Simon Elliman considers a recent episode where a 14-year-old girl died after an emergency procedure had to be carried out by torchlight on a ward, due to insufficient anaesthetists or emergency staff being available to open another theatre, and asks what the implications are for NHS resourcing.
I read recently of the inquest which took place into the death of Emma Welch, who died after suffering an internal bleed following spinal surgery to correct a curvature of her spine. A pathologist stated at the inquest that Emma’s aorta was probably punctured as a result of a rod which had been inserted during surgery being too close to the blood vessel, which perhaps gives rise to a question about the spinal surgery having been competently performed. The headlines about the incident, however, concerned the fact that the emergency operation to attempt to save Emma’s life had to take place on a ward by torchlight because no operating theatre was available. A report into her death concluded that it was probable that if she had been taken to theatre an hour earlier, the bleeding could have been controlled.
The incident has raised a number of questions. Should additional theatre capacity be made available, day and night? Should emergency teams be available, day and night, to cover incidents such as this? Can such additional capacity be resourced in a struggling NHS?
The Care Quality Commission has recently identified staffing shortfalls as a key factor affecting patient safety in hospitals. In its 2014/15 report, the CQC found that insufficient staffing numbers and skills mix were among the key factors putting safety at risk. David Behan stated: “A key concern has been the safety of care – a failure to learn from mistakes or not having the right number of staff in place at the right time.”
Meanwhile, a BBC ‘Freedom of Information’ request has recently demonstrated that the NHS in England, Wales and Northern Ireland has more than 23,443 nursing vacancies, (equivalent to 9% of the workforce). More relevantly, perhaps, to Emma Welch’s death, there were 1,265 vacancies for registered nurses in emergency departments (11% of the workforce) and 243 vacancies for consultants in emergency medicine (again 11%).
The problem of staff shortages has been endemic in the NHS over a long period. Back in 2013, the Keogh Report blamed the unacceptably high death rates in 14 hospitals on chronic nursing shortages, and Sir Bruce Keogh singled out in particular dangerous staff shortages on nights and weekends, while also attacking the reliance on sub-standard agency workers being used as cover.
The CQC report in 2015 seems to echo the Keogh Report to a worrying degree, suggesting that lessons have not been learnt. Janet Davies, chief executive and general secretary of the Royal College of Nursing has stated: “Effective workforce planning isn’t just a numbers game – it’s about having the right level of skills, seniority and experience to improve care. Too many senior nursing posts have been cut and the effects are now being felt”.
While tragic outcomes are always a possibility, whatever the standard of care, it seems that the NHS continues to expose patients to unnecessary risks as a result of under-resourcing and inappropriate deployment of resources. Of course there is no ‘silver bullet’, but lessons need to be learned, so that avoidable deaths are not repeated needlessly.