health service is exposed in official NHS Trust documents. Analysis of more than 120 Trust board papers shows NHS Trusts are faced with hundreds of risks to patient safety classed as “catastrophic” or “extreme”, with the majority linked to lack of spending, staffing shortages or the failures of privatisation.

In government, Labour will immediately undertake a full audit of the risks revealed by the research and prioritise capital spending – which Labour has already allocated – to ensure people and buildings are made safe.

Risks linked to privatisation of the NHS include:

  • A Virgin Walk-In Centre at Coventry and Warwickshire Trust has had two cases resulting in patients dying. A coroner subsequently recommended patients be assessed in 15 minutes, but that has not been implemented – apparently because Virgin’s contract does not clearly stipulate the 15 minute requirement. Virgin has been sent two performance notices but its contract has been extended.
  • An extreme risk to dermatology services at North Middlesex after private provider Concordia Specialist Care Services was liquidated and legal issues arose with its parent company Omnes.

Risks linked to capital and funding, often due to maintenance issues, include:

  • A high potential of catastrophic failure of the roof structure of the Queen Elizabeth Hospital, King’s Lynn, due to structural deficiencies, posing a direct risk to life and safety of patients.
  • At Morecambe Bay, where there are high levels of backlog maintenance on its aging equipment and “unsuitable environments for safe clinical care”, the hospital: is unable to deal with air pollution levels and consequently has closed the hospital’s day case theatres; and is currently monitoring patients’ bloods with a shared excel spreadsheet that is “demonstrably incomplete”.
  • In County Durham and Darlington, the trust is at extreme risk of: failing to meet asbestos and fire regulations, and a total power failure across multiple sites. Units for cleaning endoscopy equipment are breaking down frequently, meaning that the equipment often has to be left uncleaned.
  • The board of East Cheshire Trust warns that “If there are not enough CTG machines [for recording fetal heartbeat] to monitor high risk pregnancies on the maternity unit in the antenatal and intrapartum periods, then there is a risk that fetal compromise may not be identified in a timely manner”.
  • At the Royal Derby Hospital, there is an extreme risk linked to the emergency buzzer system in the children’s wards. There sometimes is only one staff member working in the children’s high dependency unit (Dolphin ward) but they cannot easily request help in the event of an emergency because the nurse emergency buzzer system across the three children’s wards (Dolphin, Puffin and Sunflower) sound in the wrong place when triggered, and because there is no light alert to tell staff where the emergency is taking place. This is because they are configured to the previous building layout. The Board report indicates that this has been the cause of an incident previously.

Risks linked to NHS staffing include:

  • In Doncaster And Bassetlaw, there is an extreme risk to staffing of registered children’s nurses on two different sites, which could lead to children being harmed and delays to treatment.
  • In Newcastle Upon Tyne there is an extreme risk of a shortage of radiologists affecting breast cancer screening.
  • In Mid Cheshire, there are extreme risks: that a patient experiencing a cardiac event will be missed because of nursing shortages; of major harm to rheumatology patients after getting inappropriate care because of a shortage of consultants; and to dependant respiratory patients, either due to nursing shortages or because there are too few beds.
  • At Southport And Ormskirk Hospital Trust, there is a catastrophic risk of inadequate staffing levels in the anaesthetic department due to burn out, sickness, annual leave or lack of sufficiently cheap agency staff. This could affect the safety of emergency, ICU and Maternity departments, and could mean that A&E would be closed to high risk patients, including children.

Last year (2018/19) there were 15,844 patient incidents “directly” related to estates and facilities services (an average of 70 incidents per acute, mental health and ambulance Trust) and 4,810 clinical incidents caused by estate and infrastructure failure. In 2018/19 there were also 1,541 fires recorded by NHS Trusts, and 34 people were injured as a result of fires. The cost to eliminate the backlog of maintenance repairs in NHS Trusts is now £6.5 billion. £1.1 billion of this is high-risk maintenance and repairs.

NHS leaders have already warned this year that lack of investment in facilities was impacting patient safety. And last month GPs warned that winter pressures were likely to have an impact on patient safety, and 9 out of 10 hospital bosses felt staffing pressures were putting patient’s health at risk.

Earlier this year the Chief Inspector of Hospitals at the CQC warned that the NHS had made little progress in improving patient safety over the past 20 years, and NHS Providers published research that showed 8 out of 10 trust leaders felt that reduced investment in NHS facilities was compromising patient safety.

Jonathan Ashworth, Labour’s Shadow Health Secretary, said “These shocking reports reveal an NHS in crisis and on the brink. It is one thing for clinicians and managers to say what needs fixing, but we need a Labour government that will crack on and do it.

“We pledge that within the first 100 days of a Labour government we will get on top of this to ensure the extra funding we’ve promised is prioritised to keep patients and staff safe.

“The choice at this election is clear: five more years of the Tories running our health service into the ground – with more patients waiting longer for cancer treatment and operations, and more young people denied mental health care – or a Labour government on the side of patients and staff, with a rescue plan for our NHS.”

Labour’s manifesto commits to:

  • Ending NHS privatisation: Labour will end and reverse privatisation in the NHS in the next Parliament. We will repeal the Health and Social Care Act and reinstate the responsibilities of the Secretary of State to provide a comprehensive and universal healthcare system.
  • Capital funding: Regarding the Party’s commitment to a £15 billion NHS capital investment over the Parliament: We will publish an infrastructure plan to return NHS England to the international average level of capital investment and to ensure future decisions are transparent and balanced fairly between every region. We will complete the confirmed hospital rebuilds and invest more in primary care settings, modern AI, cyber technology and state-of-the-art medical equipment, including more MRI and CT scanners.
  • And safe staffing: Agenda for Change terms and conditions will be put into law alongside safe staffing limits for all staff. We will invest, train and develop NHS staff throughout their careers. We will introduce a training bursary for nurses, midwives and allied health professionals. We will remove the obstacles to ethical international recruitment.

    Labour reviewed the board papers of every non-specialist acute NHS England Trust in December 2019, including risk registers and board assurance frameworks. NHS Trust boards classify risks in different ways. This analysis uses a very common classification amongst different boards’ papers. According to that classification, risks graded 15/25 and higher are described as “extreme” and risks with a consequence graded 5/5 are described as “catastrophic”.