Physicians worried about future patient safety, whistleblowing and rota gaps

The survey results are published in NHS reality check: Delivering care under pressure, a report being launched today at the RCP’s annual conference in Manchester. Over 2,100 RCP members responded to the survey, which asked questions about their experiences of delivering healthcare, and their confidence in being able to raise concerns about patient care.

The results, which included free text comments, show doctors overwhelmed by rising need in hospitals running at such high occupancy levels that there is no longer slack in the system. They shared their experiences of care over the past 12 months:

• 78% say demand for their service is rising.
• Over half of physicians believe patient safety has deteriorated.
• Over a third say the quality of care has lowered.
• 84% have experienced staffing shortages in their team.
• 82% believe the workforce is demoralised.

Doctors said they were ‘firefighting’, ‘papering over the cracks’ and ‘hanging on by their claws’, other comments included ‘I feel like I’m on the Titanic’, ‘55 escalation beds in operation today with no extra medical or nursing staff. Completely unsafe.’

In her speech to the RCP’s annual conference Medicine 2017, RCP president Professor Jane Dacre will say to an audience of physicians, physician associates and other healthcare staff:

I am sure these figures will not come as a surprise to anyone in the room. The physicians I know, and I include myself, are optimistic, positive, can do people who produce work round solutions to intransigent problems. However, they are being pushed to their limits and no longer are optimistic about the future …

… we worry that there are inherent safety risks in a hospital running at full or over capacity – from an increase in hospital-acquired infections to the impact of burnout from overworked staff. Doctors and other staff need to know how to raise and escalate safety concerns…

In the same survey physicians were asked if they were aware of the freedom to speak up guardian at their NHS trust and whether they felt confident in raising issues – the results are sobering:

• Only one in five doctors know who their freedom to speak up guardian is - and of those who do:
  • less than a third believe the guardians have helped improve the culture of transparency and raising concerns in their organisation
  • less than half believe that doctors in their trust are confident at speaking out.

RCP president Professor Jane Dacre added: 

NHS staff should feel empowered to bring legitimate concerns over patient safety – the evidence shows that where this happens, patient safety incidents decrease.

A separate survey on workforce also published today shows the underlying shortages of staff and rota gaps that are making it even more difficult to care for the increasing numbers of patients admitted to hospital. 

In the RCP’s snapshot census undertaken in January, 52% of respondents reported a vacancy in their department.  Of those reporting vacancies:

• 43% had one vacancy
• 31% two vacancies
• 25% three or more
• 58% of posts had been advertised more than once.

Two thirds of vacancies were replacement posts, rather than expansion posts, suggesting that if departments cannot replace colleagues then they certainly cannot expand to meet further need. The survey also shows that consultants and trainees are regularly ‘acting down’ to cover for colleagues, and that ‘workaround solutions’ for missing colleagues are becoming an ongoing problem rather than an intermittent issue.

RCP director of medical workforce Dr Harriet Gordon said:

Workforce vacancies have become normal for some years now and given the trainee vacancies, are likely to continue. Consultants are delivering patient care, but at the expense of other aspects of their role like management and training the next generation of doctors.