What Lies Behind the Shocking Rise of Serious Injuries in Social and Health Care

As Byline Times revealed, the number of patients experiencing serious injuries while in care has skyrocketed by thousands in the last five years. 

But what is behind the rise? And what happens if we leave things as they are?

It is possible that, as the CQC suggested to me, that the figures could be outliers, or that part of the rise may be explained by an increase in the number of people in health or social care settings in any given year. 

But the sheer size of the 30% rise – far outstripping the rise in number of people accessing social care for example – meant those we spoke to argued it was unlikely to be an incidental rise.

“There’s probably a cultural aspect to this,” says Chris Thomas, the head of the Commission on Health and Prosperity at the Institute for Public Policy Research think tank. “We know that in the NHS and care homes it’s a really hard sector to whistleblow in – the level of protection and the fear of repercussions makes it very challenging to see where things are going wrong.”

“That’s part of it,” Thomas goes on. “But I think that misses probably the key point that this is a system that is just running absolutely hot at the very top of its possible capacity after a lot of resource cuts and efficiency drives over the last ten years.”

It’s worth acknowledging that this rise in patient injuries is only one of several ways in which the NHS and social care are feeling the strain right now. 

NHS delays have helped cause higher-than-normal levels of death in the UK since the Covid pandemic was at its height, while as of August this year there were 7,745,030 patients awaiting treatment in England.

At the core of that is staffing. Facing burnout, stress and low pay – factors that have all led to recent unprecedented strikes among doctors and nurses – huge numbers of experienced medical staff are quitting the profession. As of June 2023, there were 125,572 vacancies in secondary care in England, leaving the UK with one of the lowest numbers of doctors per 1,000 inhabitants of the entire OECD.

“So you’ve got a more stretched staff and a more inexperienced staff,” as Thomas explains it.

“I think just overwhelmingly, you just can’t expect to get to a point where patient safety is genuinely ensured if if you’re not meeting core standards of safe staffing.”

Those problems are only added to in social care. As Dan Wellings,  a senior fellow at healthcare research charity The King’s Fund, puts it “there are lots of jobs that people could do that probably paid better than working in social care, and probably have better prospects and better allow a better quality of life”. 

The average wage for a care home worker was £9.66 an hour as of 2022, with low pay and high working pressures driving an exodus of staff that has meant there are now 165,000 vacancies across the social care sector. London alone now has a shortage of 28,000 social care staff – a vacancy rate of 12.6%.

Thanks to cuts to the council budgets that fund social care by the current government, spending per adult on social care in England fell by 6.5% between 2011 and 2018.

And it’s also worth bearing in mind that the two systems play into each other – cuts to social care, will often see hospitals and GPs picking up the slack where care homes or other social care can’t – often taking beds or filling appointments that can’t be spared.

“If you want to protect the NHS, you need to protect Social Care. The two are absolutely inextricably linked,” says Wellings.

The Government’s recent NHS Long Term Workforce Plan may go some way to addressing the issue, with its promise to train 2,000 more GPs a year and 24,000 more nurse and midwives a year, and double the number of medical school places by 2031.

But it’s not without its flaws – Thomas says he worries the scheme could end up as a “leaky bucket that doesn’t really work” if it’s not properly funded to address the long term retention of the staff it recruits.

“This is about ensuring that the health and care system has the right funding has the right staffing, and it has the right commitment in place to make it work,” says Wellings. “None of this is inevitable.”

Wellings went on to highlight the fact that the UK’s health and care system was radically improved in the late 90s and 2000s under the last Labour government after record investment that brought the UK in line with other European countries and cut waiting lists, increases beds and saw patient mortality drop and satisfaction increase.

But there are real barriers to that kind of change. First and foremost, as one interviewee put it, the “cold hand of the treasury”. It’s a point that’s been made before, but the kind of sustained long-term funding settlement needed to address health and social care issues is something that is seen as anathema to the Treasury, which critics say focuses excessively on the short term returns from government investments.

And in the meantime the slow decline of healthcare in the UK is starting to sink in with the public. Last year, public satisfaction with the NHS hit a record low of 29% – over half of the 70% who said they were satisfied with the NHS back in 2010.

“To state the obvious, we can’t continue like this. It’s not sustainable. We’ll slide towards a two-tier system where those that can will go elsewhere,” explains Wellings. 

“And we know from what the public tells us that that isn’t what they want. People don’t want a different model, they just want the one they have got to work.”