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Patient safety in the NHS

Glossary of patient safety indicators

The patient safety information on NHS Choices allows you to compare hospitals and find out how they are doing in terms of cleanliness and infections such as MRSA, preventing blood clots, or reporting incidents. It also shows if a hospital has enough nursing and midwifery staff to provide safe care to patients.

No data can provide certainty about how safe the care of an individual patient was, is or will be, or determine whether hospitals are safe or not. But it is an important tool that allows patients, the public and the NHS to ask questions and encourage continuous improvement.

The patient safety data on this site covers the following aspects:


Care Quality Commission: national standard

The Care Quality Commission (CQC) is the independent regulator for health and adult social care in England. CQC checks whether services meet national standards of quality and safety. The indicator on NHS Choices shows you whether a hospital is meeting safety standards as expected.

Hospitals are rated as either meeting the required standards or not. This is the most authoritative view of the safety of a hospital and is the most meaningful source of data on patient safety available.

Visit CQC's website for information about how CQC inspects organisations

Safe staffing: nursing hours filled as planned

Find out how well a hospital's nursing and midwifery staffing requirements are being met.

Nurses, midwives and care staff are part of a wider team of healthcare professionals providing patient care. Often working alongside therapists, specialist nurses and psychologists, they play an important role in providing high quality and safe care to patients.

Safety of care relates to a number of factors, including the skills and experience of staff and the different needs of patients in their care. Each ward manager works closely with the director of nursing to make decisions about staff requirements for each shift, and ensure patient needs can be met. The number of staff required at any time is called the planned staffing number.

The data is presented in two ways on NHS Choices:

  1. You can see if a hospital's nursing and midwifery staffing requirements are being met overall.
  2. For each hospital, you can also see as a percentage of hours in a day or night whether the actual number of nurses on duty met what was planned in a hospital or ward. We will present a result for both registered and unregistered nurses.

Sometimes the actual staffing number is below the planned number. This may be the result of staff sickness, or because there is a lower number of patients on the ward than usual, so staff have been moved to work in another area.

Sometimes the actual staffing number will be higher than the planned number. This may be because there are a lot of patients on the ward who need extra care because of their physical or mental health condition.

Some hospitals will be unable to meet their staffing needs with permanent staff all of the time on every shift.

Information about staffing levels alone cannot tell you whether a hospital is safe or unsafe, but a regular lower percentage of the planned staff being in place is a cause for concern.

What is the difference between an unregistered and a registered nurse?

A registered nurse is a member of the registered nursing or midwifery staff on the duty rota dedicated to the inpatient wards. This includes supervisory ward managers, sisters, charge nurses, midwives and staff nurses.

An unregistered nurse is a member of staff on the duty rota dedicated to the inpatient wards whose work is supervised by a registered nurse.

Infection control and cleanliness

Find out how well an organisation performs in terms of infection control and cleanliness. 

The indicator you can see on this website is constructed from the existing data displayed about the number of Clostridium difficile (C. difficile) and MRSA infections, and patients' views on the cleanliness of wards.

The patient safety indicator combines this information with additional data to provide an overall rating for preventing infection and cleanliness.

The results are displayed with different coloured icons:

  • green = good
  • blue = OK
  • red = poor

The rating does not describe whether a hospital is safe, but it does give an indication of how it is performing in terms of cleanliness and infections.

Open and honest reporting

You can now find out how well your hospital performs in open and honest reporting of patient safety incidents. This indicator gives an overall picture of whether the hospital has a good patient safety incident reporting culture.

Note: This indicator only applies to hospitals that are part of a trust providing acute care, for example on medical and surgical wards and in outpatient and emergency departments. It does not apply where the acute trust is a specialist trust that only provides care to certain age groups (e.g. a children's hospital) or only treats certain conditions (e.g. trusts that only provide cancer care or orthopaedic surgery).

A good reporting culture means that the hospital reports incidents frequently  serious incidents as well as those with low or no harm to patients. Reporting even these less serious incidents shows that an organisation understands that these are opportunities to learn and improve.

A good reporting culture is also indicated when members of staff can say their organisation has a fair and effective incident reporting procedure.

The ratings for this indicator are displayed with different coloured icons:

  • green = good
  • blue = OK
  • red = poor

This does not describe whether a hospital is safe, but it does give an indication of how well developed the hospital's patient safety incident reporting culture is.

Patients assessed for risk of blood clots

Deep vein thrombosis (DVT) and pulmonary embolism are collectively known as venous thromboembolism (VTE), a condition where blood clots form in the veins. Anyone can develop VTE, but people are more at risk when they are less mobile and unwell. This means that the risk of VTE increases with acute medical illness, long-term health problems, and some surgical operations.

Hospitals are expected to assess the patients they admit for the risk of VTE. All hospitals should risk-assess at least 95% of inpatients when they are admitted. A value above 95% is good and fewer than this is poor.

NHS England patient safety reporting

Patient safety alerts are sent out by NHS England to rapidly alert the healthcare system to risks and provide guidance on preventing potential incidents that may lead to harm or death.

Find out what constitutes a patient safety alert.

Alerts are key in helping hospitals to improve the quality of care they provide. They also demonstrate a hospital's accountability for the safety of their patients. All hospitals should respond to patient safety alerts in the timeframe given to them by NHS England. Any delay in taking the relevant actions required is a cause for concern.

The performance of your hospital is shown on NHS Choices in two ways:

  • poor =  the hospital has not completed one or more safety alerts for which the deadline has passed
  • good = the hospital has dealt with all patient safety alerts within the given timeframe

Recommended by staff

This indicator shows the percentage of staff (as measured by the NHS Staff Survey) happy to recommend the hospital if a friend or relative needed treatment. It is based on the standard of care the hospital provides. 

The indicator is displayed on three ways on this site. It shows if the hospital is performing:

  • as expected
  • worse than average
  • better than average

The rating does not describe whether a hospital is safe, but staff opinion of the quality of care provided by an organisation is an important indicator about the safety of care and the quality of care in general.

NHS Safety Thermometer data on pressure ulcers and falls with harm

The NHS Safety Thermometer is a point of care survey instrument. It is used in hospitals and other organisations to check how many patients in their care have suffered one or more of a defined list of "harms" associated with patient safety. It allows teams to measure harm and the proportion of patients that are "harm free" during their working day.

For more detailed information, visit either the NHS Safety Thermometer or the Health and Social Care Information Centre(HSCIC) website.

On NHS Choices we display two "harms" measured by the NHS Safety Thermometer on each hospital's overview page profile. You can see:

  • the number of patients being cared for who have a pressure ulcer (bed sore)
  • the number of patients being cared for who have been hurt by a fall in the last three days

You'll also be able to see the percentage of patients surveyed each month. 

Note: NHS Safety Thermometer data should not be used to compare hospitals or make judgements about which hospitals are safer than others.

Page last reviewed: 26/06/2014

Next review due: 30/09/2016

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