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Published On: Wed, Mar 7th, 2018

NHS trusts reported over 40K serious incidents

Following a Freedom of Information request medical negligence solicitors, Blackwater Law have found that there have been more than 40,000 Serious Incidents recorded by NHS trusts in England and Wales and Welsh health boards.

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Serious Incidents are adverse events where the consequences are so significant or where the potential for learning is so great that a heightened level of response is justified. There is no definitive list of what constitutes a Serious Incident, as there are so many different circumstances where a Serious Incident may arise from. However, Serious Incidents include things such as avoidable deaths, avoidable or unexpected injury to a patient or even incidents leading to widespread public concern about a trusts ability to provide an acceptable level of care.

The data obtained by Blackwater Law shows that 40,668 Serious Incidents were recorded across 228 NHS trusts in England and Wales and 7 Welsh health boards during the period 1st April 2015 – 31st March 2017, with 20,433 Serious Incidents being reported in the period 1st April 2016 – 31st March 2017.

In order to gain a further picture of the occurrences and types of Serious Incident, the trusts and Welsh health boards were categorised as below based on the main services offered by each individual trust, however it is appreciated that there may be some overlap in the services offered by mental health and acute and community health trusts.

Acute and community health – 171 trusts and Welsh health boards

Mental health – 53 trusts

Ambulance – 11 trusts

Acute and community health

A total of 27,789 Serious Incidents were reported by acute and community health trusts and Welsh health boards during the period 1st April 2015 – 31st March 2017 with 14,034 Serious Incidents being recorded during 2016/2017.

As to be anticipated given the differing numbers of services and the variety in the number of sites that each trust operates, the number of Serious Incidents recorded by each trust varies significantly. During the period 1st April 2016 – 31st March 2017 the highest number of Serious Incidents recorded by an individual trust was 778 and the lowest number recorded by an individual trust was 1 Serious Incident. Out of the 171 acute and community health trusts, 41 (24%) recorded 100 or more Serious Incidents during the year whereas only 12 trusts recorded 10 or less Serious Incidents.

In addition to the above, 96 out of the 171 acute and community health trusts provided a breakdown and description of each of the Serious Incidents that had occurred in their trust enabling Blackwater Law to further understand the most commonly occurring Serious Incident type. As this yielded 679 different descriptions and types of Serious Incident, the data was then interpreted and grouped into similar categories.

Type of Serious Incident As a percentage of the 16/17 incidents for which a category or description was provided by the NHS
Pressure damage/sores/ulcers 22.4%
Accidents to service users or staff including slip, trip, falls (actual or suspected) 17.3%
Delays and diagnostic incident 16.5%
Clinical/patient care issues including sub-optimal care of the deteriorating patient, tests and test results 15.9%
Maternity, labour and delivery including neonatal 5.6%

 

Mental health trusts

11,872 Serious Incidents had been recorded by 53 mental health trusts during the same two year time period.

47% of the mental health trusts recorded 100 or more Serious Incidents during the period 1st April 2016 – 31st March 2017 whereas only 1 trust recorded less than 10, illustrating a wide amount of variation in the amount of Serious Incidents recorded by each individual trust. Similar to acute and community health trusts, each individual mental health trust offers a range of services and may operate across only one site or have multiple sites.

29 out of the 53 mental health trusts provided a breakdown of the type and category of each Serious Incident that they had recorded during the period 1st April 2016 – 31st March 2017. The 5 most commonly occurring Serious Incident type are shown in the table below:

 

Type of Serious Incident As a percentage of the 16/17 incidents for which a category or description was provided by the NHS
Unknown/unexplained death 24.2%
Self harm and suicide, attempted and actual (including threats) 23.2%
Clinical/patient care procedure (including substance misuse, pressure ulcer, moisture lesion, wound) medication error/incident/delay 13%
Abuse/aggression (including violence) actual or alleged to patient or staff 8.1%
Accident to service users or staff, falls and ill health 5.2%

 

Ambulance trusts

Data was obtained for the 11 ambulance trusts servicing England and Wales which revealed that a total of 1,007 Serious Incidents had been recorded across the same two financial year period, with 526 Serious Incidents recorded in the period 1st April 2016 – 31st March 2017.

The highest number of Serious Incidents recorded by an individual ambulance trust was 95 compared to 7 recorded by the trust with the least amount of Serious Incidents.

7 out of the 11 ambulance trusts provided a breakdown in the types of Serious Incidents that had been recorded during the financial year 2016/2017. This showed clinical and patient care and delays accounted for 54% of the overall Serious Incidents followed by non-conveyance with 8% and accidents including slip, trips and falls and traffic accidents which accounted for 5.7% of all Serious Incidents across the 7 ambulance trusts.

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