Tag Archives: patients’

The GPs offering a lifeline to homeless patients | Patrick Greenfield

At least 56 homeless people have died on the streets and in temporary accommodation in the UK so far this year. It brings the total recorded to almost 300 since 2013, according to research by the Guardian and the Bureau of Investigative Journalism. The true figure is likely much higher as no official figures are collected, making it hard for health professionals to respond to the increasing number of deaths.

“Very often people are dying prematurely, and it’s just being put down as: well, they were homeless,” says Dr Tim Worthley, who is one of three specialist GPs at homeless surgery Arch Healthcare in Brighton, East Sussex. In 2011, he started to record how many homeless people who attended his practice died. “People would just die, and that was that. The least I thought I could do was to start keeping lists,” he says. During 2017, he recorded 17 deaths among the 1,100 patients who sought treatment, more than twice the death rate in Brighton as a whole. Of these, 14 were men, and three were women. The average age at death was just 46.

Rough sleepers and those in emergency or temporary accommodation do not typically die of exposure or other direct effects of homelessness, according to international research by the US-based National Health Care for the Homeless Council. Instead, they mainly die as a result of treatable conditions such as liver and gastrointestinal diseases, respiratory problems and the consequences of drug and alcohol addiction. But accessing treatment at an early stage in the UK can be very difficult for homeless people, who face bureaucratic barriers including needing a proof of address to register at a GP surgery when they are also often in personal crisis.

Although a lot of guidance on commissioning primary healthcare for homeless people has been issued since the 1990s, access varies greatly from region to region. A recent King’s College London study found that only 43% of homelessness projects were linked to a specialist healthcare service like Arch, with particular gaps in small towns and rural areas.


The more you push people to the margins, the more they fall out of the system and end up on the streets

Rough sleeping has more than doubled nationally since 2010, with thousands bedding down outside every night, while the numbers of homeless people in temporary accommodation has grown by 61% since 2010. Homeless patients often arrive at A&E with a combination of physical and mental health and addiction problems, and therefore spend much longer in hospital than the average patient.

“Because of the huge pressure on services, I see healthcare – especially GP surgeries and hospitals – as a conveyor belt that’s moving increasingly quickly, says Worthley. “In order to access healthcare, you need to be able to jump on at the beginning at the right place and you need to keep pace with it all. You need to play the game, get to your appointments, and you get treated.

“If you get on at the wrong point, or are limping too much, or can’t cope with the pace, or say no because you’re scared or whatever, then you fall off and don’t get the care. There are all these people falling by the wayside and not getting the care they need. And homeless people are absolutely among them.”

From October, key parts of the NHS, including A&E and all inpatient treatment centres, will be obliged to refer patients who are homeless or threatened with homelessness to a local housing authority as part of the Homelessness Reduction Act that came into force in April. However, GP surgeries are exempt, and with hospitals not being allowed to record a patient’s housing status on admission, there are concerns over how the new rules will work.

Dr Tim Worthley with a patient


During 2017, Dr Tim Worthley recorded 17 deaths among the 1,100 patients who sought treatment, more than twice the death rate in Brighton as a whole. Photograph: Martin Godwin for the Guardian

Some charities are taking matters into their own hands. Pathway has set up teams of specialist GPs, nurses and community workers in 11 hospitals in Bradford, London, Brighton, Manchester and Leeds to use hospital admission as a chance to help patients turn their lives around. The small charity, currently funded through private grants, has also created gold standard commissioning guidelines for homeless care.

It was set up in 2009 following the death of a rough sleeper shortly after he was discharged from University College hospital in London. The first Pathway team consisted of a senior GP, a specialist nurse and a practitioner with knowledge of the welfare system. Whenever a homeless person was admitted to the hospital, a member of the Pathway team was called to help guide both staff and the patient.

“With people who have been on the streets for a long time, they’ve usually got a lot of medical conditions which may be interacting with each other. For example, the orthopaedic surgeon may not be great at thinking about how a patient’s diabetes is being managed in the context of a twisted ankle and long-term drug dependency,” says Alex Bax, chief executive of Pathway. “The orthopaedic surgeon might be under pressure to get you out because they’ve got an elective list, so the Pathway teams become clinically engaged, advocating for better, more coordinated care for patients.”

After their time in hospital, the Pathway team, which is often created using existing NHS budgets, helps homeless patients find hostel accommodation, supported living and care homes, ensures access to drug and alcohol addiction services, benefits and legal advice, and helps with lost paperwork.

“Homelessness is in part a problem with housing and part driven by government welfare reform. The overwhelming cause of homelessness now, which is a staggering change, is the ending of a shorthold tenancy, which effectively means it’s because they can’t pay the rent,” says Bax. “The more you push people to the margins, particularly vulnerable people, those who are a bit more troubled, a bit more chaotic, the more they fall out of the system and end up on the streets. That’s what’s happening. It’s the vulnerable who get pushed right to the edge and then fall off. The government’s policies are herding people to the edge of these cliffs, and a lot of people are clinging on to the top.”

According to Bax, in order to get value for money from a dedicated Pathway team, a hospital needs to have about 250 homeless patients per annum, – which means at any one time there might be six to 10 such inpatients.

Campaigners believe that if this model was extended to more hospitals, it could help prevent homeless people, such as a man known to locals as Ben, from dying on the streets. The week before Ben was found dead inside a tent in Retford, Nottinghamshire, he had been receiving treatment in hospital for pneumonia. When it was time to leave, the 53-year-old did not want to stay in temporary accommodation, so he was discharged on to the streets. A member of staff at the hospital drove Ben back to the doorway nearly an hour away where he had been sleeping all winter, and a shopkeeper met him with new camping gear and blankets to withstand the winter chill. Days later, freezing Siberian air engulfed the British Isles and Ben’s body was found on the morning of 27 February.

Back in Brighton, Worthley believes Arch Healthcare, which uses Pathway’s approach to support patients in temporary accommodation or on the street when they are discharged from hospital, is making a difference. The service was first commissioned by Brighton and Hove CCG after a successful pilot in 2013 recorded significant improvements in patients’ health and readmission rates.

“Although many of the problems remain and we have more homeless people with relatively fewer resources, now the different teams in Brighton work more collaboratively to give these women and men better support and more dignity,” says Worthley.

The GPs offering a lifeline to homeless patients | Patrick Greenfield

At least 56 homeless people have died on the streets and in temporary accommodation in the UK so far this year. It brings the total recorded to almost 300 since 2013, according to research by the Guardian and the Bureau of Investigative Journalism. The true figure is likely much higher as no official figures are collected, making it hard for health professionals to respond to the increasing number of deaths.

“Very often people are dying prematurely, and it’s just being put down as: well, they were homeless,” says Dr Tim Worthley, who is one of three specialist GPs at homeless surgery Arch Healthcare in Brighton, East Sussex. In 2011, he started to record how many homeless people who attended his practice died. “People would just die, and that was that. The least I thought I could do was to start keeping lists,” he says. During 2017, he recorded 17 deaths among the 1,100 patients who sought treatment, more than twice the death rate in Brighton as a whole. Of these, 14 were men, and three were women. The average age at death was just 46.

Rough sleepers and those in emergency or temporary accommodation do not typically die of exposure or other direct effects of homelessness, according to international research by the US-based National Health Care for the Homeless Council. Instead, they mainly die as a result of treatable conditions such as liver and gastrointestinal diseases, respiratory problems and the consequences of drug and alcohol addiction. But accessing treatment at an early stage in the UK can be very difficult for homeless people, who face bureaucratic barriers including needing a proof of address to register at a GP surgery when they are also often in personal crisis.

Although a lot of guidance on commissioning primary healthcare for homeless people has been issued since the 1990s, access varies greatly from region to region. A recent King’s College London study found that only 43% of homelessness projects were linked to a specialist healthcare service like Arch, with particular gaps in small towns and rural areas.


The more you push people to the margins, the more they fall out of the system and end up on the streets

Rough sleeping has more than doubled nationally since 2010, with thousands bedding down outside every night, while the numbers of homeless people in temporary accommodation has grown by 61% since 2010. Homeless patients often arrive at A&E with a combination of physical and mental health and addiction problems, and therefore spend much longer in hospital than the average patient.

“Because of the huge pressure on services, I see healthcare – especially GP surgeries and hospitals – as a conveyor belt that’s moving increasingly quickly, says Worthley. “In order to access healthcare, you need to be able to jump on at the beginning at the right place and you need to keep pace with it all. You need to play the game, get to your appointments, and you get treated.

“If you get on at the wrong point, or are limping too much, or can’t cope with the pace, or say no because you’re scared or whatever, then you fall off and don’t get the care. There are all these people falling by the wayside and not getting the care they need. And homeless people are absolutely among them.”

From October, key parts of the NHS, including A&E and all inpatient treatment centres, will be obliged to refer patients who are homeless or threatened with homelessness to a local housing authority as part of the Homelessness Reduction Act that came into force in April. However, GP surgeries are exempt, and with hospitals not being allowed to record a patient’s housing status on admission, there are concerns over how the new rules will work.

Dr Tim Worthley with a patient


During 2017, Dr Tim Worthley recorded 17 deaths among the 1,100 patients who sought treatment, more than twice the death rate in Brighton as a whole. Photograph: Martin Godwin for the Guardian

Some charities are taking matters into their own hands. Pathway has set up teams of specialist GPs, nurses and community workers in 11 hospitals in Bradford, London, Brighton, Manchester and Leeds to use hospital admission as a chance to help patients turn their lives around. The small charity, currently funded through private grants, has also created gold standard commissioning guidelines for homeless care.

It was set up in 2009 following the death of a rough sleeper shortly after he was discharged from University College hospital in London. The first Pathway team consisted of a senior GP, a specialist nurse and a practitioner with knowledge of the welfare system. Whenever a homeless person was admitted to the hospital, a member of the Pathway team was called to help guide both staff and the patient.

“With people who have been on the streets for a long time, they’ve usually got a lot of medical conditions which may be interacting with each other. For example, the orthopaedic surgeon may not be great at thinking about how a patient’s diabetes is being managed in the context of a twisted ankle and long-term drug dependency,” says Alex Bax, chief executive of Pathway. “The orthopaedic surgeon might be under pressure to get you out because they’ve got an elective list, so the Pathway teams become clinically engaged, advocating for better, more coordinated care for patients.”

After their time in hospital, the Pathway team, which is often created using existing NHS budgets, helps homeless patients find hostel accommodation, supported living and care homes, ensures access to drug and alcohol addiction services, benefits and legal advice, and helps with lost paperwork.

“Homelessness is in part a problem with housing and part driven by government welfare reform. The overwhelming cause of homelessness now, which is a staggering change, is the ending of a shorthold tenancy, which effectively means it’s because they can’t pay the rent,” says Bax. “The more you push people to the margins, particularly vulnerable people, those who are a bit more troubled, a bit more chaotic, the more they fall out of the system and end up on the streets. That’s what’s happening. It’s the vulnerable who get pushed right to the edge and then fall off. The government’s policies are herding people to the edge of these cliffs, and a lot of people are clinging on to the top.”

According to Bax, in order to get value for money from a dedicated Pathway team, a hospital needs to have about 250 homeless patients per annum, – which means at any one time there might be six to 10 such inpatients.

Campaigners believe that if this model was extended to more hospitals, it could help prevent homeless people, such as a man known to locals as Ben, from dying on the streets. The week before Ben was found dead inside a tent in Retford, Nottinghamshire, he had been receiving treatment in hospital for pneumonia. When it was time to leave, the 53-year-old did not want to stay in temporary accommodation, so he was discharged on to the streets. A member of staff at the hospital drove Ben back to the doorway nearly an hour away where he had been sleeping all winter, and a shopkeeper met him with new camping gear and blankets to withstand the winter chill. Days later, freezing Siberian air engulfed the British Isles and Ben’s body was found on the morning of 27 February.

Back in Brighton, Worthley believes Arch Healthcare, which uses Pathway’s approach to support patients in temporary accommodation or on the street when they are discharged from hospital, is making a difference. The service was first commissioned by Brighton and Hove CCG after a successful pilot in 2013 recorded significant improvements in patients’ health and readmission rates.

“Although many of the problems remain and we have more homeless people with relatively fewer resources, now the different teams in Brighton work more collaboratively to give these women and men better support and more dignity,” says Worthley.

The GPs offering a lifeline to homeless patients | Patrick Greenfield

At least 56 homeless people have died on the streets and in temporary accommodation in the UK so far this year. It brings the total recorded to almost 300 since 2013, according to research by the Guardian and the Bureau of Investigative Journalism. The true figure is likely much higher as no official figures are collected, making it hard for health professionals to respond to the increasing number of deaths.

“Very often people are dying prematurely, and it’s just being put down as: well, they were homeless,” says Dr Tim Worthley, who is one of three specialist GPs at homeless surgery Arch Healthcare in Brighton, East Sussex. In 2011, he started to record how many homeless people who attended his practice died. “People would just die, and that was that. The least I thought I could do was to start keeping lists,” he says. During 2017, he recorded 17 deaths among the 1,100 patients who sought treatment, more than twice the death rate in Brighton as a whole. Of these, 14 were men, and three were women. The average age at death was just 46.

Rough sleepers and those in emergency or temporary accommodation do not typically die of exposure or other direct effects of homelessness, according to international research by the US-based National Health Care for the Homeless Council. Instead, they mainly die as a result of treatable conditions such as liver and gastrointestinal diseases, respiratory problems and the consequences of drug and alcohol addiction. But accessing treatment at an early stage in the UK can be very difficult for homeless people, who face bureaucratic barriers including needing a proof of address to register at a GP surgery when they are also often in personal crisis.

Although a lot of guidance on commissioning primary healthcare for homeless people has been issued since the 1990s, access varies greatly from region to region. A recent King’s College London study found that only 43% of homelessness projects were linked to a specialist healthcare service like Arch, with particular gaps in small towns and rural areas.


The more you push people to the margins, the more they fall out of the system and end up on the streets

Rough sleeping has more than doubled nationally since 2010, with thousands bedding down outside every night, while the numbers of homeless people in temporary accommodation has grown by 61% since 2010. Homeless patients often arrive at A&E with a combination of physical and mental health and addiction problems, and therefore spend much longer in hospital than the average patient.

“Because of the huge pressure on services, I see healthcare – especially GP surgeries and hospitals – as a conveyor belt that’s moving increasingly quickly, says Worthley. “In order to access healthcare, you need to be able to jump on at the beginning at the right place and you need to keep pace with it all. You need to play the game, get to your appointments, and you get treated.

“If you get on at the wrong point, or are limping too much, or can’t cope with the pace, or say no because you’re scared or whatever, then you fall off and don’t get the care. There are all these people falling by the wayside and not getting the care they need. And homeless people are absolutely among them.”

From October, key parts of the NHS, including A&E and all inpatient treatment centres, will be obliged to refer patients who are homeless or threatened with homelessness to a local housing authority as part of the Homelessness Reduction Act that came into force in April. However, GP surgeries are exempt, and with hospitals not being allowed to record a patient’s housing status on admission, there are concerns over how the new rules will work.

Dr Tim Worthley with a patient


During 2017, Dr Tim Worthley recorded 17 deaths among the 1,100 patients who sought treatment, more than twice the death rate in Brighton as a whole. Photograph: Martin Godwin for the Guardian

Some charities are taking matters into their own hands. Pathway has set up teams of specialist GPs, nurses and community workers in 11 hospitals in Bradford, London, Brighton, Manchester and Leeds to use hospital admission as a chance to help patients turn their lives around. The small charity, currently funded through private grants, has also created gold standard commissioning guidelines for homeless care.

It was set up in 2009 following the death of a rough sleeper shortly after he was discharged from University College hospital in London. The first Pathway team consisted of a senior GP, a specialist nurse and a practitioner with knowledge of the welfare system. Whenever a homeless person was admitted to the hospital, a member of the Pathway team was called to help guide both staff and the patient.

“With people who have been on the streets for a long time, they’ve usually got a lot of medical conditions which may be interacting with each other. For example, the orthopaedic surgeon may not be great at thinking about how a patient’s diabetes is being managed in the context of a twisted ankle and long-term drug dependency,” says Alex Bax, chief executive of Pathway. “The orthopaedic surgeon might be under pressure to get you out because they’ve got an elective list, so the Pathway teams become clinically engaged, advocating for better, more coordinated care for patients.”

After their time in hospital, the Pathway team, which is often created using existing NHS budgets, helps homeless patients find hostel accommodation, supported living and care homes, ensures access to drug and alcohol addiction services, benefits and legal advice, and helps with lost paperwork.

“Homelessness is in part a problem with housing and part driven by government welfare reform. The overwhelming cause of homelessness now, which is a staggering change, is the ending of a shorthold tenancy, which effectively means it’s because they can’t pay the rent,” says Bax. “The more you push people to the margins, particularly vulnerable people, those who are a bit more troubled, a bit more chaotic, the more they fall out of the system and end up on the streets. That’s what’s happening. It’s the vulnerable who get pushed right to the edge and then fall off. The government’s policies are herding people to the edge of these cliffs, and a lot of people are clinging on to the top.”

According to Bax, in order to get value for money from a dedicated Pathway team, a hospital needs to have about 250 homeless patients per annum, – which means at any one time there might be six to 10 such inpatients.

Campaigners believe that if this model was extended to more hospitals, it could help prevent homeless people, such as a man known to locals as Ben, from dying on the streets. The week before Ben was found dead inside a tent in Retford, Nottinghamshire, he had been receiving treatment in hospital for pneumonia. When it was time to leave, the 53-year-old did not want to stay in temporary accommodation, so he was discharged on to the streets. A member of staff at the hospital drove Ben back to the doorway nearly an hour away where he had been sleeping all winter, and a shopkeeper met him with new camping gear and blankets to withstand the winter chill. Days later, freezing Siberian air engulfed the British Isles and Ben’s body was found on the morning of 27 February.

Back in Brighton, Worthley believes Arch Healthcare, which uses Pathway’s approach to support patients in temporary accommodation or on the street when they are discharged from hospital, is making a difference. The service was first commissioned by Brighton and Hove CCG after a successful pilot in 2013 recorded significant improvements in patients’ health and readmission rates.

“Although many of the problems remain and we have more homeless people with relatively fewer resources, now the different teams in Brighton work more collaboratively to give these women and men better support and more dignity,” says Worthley.

NHS warns patients they could lose text alerts as GDPR deluge continues

The National Health Service is texting patients to warn they could lose alerts about hospital and doctor appointments, joining the deluge of more than 1bn “GDPR” messages currently hitting personal inboxes to meet an EU deadline this week.

GDPR, which stands for General Data Protection Regulation, has been described as the biggest overhaul of online privacy since the birth of the internet, and comes into force on Friday May 25. It gives all EU citizens the right to know what data is stored on them and to have it deleted, plus protect them from privacy and data breaches. If companies fail to comply, they can be hit with fines of up to €20m (£17.5m) or 4% of global turnover.

Companies and organisations around the world – from giant corporations to charities and church groups – are now anxiously contacting users to check they are happy to carry on receiving their emails and texts.

Q&A

What is GDPR?

The European Union’s new stronger, unified data protection laws, the General Data Protection Regulation (GDPR), will come into force on 25 May 2018, after more than six years in the making.

GDPR will replace the current patchwork of national data protection laws, give data regulators greater powers to fine, make it easier for companies with a “one-stop-shop” for operating across the whole of the EU, and create a new pan-European data regulator called the European Data Protection Board.

The new laws govern the processing and storage of EU citizens’ data, both that given to and observed by companies about people, whether or not the company has operations in the EU. They state that data protection should be both by design and default in any operation.

GDPR will refine and enshrine the “right to be forgotten” laws as the “right to erasure”, and give EU citizens the right to data portability, meaning they can take data from one organisation and give it to another. It will also bolster the requirement for explicit and informed consent before data is processed, and ensure that it can be withdrawn at any time.

To ensure companies comply, GDPR also gives data regulators the power to fine up to €20m or 4% of annual global turnover, which is several orders of magnitude larger than previous possible fines. Data breaches must be reported within 72 hours to a data regulator, and affected individuals must be notified unless the data stolen is unreadable, ie strongly encrypted.

Each person in the UK is understood to have about 100 “data relationships” and with many companies sending out multiple reminders, the total number of GDPR emails is expected to soar above one billion by this Friday.

But with GDPR fatigue setting in, and with many messages heading straight into spam boxes, the figures suggest that few people are responding.

Polling by consultancy Accenture has found that more than half of consumers are not responding to emails from brands, with about a third of people deleting the emails almost as soon as they arrive in their inbox.

Some small businesses are reporting that “reconfirmation” rates are averaging just 10%, meaning they are losing 90% of their marketing email lists.

“Up to the deadline you are going to continue to see some panic and mass communications. Then there will be a lull before it begins again, as this is an ongoing requirement,” said Russell Marsh of Accenture. He is forecasting that some companies will return to direct mail to target customers, as it does not fall under the same GDPR legislation.

Many people are enjoying a once in a lifetime opportunity to clear out their inboxes. But while many can be safely ignored, others – such as from the NHS – will need action.

The NHS message reads: “The law is changing and we must get explicit permissions from patients when using their data. To continue to receive SMS text messages, reply START.”

The messages are being sent from the NHS automated appointment reminder system, used by millions of people across the UK. Data rules mean that the messages are sent by each individual NHS trust rather than centrally from the NHS.

Companies are handling the new rules in different ways, as there is no prescribed format for GDPR approval. If a company has a “legitimate interest” in contacting a customer – such as their principal bank account – then it only needs to let the customer know that privacy details have been updated.

But if the email address had been obtained in other ways – such as a pre-ticked box – then that is not regarded as legitimate, and the company has to contact the consumer and obtain approval for further communications. Some companies are insisting users go through the rigmarole of logging in, which might entail trying to remember a password or setting up a new account.

“It will be their interpretation of what they need to do to be compliant,” said Robert Parker at the UK’s Information Commissioner’s Office.

Companies are resorting to ever more desperate ways to catch the eye of users in inboxes deluged with GDPR emails. Many are in the plaintive “Do you still want to hear from us?” style, others warn that “Time is running out”, while some demand “Urgent action required”. Or as one flower delivery company GDPR email says: “Take it or leaf it”.

Danger to patients revealed in reports by 18,000 NHS nurses

Cancer sufferers are being put at risk and care for patients undergoing surgery is “severely compromised” as a result of constant staff shortages on wards, according to devastating first-hand testimony from inside the NHS.

An astonishing dossier of concerns raised by nurses about the impact of staffing levels on patients reveals that nurses with the right skills are often in short supply, full staffing levels are becoming a “rare event”, and some emergency patients are being sent home as a result.

The testimony, compiled from 18,000 anonymous submissions from hospital nurses and shared with the Observer, states that some nurses are being asked to complete procedures beyond their expertise, while many vulnerable patients are not being given the emotional support they need. Some experienced nurses say they believe they are seeing the worst shortages in decades.

Compiled by the Royal College of Nursing, the dossier reveals the severe concerns over patient safety. One nurse writes: “A lack of trained chemotherapy nurses means we are treating patients every day in an unsafe manner, mistakes are being made and management have no answers to the staffing crisis.”

Another states: “Our [cancer] patients may have to have less psychological support as we do not have the time to sit with them and reassure them. It may also mean that timely chemotherapy delivery is difficult. Today’s shift, where we were fully staffed with the majority of our own team, was a very rare event.”

There were similar concerns in relation to patients heading for surgery. “The level of [nursing] staff running theatre lists daily is inadequate,” one nurse states. “We are operating with the worst levels in theatre that I have seen in 40-plus years in theatres. Patient care is severely compromised due to staffing levels.”

Another writes: “Many times I have felt unsafe and when escalated have been told ‘but nothing major happened’, meaning the ‘what ifs’ are never addressed until something happens. The skill-set of nurses is a major problem, with nurses having to scrub for cases out of their competency through sheer lack of numbers.”

Meanwhile, an A&E nurse reveals: “Due to staffing issues some emergency triage patients are sent home, if they are clinically stable, to return again the next day to be treated.”

There are also serious complaints about the level of provision of psychiatric nurses. “One community psychiatric nurse for half a county for a whole day is not a safe staffing level,” writes one nurse. “Staffing levels and high staff turnovers are a huge problem … that needs addressing before anyone else is harmed.”

A recent report by Macmillan Cancer Support found that there were widespread shortages of specialist cancer nurses. Hospitals in England were found to have vacancies for more than 400 specialist cancer nurses, chemotherapy nurses, palliative care nurses and also cancer support workers.

The disclosures come as the Royal College of Nursing calls for new English laws to make ministers accountable for ensuring safe staffing levels. In 2016 Wales became the first country in Europe to introduce safe staffing laws for nursing, while Nicola Sturgeon, the first minister, has promised legislation in Scotland.

In her speech to the college’s annual congress on Sunday its general secretary, Janet Davies, will say that nurse recruitment and morale have been plunged into crisis by “workforce planning driven by finance and not the needs of patients. The care we are able to provide is totally compromised by short staffing, and we cannot repeat this often enough: mortality levels increase when the level of registered nurses falls. We know our patient outcomes are better when there are more nurses to care for them.”

A Department of Health and Social Care spokeswoman said that overall staffing levels in the NHS were at a peak. “The NHS would collapse without our wonderful nurses – the fact that the NHS is ranked as the safest healthcare system in the world is a testament to them,” she said.

“From this year we will train 25% more nurses, we are committed to helping them work more flexibly to improve their work-life balance, and we have awarded a pay rise of between 6.5% and 29% in a deal backed by the Royal College of Nursing themselves.”

Danger to patients revealed in reports by 18,000 NHS nurses

Cancer sufferers are being put at risk and care for patients undergoing surgery is “severely compromised” as a result of constant staff shortages on wards, according to devastating first-hand testimony from inside the NHS.

An astonishing dossier of concerns raised by nurses about the impact of staffing levels on patients reveals that nurses with the right skills are often in short supply, full staffing levels are becoming a “rare event”, and some emergency patients are being sent home as a result.

The testimony, compiled from 18,000 anonymous submissions from hospital nurses and shared with the Observer, states that some nurses are being asked to complete procedures beyond their expertise, while many vulnerable patients are not being given the emotional support they need. Some experienced nurses say they believe they are seeing the worst shortages in decades.

Compiled by the Royal College of Nursing, the dossier reveals the severe concerns over patient safety. One nurse writes: “A lack of trained chemotherapy nurses means we are treating patients every day in an unsafe manner, mistakes are being made and management have no answers to the staffing crisis.”

Another states: “Our [cancer] patients may have to have less psychological support as we do not have the time to sit with them and reassure them. It may also mean that timely chemotherapy delivery is difficult. Today’s shift, where we were fully staffed with the majority of our own team, was a very rare event.”

There were similar concerns in relation to patients heading for surgery. “The level of [nursing] staff running theatre lists daily is inadequate,” one nurse states. “We are operating with the worst levels in theatre that I have seen in 40-plus years in theatres. Patient care is severely compromised due to staffing levels.”

Another writes: “Many times I have felt unsafe and when escalated have been told ‘but nothing major happened’, meaning the ‘what ifs’ are never addressed until something happens. The skill-set of nurses is a major problem, with nurses having to scrub for cases out of their competency through sheer lack of numbers.”

Meanwhile, an A&E nurse reveals: “Due to staffing issues some emergency triage patients are sent home, if they are clinically stable, to return again the next day to be treated.”

There are also serious complaints about the level of provision of psychiatric nurses. “One community psychiatric nurse for half a county for a whole day is not a safe staffing level,” writes one nurse. “Staffing levels and high staff turnovers are a huge problem … that needs addressing before anyone else is harmed.”

A recent report by Macmillan Cancer Support found that there were widespread shortages of specialist cancer nurses. Hospitals in England were found to have vacancies for more than 400 specialist cancer nurses, chemotherapy nurses, palliative care nurses and also cancer support workers.

The disclosures come as the Royal College of Nursing calls for new English laws to make ministers accountable for ensuring safe staffing levels. In 2016 Wales became the first country in Europe to introduce safe staffing laws for nursing, while Nicola Sturgeon, the first minister, has promised legislation in Scotland.

In her speech to the college’s annual congress on Sunday its general secretary, Janet Davies, will say that nurse recruitment and morale have been plunged into crisis by “workforce planning driven by finance and not the needs of patients. The care we are able to provide is totally compromised by short staffing, and we cannot repeat this often enough: mortality levels increase when the level of registered nurses falls. We know our patient outcomes are better when there are more nurses to care for them.”

A Department of Health and Social Care spokeswoman said that overall staffing levels in the NHS were at a peak. “The NHS would collapse without our wonderful nurses – the fact that the NHS is ranked as the safest healthcare system in the world is a testament to them,” she said.

“From this year we will train 25% more nurses, we are committed to helping them work more flexibly to improve their work-life balance, and we have awarded a pay rise of between 6.5% and 29% in a deal backed by the Royal College of Nursing themselves.”

Danger to patients revealed in reports by 18,000 NHS nurses

Cancer sufferers are being put at risk and care for patients undergoing surgery is “severely compromised” as a result of constant staff shortages on wards, according to devastating first-hand testimony from inside the NHS.

An astonishing dossier of concerns raised by nurses about the impact of staffing levels on patients reveals that nurses with the right skills are often in short supply, full staffing levels are becoming a “rare event”, and some emergency patients are being sent home as a result.

The testimony, compiled from 18,000 anonymous submissions from hospital nurses and shared with the Observer, states that some nurses are being asked to complete procedures beyond their expertise, while many vulnerable patients are not being given the emotional support they need. Some experienced nurses say they believe they are seeing the worst shortages in decades.

Compiled by the Royal College of Nursing, the dossier reveals the severe concerns over patient safety. One nurse writes: “A lack of trained chemotherapy nurses means we are treating patients every day in an unsafe manner, mistakes are being made and management have no answers to the staffing crisis.”

Another states: “Our [cancer] patients may have to have less psychological support as we do not have the time to sit with them and reassure them. It may also mean that timely chemotherapy delivery is difficult. Today’s shift, where we were fully staffed with the majority of our own team, was a very rare event.”

There were similar concerns in relation to patients heading for surgery. “The level of [nursing] staff running theatre lists daily is inadequate,” one nurse states. “We are operating with the worst levels in theatre that I have seen in 40-plus years in theatres. Patient care is severely compromised due to staffing levels.”

Another writes: “Many times I have felt unsafe and when escalated have been told ‘but nothing major happened’, meaning the ‘what ifs’ are never addressed until something happens. The skill-set of nurses is a major problem, with nurses having to scrub for cases out of their competency through sheer lack of numbers.”

Meanwhile, an A&E nurse reveals: “Due to staffing issues some emergency triage patients are sent home, if they are clinically stable, to return again the next day to be treated.”

There are also serious complaints about the level of provision of psychiatric nurses. “One community psychiatric nurse for half a county for a whole day is not a safe staffing level,” writes one nurse. “Staffing levels and high staff turnovers are a huge problem … that needs addressing before anyone else is harmed.”

A recent report by Macmillan Cancer Support found that there were widespread shortages of specialist cancer nurses. Hospitals in England were found to have vacancies for more than 400 specialist cancer nurses, chemotherapy nurses, palliative care nurses and also cancer support workers.

The disclosures come as the Royal College of Nursing calls for new English laws to make ministers accountable for ensuring safe staffing levels. In 2016 Wales became the first country in Europe to introduce safe staffing laws for nursing, while Nicola Sturgeon, the first minister, has promised legislation in Scotland.

In her speech to the college’s annual congress on Sunday its general secretary, Janet Davies, will say that nurse recruitment and morale have been plunged into crisis by “workforce planning driven by finance and not the needs of patients. The care we are able to provide is totally compromised by short staffing, and we cannot repeat this often enough: mortality levels increase when the level of registered nurses falls. We know our patient outcomes are better when there are more nurses to care for them.”

A Department of Health and Social Care spokeswoman said that overall staffing levels in the NHS were at a peak. “The NHS would collapse without our wonderful nurses – the fact that the NHS is ranked as the safest healthcare system in the world is a testament to them,” she said.

“From this year we will train 25% more nurses, we are committed to helping them work more flexibly to improve their work-life balance, and we have awarded a pay rise of between 6.5% and 29% in a deal backed by the Royal College of Nursing themselves.”

Danger to patients revealed in reports by 18,000 NHS nurses

Cancer sufferers are being put at risk and care for patients undergoing surgery is “severely compromised” as a result of constant staff shortages on wards, according to devastating first-hand testimony from inside the NHS.

An astonishing dossier of concerns raised by nurses about the impact of staffing levels on patients reveals that nurses with the right skills are often in short supply, full staffing levels are becoming a “rare event”, and some emergency patients are being sent home as a result.

The testimony, compiled from 18,000 anonymous submissions from hospital nurses and shared with the Observer, states that some nurses are being asked to complete procedures beyond their expertise, while many vulnerable patients are not being given the emotional support they need. Some experienced nurses say they believe they are seeing the worst shortages in decades.

Compiled by the Royal College of Nursing, the dossier reveals the severe concerns over patient safety. One nurse writes: “A lack of trained chemotherapy nurses means we are treating patients every day in an unsafe manner, mistakes are being made and management have no answers to the staffing crisis.”

Another states: “Our [cancer] patients may have to have less psychological support as we do not have the time to sit with them and reassure them. It may also mean that timely chemotherapy delivery is difficult. Today’s shift, where we were fully staffed with the majority of our own team, was a very rare event.”

There were similar concerns in relation to patients heading for surgery. “The level of [nursing] staff running theatre lists daily is inadequate,” one nurse states. “We are operating with the worst levels in theatre that I have seen in 40-plus years in theatres. Patient care is severely compromised due to staffing levels.”

Another writes: “Many times I have felt unsafe and when escalated have been told ‘but nothing major happened’, meaning the ‘what ifs’ are never addressed until something happens. The skill-set of nurses is a major problem, with nurses having to scrub for cases out of their competency through sheer lack of numbers.”

Meanwhile, an A&E nurse reveals: “Due to staffing issues some emergency triage patients are sent home, if they are clinically stable, to return again the next day to be treated.”

There are also serious complaints about the level of provision of psychiatric nurses. “One community psychiatric nurse for half a county for a whole day is not a safe staffing level,” writes one nurse. “Staffing levels and high staff turnovers are a huge problem … that needs addressing before anyone else is harmed.”

A recent report by Macmillan Cancer Support found that there were widespread shortages of specialist cancer nurses. Hospitals in England were found to have vacancies for more than 400 specialist cancer nurses, chemotherapy nurses, palliative care nurses and also cancer support workers.

The disclosures come as the Royal College of Nursing calls for new English laws to make ministers accountable for ensuring safe staffing levels. In 2016 Wales became the first country in Europe to introduce safe staffing laws for nursing, while Nicola Sturgeon, the first minister, has promised legislation in Scotland.

In her speech to the college’s annual congress on Sunday its general secretary, Janet Davies, will say that nurse recruitment and morale have been plunged into crisis by “workforce planning driven by finance and not the needs of patients. The care we are able to provide is totally compromised by short staffing, and we cannot repeat this often enough: mortality levels increase when the level of registered nurses falls. We know our patient outcomes are better when there are more nurses to care for them.”

A Department of Health and Social Care spokeswoman said that overall staffing levels in the NHS were at a peak. “The NHS would collapse without our wonderful nurses – the fact that the NHS is ranked as the safest healthcare system in the world is a testament to them,” she said.

“From this year we will train 25% more nurses, we are committed to helping them work more flexibly to improve their work-life balance, and we have awarded a pay rise of between 6.5% and 29% in a deal backed by the Royal College of Nursing themselves.”

Danger to patients revealed in reports by 18,000 NHS nurses

Cancer sufferers are being put at risk and care for patients undergoing surgery is “severely compromised” as a result of constant staff shortages on wards, according to devastating first-hand testimony from inside the NHS.

An astonishing dossier of concerns raised by nurses about the impact of staffing levels on patients reveals that nurses with the right skills are often in short supply, full staffing levels are becoming a “rare event”, and some emergency patients are being sent home as a result.

The testimony, compiled from 18,000 anonymous submissions from hospital nurses and shared with the Observer, states that some nurses are being asked to complete procedures beyond their expertise, while many vulnerable patients are not being given the emotional support they need. Some experienced nurses say they believe they are seeing the worst shortages in decades.

Compiled by the Royal College of Nursing, the dossier reveals the severe concerns over patient safety. One nurse writes: “A lack of trained chemotherapy nurses means we are treating patients every day in an unsafe manner, mistakes are being made and management have no answers to the staffing crisis.”

Another states: “Our [cancer] patients may have to have less psychological support as we do not have the time to sit with them and reassure them. It may also mean that timely chemotherapy delivery is difficult. Today’s shift, where we were fully staffed with the majority of our own team, was a very rare event.”

There were similar concerns in relation to patients heading for surgery. “The level of [nursing] staff running theatre lists daily is inadequate,” one nurse states. “We are operating with the worst levels in theatre that I have seen in 40-plus years in theatres. Patient care is severely compromised due to staffing levels.”

Another writes: “Many times I have felt unsafe and when escalated have been told ‘but nothing major happened’, meaning the ‘what ifs’ are never addressed until something happens. The skill-set of nurses is a major problem, with nurses having to scrub for cases out of their competency through sheer lack of numbers.”

Meanwhile, an A&E nurse reveals: “Due to staffing issues some emergency triage patients are sent home, if they are clinically stable, to return again the next day to be treated.”

There are also serious complaints about the level of provision of psychiatric nurses. “One community psychiatric nurse for half a county for a whole day is not a safe staffing level,” writes one nurse. “Staffing levels and high staff turnovers are a huge problem … that needs addressing before anyone else is harmed.”

A recent report by Macmillan Cancer Support found that there were widespread shortages of specialist cancer nurses. Hospitals in England were found to have vacancies for more than 400 specialist cancer nurses, chemotherapy nurses, palliative care nurses and also cancer support workers.

The disclosures come as the Royal College of Nursing calls for new English laws to make ministers accountable for ensuring safe staffing levels. In 2016 Wales became the first country in Europe to introduce safe staffing laws for nursing, while Nicola Sturgeon, the first minister, has promised legislation in Scotland.

In her speech to the college’s annual congress on Sunday its general secretary, Janet Davies, will say that nurse recruitment and morale have been plunged into crisis by “workforce planning driven by finance and not the needs of patients. The care we are able to provide is totally compromised by short staffing, and we cannot repeat this often enough: mortality levels increase when the level of registered nurses falls. We know our patient outcomes are better when there are more nurses to care for them.”

A Department of Health and Social Care spokeswoman said that overall staffing levels in the NHS were at a peak. “The NHS would collapse without our wonderful nurses – the fact that the NHS is ranked as the safest healthcare system in the world is a testament to them,” she said.

“From this year we will train 25% more nurses, we are committed to helping them work more flexibly to improve their work-life balance, and we have awarded a pay rise of between 6.5% and 29% in a deal backed by the Royal College of Nursing themselves.”

Danger to patients revealed in reports by 18,000 NHS nurses

Cancer sufferers are being put at risk and care for patients undergoing surgery is “severely compromised” as a result of constant staff shortages on wards, according to devastating first-hand testimony from inside the NHS.

An astonishing dossier of concerns raised by nurses about the impact of staffing levels on patients reveals that nurses with the right skills are often in short supply, full staffing levels are becoming a “rare event”, and some emergency patients are being sent home as a result.

The testimony, compiled from 18,000 anonymous submissions from hospital nurses and shared with the Observer, states that some nurses are being asked to complete procedures beyond their expertise, while many vulnerable patients are not being given the emotional support they need. Some experienced nurses say they believe they are seeing the worst shortages in decades.

Compiled by the Royal College of Nursing, the dossier reveals the severe concerns over patient safety. One nurse writes: “A lack of trained chemotherapy nurses means we are treating patients every day in an unsafe manner, mistakes are being made and management have no answers to the staffing crisis.”

Another states: “Our [cancer] patients may have to have less psychological support as we do not have the time to sit with them and reassure them. It may also mean that timely chemotherapy delivery is difficult. Today’s shift, where we were fully staffed with the majority of our own team, was a very rare event.”

There were similar concerns in relation to patients heading for surgery. “The level of [nursing] staff running theatre lists daily is inadequate,” one nurse states. “We are operating with the worst levels in theatre that I have seen in 40-plus years in theatres. Patient care is severely compromised due to staffing levels.”

Another writes: “Many times I have felt unsafe and when escalated have been told ‘but nothing major happened’, meaning the ‘what ifs’ are never addressed until something happens. The skill-set of nurses is a major problem, with nurses having to scrub for cases out of their competency through sheer lack of numbers.”

Meanwhile, an A&E nurse reveals: “Due to staffing issues some emergency triage patients are sent home, if they are clinically stable, to return again the next day to be treated.”

There are also serious complaints about the level of provision of psychiatric nurses. “One community psychiatric nurse for half a county for a whole day is not a safe staffing level,” writes one nurse. “Staffing levels and high staff turnovers are a huge problem … that needs addressing before anyone else is harmed.”

A recent report by Macmillan Cancer Support found that there were widespread shortages of specialist cancer nurses. Hospitals in England were found to have vacancies for more than 400 specialist cancer nurses, chemotherapy nurses, palliative care nurses and also cancer support workers.

The disclosures come as the Royal College of Nursing calls for new English laws to make ministers accountable for ensuring safe staffing levels. In 2016 Wales became the first country in Europe to introduce safe staffing laws for nursing, while Nicola Sturgeon, the first minister, has promised legislation in Scotland.

In her speech to the college’s annual congress on Sunday its general secretary, Janet Davies, will say that nurse recruitment and morale have been plunged into crisis by “workforce planning driven by finance and not the needs of patients. The care we are able to provide is totally compromised by short staffing, and we cannot repeat this often enough: mortality levels increase when the level of registered nurses falls. We know our patient outcomes are better when there are more nurses to care for them.”

A Department of Health and Social Care spokeswoman said that overall staffing levels in the NHS were at a peak. “The NHS would collapse without our wonderful nurses – the fact that the NHS is ranked as the safest healthcare system in the world is a testament to them,” she said.

“From this year we will train 25% more nurses, we are committed to helping them work more flexibly to improve their work-life balance, and we have awarded a pay rise of between 6.5% and 29% in a deal backed by the Royal College of Nursing themselves.”