Why going into hospital can be VERY bad for your health: They’re supposed to be places of healing. Yet, 250,000 NHS patients suffer falls in hospital every year. And that’s just one of the risks to contend with…

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Written By Rivera Claudia

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Janet Allen is not one to let old age define her, according to her family. Until just over a year ago, the 85-year-old widow, who previously worked in admin, was living independently, walking a friend’s dog several times a week and relishing frequent visits from her four great-grandchildren.

But all that changed in January 2023 after Janet, who lives in Banstead, Surrey, fell from her bed and shattered her right hip.

It led to a chain of events that has left her frail, infirm and confined to a care home — unable to enjoy the freedom and independence she once thrived on.

Janet Allen, pictured with her grandson Jefferson, shattered her hip when she tried to climb out of her bed at Kingston Hospital 

It’s an unfortunate tale, certainly — but what makes Janet’s story so concerning is that the fall happened in hospital — the one place any vulnerable person should expect to feel safe and looked after.

Janet had been admitted to Kingston Hospital, Surrey, with a chest infection triggered by a severe bout of flu. As well as suffering a fever and breathlessness, she was experiencing dizziness and confusion (a common effect of infection in older people).

Having had a fall at home a few days earlier — which had left her bruised but thankfully not seriously injured — Janet was at high risk of another tumble.

As such, on arrival in an ambulance at A&E, she should have been given a falls risk assessment, to establish how likely it was she could suffer another collapse that might leave her with a fracture.

This is standard NHS protocol for any patient who is frail or unsteady; if someone is judged to be high risk, based on this assessment, they should receive round-the-clock supervision to prevent accidents happening, because a fracture could be life-changing.

In most cases, this will involve one nurse constantly monitoring up to six at-risk patients at a time — often in bays near the nursing station.

But, as Kingston Hospital NHS Foundation Trust later admitted in a written apology to the family, staff failed to complete the assessment properly and had left Janet unsupervised for long periods of time.

‘Mum was always capable of caring for herself and living an independent life before this happened,’ says her daughter Jackie Batts, 58, a former hairdresser from Sutton, Surrey.

‘But she’s never been able to go back home since, and that has been absolutely crushing for her.’

Yet, sadly, Janet’s experience is far from unusual.

NHS England data reveals 250,000 patients a year in England and Wales suffer potentially dangerous falls while in hospital for treatment

NHS England data reveals 250,000 patients a year in England and Wales suffer potentially dangerous falls while in hospital for treatment

In fact, every year 250,000 NHS patients in England and Wales alone suffer potentially dangerous falls while in hospital for treatment, according to NHS England data. Around 100,000 are left with bruises, grazes and lacerations, while 2,000 or so fracture a hip. An estimated 130 a year die from their injuries.

The annual bill for treating in-hospital injuries from falls is a staggering £630 million.

Falls represent the greatest threat to in-patient safety, mainly because a large proportion of hospital patients are elderly and fit into the at-risk group. But they are not the only danger patients of all ages face in hospital.

Last week, a coroner’s inquest heard how two patients at Manchester Royal Infirmary died after being served chicken mayonnaise sandwiches infected with the bug listeria.

The deaths of former nurse Beverley Sowah, 57, and retired pharmacy assistant Enid Heap, 84, were caused by meat which, it later transpired, had been past its use-by date.

Some patients have died after becoming trapped in their hospital beds — last September, the Medicines and Healthcare products Regulatory Agency (MHRA) issued an alert over the number of such accidents.

Between January 2018 and December 2022, the MHRA received reports of 18 deaths and 54 cases of serious injuries involving beds, rails, trolleys and grab handles, often due to worn or broken parts giving way.

Several deaths were due to unsupervised patients becoming caught up in gaps in the bed, or in the rails that had been meant to protect them.

One patient died of asphyxiation after getting his head trapped in the gap between the bed rail and the headboard.

In another tragic case, a young child died after their head got stuck between the bars of a hospital bed rail — no one had carried out a risk assessment to see if this was a hazard.

Jackie Batts, Janet's daughter, and her family are now pursuing possible legal action against Kingston Hospital

Jackie Batts, Janet’s daughter, and her family are now pursuing possible legal action against Kingston Hospital

‘The gap between the horizontal bars was too large and the child slipped between them and asphyxiated as a result of head entrapment,’ said the MHRA.

These tragedies may seem rare — but, in fact, they could be more likely than other, more common fears, with research suggesting the chances of dying from medical error — of any kind — is 33,000 times greater than dying in a plane crash.

Latest figures from the National Reporting and Learning System, a database of patient safety incidents across the whole NHS, show that in England between April 2021 and March 2022 there were 1.65 million cases of patients being put in harm’s way as a result of NHS blunders — and the problem is getting worse, with the number of cases up by 8 per cent on the year before. More than 70,000 cases led to moderate-to-severe injury and, in nearly 6,000 cases, the patient died.

These figures cover everything from medication errors and delays in treatment to misdiagnosis and accidents in hospital, but the majority are due to falls.

‘Most of these incidents are entirely preventable,’ says Paul Whiteing, chief executive of the charity Action Against Medical Accidents. ‘It’s a major concern to us that they happen.’

The causes vary, but staff shortages, lack of time and taking short cuts — with risk assessments simply not being done — are key factors.

Preventable falls are a major issue. ‘We come across these cases all the time,’ says Kashmir Uppal, a partner at legal firm Shoosmiths in London.

‘A lot of them involve the elderly, as they are most at risk of falls. There’s a straightforward form that should be completed every time an elderly or at-risk patient comes into A&E.

‘Yet too often they don’t bother with the assessment.’

This risk assessment is a tick-box exercise that involves recording information such as a patient’s history of falls, as well as assessing their gait, balance and mobility, and whether poor eyesight puts them at risk of tumbling.

Last year, the Parliamentary Health Service Ombudsman for England, Rob Behrens, issued a damning report that said the NHS was not taking patient safety seriously enough. ‘We are still seeing too many preventable tragedies,’ Mr Behrens said.

‘The NHS seems unable to learn from its mistakes, and we see the same repeated failings time and time again.’

He called for a greater emphasis on patient safety, better support for families affected by harm, and improved staffing to reduce the risk of mishaps. He also pointed to ‘a deficit of accountability and compassion’ for patients and their families when things go wrong.

The recent litany of avoidable deaths includes a 78-year-old man who suffered a bleed on the brain after falling from his hospital bed three times. Despite being high-risk, he’d not been properly supervised by staff, and in February last year [2023], NHS Highland in Scotland was fined £180,000 over his death.

In April 2021, Croydon University Hospital was forced to apologise following the death of a vulnerable 84-year-old man who had hit his head in a fall while unsupervised.

George Malcolm Gomez, from South Norwood, London, had been admitted for abdominal pain but fell out of bed because there were not enough nurses to supervise him, an inquest heard.

Disturbingly, more patients fall from beds fitted with bed rails than those without. These rails can be lifted into a raised position to stop patients accidentally rolling off the bed and injuring themselves.

Yet what happens in many cases is patients scramble over the rails and end up falling from an even greater height — and, tragically, doing even more damage.

As well as a lack of supervision, last year’s MHRA alert highlighted failings in something as simple as maintenance, in relation to worn or broken parts in rails or grab handles, for instance.

‘These should have been replaced during regular servicing which was either not carried out or carried out improperly,’ it said.

In the case of the child who died after their head became lodged between bed rails, the MHRA warned NHS trusts: ‘A risk assessment should always be carried out on the suitability of the bed rail for the individual child or adult, as gaps will need to be reduced. All gaps between bars should be a maximum of 60mm.’

Janet Allen’s problems began when she fell ill over Christmas in 2022. ‘Mum had developed flu and it turned into a chest infection which gradually made her sicker,’ says Jackie.

On a GP’s advice, Janet was taken to Kingston Hospital by ambulance over the festive period, treated with antibiotics and discharged a few days later.

But her symptoms soon worsened and it became clear the infection had not completely gone; she was readmitted to hospital.

‘This time it was so busy there wasn’t a bed available — she was kept on a trolley for two days,’ says Jackie.

‘She was put in a bay where the staff could supposedly keep an eye on her as she was at a high risk of falling and injuring herself if she got out of bed.

‘But it later emerged they didn’t do that, and she was left alone much of the time. She became increasingly confused and tried to climb out of bed to find my dad, Eddie, who she’d forgotten had died two years earlier.’

As Janet attempted to climb over the rail, she fell — shattering her right hip.

She underwent an emergency hip replacement two days later, and after three weeks in hospital, she was discharged to a local rehab centre to try to regain movement and strength.

 I know staff were under a lot of pressure and doing their best in difficult circumstances, but no one was observing Mum

But, weakened and unsteady, Janet suffered another serious fall a few weeks later, breaking her other hip, requiring a second joint replacement.

Suddenly her life of independent living was over and she has since been in a care home.

Kingston Hospital NHS Foundation Trust later issued an apology to Janet’s family and ‘fully acknowledged the areas where our care fell short of what is expected’, admitting staff had failed to carry out a proper falls-risk assessment on Janet or monitor her properly.

It blamed staff shortages, a heavier than normal workload and a Covid outbreak which had stretched its resources — but said it had introduced measures to reduce the danger of other patients suffering a similar fate.

These included kitting all at-risk patients out with yellow socks as a simple way for staff to identify them.

Jackie says she cannot understand why simple technology — such as alarms that go off when a patient tries to get out of bed — are not routinely used in all hospitals, as they are in many care homes.

She says: ‘I know staff were under a lot of pressure and doing their best in difficult circumstances, but no one was observing Mum.

‘The net result is the NHS has had to spend a great deal more money treating her two hip fractures than it would have cost to staff the hospital properly.’

The NHS says efforts are being made to tackle the burden of accidents in hospitals.

In 2022, it launched an initiative, the Patient Safety Incident Response Framework, designed to place much greater emphasis on learning from mistakes rather than punishing them or ignoring them.

The framework sets out precisely how NHS trusts should investigate safety incidents and how they should draw up response plans to make sure the same thing doesn’t happen again.

‘It’s too early to say whether it’s working or not,’ says Paul Whiteing from Action Against Medical Accidents.

‘But we have not seen a decline in calls to our helpline as a result of it.

‘We still have people coming to us who are hitting brick walls within NHS Trusts, or raising concerns about safety and being given short shrift.

‘The NHS is made up of hundreds of bodies, so change will take time. But at the moment, the volume of incidents is still significant.’

Jackie and her family are now pursuing possible legal action against Kingston Hospital.

‘I’m not bashing the NHS,’ she says, ‘but Mum has had to sell her beloved home in order to fund her care, and all her savings have gone.

‘She used to live independently and now is in a home and needs a walking frame to get around — I can’t believe the change in her.’

A spokesman for Kingston Hospital NHS Foundation Trust told Good Health: ‘The incident was investigated fully at the time and an action plan agreed to prevent similar incidents happening in the future. The safety of all our patients continues to be our priority.’

HOW TO STAY SAFE IN HOSPITAL 

Wear rubber-soled slippers or trainers to reduce the risk of slipping or falling.

If you use a walking aid at home, ask a family member or friend to bring it into hospital for you.

If you’re frail and need help getting around, don’t be afraid to ask staff for assistance.

Make sure you tell the nurses if you have any allergies to certain foods, medicines or materials such as latex (used in disposable gloves).

Check the identification details on your wristband and let staff know as soon as possible if they are wrong; it could stop you being mixed up with another patient and being given the wrong medicines or tests.

Always inform carers about any prescription drugs or vitamins you take and bring them with you, in case they interact with any drugs given in hospital and cause a nasty reaction.

If you are worried, ask if any of the drugs you are treated with while in hospital are known to cause adverse side-effects.

SOURCE: NHS ENGLAND

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