NHS Workload 'Increasing Risk of Patient Harm': CQC 

Peter Russell

December 19, 2018

Too many people are being injured or suffering unnecessary harm because NHS staff are too overworked and not given sufficient training, according to the Care Quality Commission (CQC).

England's chief inspector of hospitals called for a change in culture within the healthcare system to reduce the number of patients who experience "avoidable harm".

The CQC report, Opening the Door to Change , examined circumstances that led up to so-called 'never events' in NHS trusts in England.

Never events are patient safety incidents. What sets never events apart is that they are believed to be wholly preventable by the implementation of the appropriate safety protocols.

The review was carried out at the request of the Secretary of State for Health and Social Care and sought to help understand how patient safety could be improved.

Professor Ted Baker, CQC's chief inspector of hospitals, said: "NHS staff do a remarkable job to keep patients safe. But despite their best efforts, never events and other patient safety incidents continue to happen. In theory these events are entirely preventable: in practice too many patients suffer harm. 

"Staff know that what they do carries risk, but the culture in which they work is one that views itself as essentially safe, where errors are considered exceptional, and where rigid hierarchical structures make it hard for staff to speak up about potential safety issues or raise concerns."

CQC inspectors visited 18 NHS trusts between April and June 2018 where they carried out one-to-one interviews, reviewed policies and procedures, and held workshops with patients and health staff.

Staff 'Overwhelmed by Workload'

They found that although patient safety alerts were generally seen as an effective way to share safety guidance, competing pressures, including high workloads, and different approaches to governance, were creating "challenges" for health trusts.

NHS staff and managers told inspectors they felt "overwhelmed by the volume and nature of the demands currently placed on them".

Also, although professional organisations, including Royal colleges, regulators, and the CQC itself, had a substantial role to play in ensuring patient safety, the current system was "confused and complex, with no clear understanding of how it is organised and who is responsible for what".

The report said that made it hard for NHS trusts to prioritise what needed to be done and when.

Although acknowledging that healthcare was by its nature 'high risk', the CQC report said this was not always reflected in the NHS's culture and practice. In contrast, other safety critical industries adopted a culture that underpinned their working practices.


The review called for training programmes to incorporate patient safety into the NHS work ethos.

The CQC made a number of recommendations. These included:

  • Ensuring that NHS Improvement worked in partnership with Health Education England and others to make sure that the entire NHS workforce has a common understanding of patient safety and how it can be achieved

  • Making safety a top priority for the National Patient Safety Strategy in its support for the NHS, clarifying the roles and responsibilities of key players, including patients

  • Making sure that those responsible for patient safety are properly trained

  • Ensuring that NHS Improvement works with professional regulators, Royal colleges, frontline staff and patient groups to develop a framework for identifying where clinical processes and other elements, such as equipment and governance processes, can and should be standardised

"This change in approach is essential if we are to create a just culture where learning is shared, and where solutions are created proactively to manage risk," said Prof Baker. "Only then will we be able to reduce the toll of never events and the much greater number of other safety incidents."

In the light of its findings, the CQC said it would strengthen its assessment and regulation of safety during inspection of NHS trusts and other sectors. 

Dr Aidan Fowler, national director of patient safety at NHS Improvement, commented: "Continuous learning and improvement must be at the heart of protecting patients from avoidable harm. The strategy proposes halving the number of patient safety incidents in key areas and introducing a national curriculum to standardise how incidents are reported and acted on."

'Making Progress'

Commenting on the report, Caroline Dinenage, minister for care, said: "This important report recognises that NHS staff's commitment to patient safety is unwavering, but this needs to be matched by systems and a working culture which give safety the priority it deserves.

"We have made great progress towards creating a better learning culture within the NHS, with greater transparency and increased support in place for staff who want to speak up about safety concerns.

"We know we can do more to ensure no patient has to suffer avoidable harm and I want all staff to tell us how we can support them so that safety is a strand that runs through every part of the NHS."


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