How Many Dentists are Training and Qualifying in the UK?

The UK is facing a shortage of dentists. According to one report, there were 21,544 dentists in the UK at the end of January 2022, compared to 23,733 at the end of 2020.

The British Dental Association (BDA) found that 75% intend to reduce, or further reduce, their NHS commitment over the next 12 months when they surveyed dentists.

NHS Dentist Shortage News

Indeed, many stories of “dental deserts” have made the news in the early months of 2023:

For more, you can read our full guide to the NHS dentist shortage. This guide discusses some of the underlying causes of this shortage, and some of the initiatives that may address the shortage.

In this post we’ll provide an essential update on the situation through taking a closer look at the current figures for the number of dentists currently training and qualifying in the UK.

How Many Dentists are Operating in the UK?

The most up-to-date NHS dental statistics for England are from 25 August 2022. These figures reveal that 24,272 dentists performed NHS activity in 2021-2022, an increase of 539 on the previous year.

These statistics are from the NHS Dental Statistics for England 2021-22 and also show 26.4m courses of treatment were delivered in 2021-2022, an increase of 120% compared to the previous year.

These figures do not show the number of dentists currently training and qualifying in the UK. Though they suggest that the UK’s dental shortage seems to be improving, the figures only refer to England. And as we’ve seen, residents in rural areas, such as in Scotland, may still be living in “dental deserts” where they’ll struggle to receive treatment.

Also, if there are only 539 more dentists in England in 2021-2022 compared to the previous year, then the workforce may not have grown enough to meet the demand for treatment.

How Many Dentists are Training and Qualifying in the UK?

In August 2021, the government adjusted the cap to allow over 9,000 places on medical and dentistry courses for 2021 student intake. By September, Further Education News was already reporting a record number of applicants to dentistry courses at UK universities.

Yet by July 2022, the BDA were reporting a “larger than usual” decrease in the number of dental graduated accepting foundation training places.

In March 2023, the BDA revealed that half of all dentists have cut their NHS commitment “with more to come”. Unfortunately, no matter how many dentists are currently training and qualifying in the UK, all figures suggest that the NHS dental shortage will not be resolved anytime soon.

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Examples of Continuity of Care in GP Surgeries

If you manage or work in a GP surgery, continuity of care can make a huge difference to your patients’ experience and their overall wellbeing.

In this post, we’ll explain what continuity of care is in a GP setting, before exploring some of the policies and procedures that will help you deliver a higher quality of care to your patients.

What Is Continuity of Care?

Continuity of care is a strategy for making primary care local, accessible and familiar. It’s all about building strong and ongoing relationships between GPs and patients. At the heart of continuity of care is the idea that patients should see the same GP as often as possible.

For patients, this means that their care will be personalised, and focused on their unique needs and circumstances.

Continuity of care means that the GP develops a deep understanding of the patient and their medical history. As a result, the GP can make more informed diagnoses, and patients can better trust their GP’s advice and judgement.

Management Continuity

In delivering continuity of care, management continuity is just as important as relationship continuity. This means ensuring effective information sharing and co-ordination of services when a patient receives care from more than one clinician or provider.

On a fundamental level, continuity of care means that a patient will regularly consult the same GP so that they can develop a stronger therapeutic relationship.

Yet continuity of care goes deeper than this. Due to a number of factors, it’s not always possible for patients to see the same GP at every visit. The considerable NHS backlog, coupled with patients’ needs and expectations for fast access, means that patients often need to see whichever GP is available.

What Does Continuity of Care Look Like in Practice?

Here are some principles that can help GP practices work towards continuity of care:

  • Access arrangements – When booking appointments, patients often have to make a choice between seeing their regular GP, or getting a faster consultation. At the front desk, patients should be advised on the benefits of continuity, even if this sometimes means waiting longer for appointments.
  • Transparency – Clinics should be open about the availability of their clinicians for different types of consultation. They should publish the clinic’s policy on continuity of care, and make this policy accessible to staff and patients alike.
  • Consultations – The emphasis should be on quality, rather than quantity. There should be sufficient time in the consultations for the sort of interactions that lead to a productive therapeutic relationship.
  • Management continuity – All healthcare providers make relevant patient information readily available, with established routines for handovers and information exchanges. Providers make personal contact between each other, with proactive follow-ups on patients following procedures or health events.

Should Continuity of Care Still be a Priority?

If the NHS is facing a backlog, and if patients must routinely wait for consultations, does it still make sense to promote continuity of care?

As part of a 2010 inquiry into the quality of general practice in England, The King’s Trust conducted a consultation of continuity of care and the patient experience.

Their consultation found that the strong therapeutic relationships created by continuity of care result in:

  • Increased levels of patient satisfaction.
  • Greater morale among staff at all levels.
  • Reduced costs.
  • Better health outcomes.

So though the current emphasis might be on reducing the backlog, continuity of care may still be the most effective and sustainable strategy for maintaining good care quality standards.

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The Link Between Adult Social Care and Hospital Discharges

The NHS is currently facing a significant backlog that shows no sign of easing in the foreseeable future.

As a measure for easing the pressures, Prime Minister Rishi Sunak has discussed greater investment in social care.

In this post, we’ll explore the link between adult social care and hospital discharges. We shall explain how investing in social care may help free up hospital beds for other critical care patients.

How Can Adult Social Care Investment Free Up Hospital Beds?

Not all patients necessarily need to be in hospital to receive the care they need. Some patients can instead receive care in the community. Essentially, this means that they’ll leave hospital and go to either their home, a family member’s home, or a dedicated residential setting.

A care worker or nurse will then visit them routinely to give them the care they need. This might involve administering medication, supervising physiotherapy exercises, or simply checking up on them to see how they’re progressing following hospital treatment.

If need be, the care worker may refer the patient back to hospital to receive more intensive care or supervision. But in most cases, the patient can make a full recovery from the comfort of their own home.

Why Are Adult Social Care Issues Causing Hospital Bed Shortages?

Every patient receiving care in the community is a patient who is not taking up a hospital bed. This frees up hospital beds for more critical cases. It also increases the overall capacity of the hospital and its staff. This can make a difference to many of the crises the NHS is currently facing, from the backlog of care to the long ambulance waiting times.

How is the Government Investing in Adult Social Care?

During the 2020 pandemic, the Department of Health and Social Care (DHSC) was committed to freeing up as many hospital beds as possible. They aimed to reduce pressures on the NHS and to ensure that there would be capacity for any COVID patient who needed hospital care. And they did this via a fund that would allow patients to receive up to six weeks of free social care upon leaving hospital.

In September 2022, there were reportedly 13,000 people in hospital who could instead be receiving care in the community. So the Secretary of State for Health and Social Care unveiled a £500m grant for adult social care.

Will This Investment Make a Difference?

Unfortunately, the adult social care sector is itself going through some tough times.

Vacancies in adult social care rose by 52% in 2021-2022. So even if the government pledges to fund adult social care, there may not be the capacity to handle the increased caseload this would bring.

The DHSC has also discussed launching a domestic adult social care recruitment campaign. But given how long it takes to recruit and train specialist social workers to provide care in the community, it’s unlikely that this will make a difference in the short-term.

Investing in adult social care is a vital step to addressing the NHS’s backlog, and the numerous additional problems it brings. Though as is usually the case, things are far more complicated than they initially seem, and we’re unlikely to see any noticeable improvements in the near future.

How Can Hospitals Manage in the Short-Term?

While this issue continues to affect practice, hospitals and healthcare staff continue to work to the best of their ability to deliver efficient and high-quality care.

We have been working with healthcare professionals for over 20 years to find solutions and procedures to help improve efficiency through infection control and air quality monitoring as well as by providing products to help improve turn-around times and patient outcomes.

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Why Are Ambulance Waiting Times Getting Longer?

UK ambulance waiting times are bad, and they show every sign of getting worse.

Some cases have been so severe that they’ve made the news. For example, an 85 year old in Cornwall had to wait a total of 40 hours to get to A&E. This included 14 hours for the ambulance to reach her, and a further 26 hours before she was taken into the hospital. And even then, she did not receive treatment for hours.

This is an extreme case. But still, UK ambulance waiting times are long and getting longer.

What’s the Average UK Ambulance Waiting Time for Critical Calls?

The NHS sets a target response time of 7 minutes for critical calls. Through 2021/22, critical patients waited an average of 8 and a half minutes for a response. This might not sound like much, but it’s almost a fifth longer than patients had to wait in 2018/2019. Also, for critical patients, every second counts. An extra minute’s wait could mean life or death.

What’s the Average UK Ambulance Waiting Time for Non-Critical Calls?

For less urgent cases, waits have doubled over the past few years to an average of 3 hours.

And unfortunately, the situation does not look likely to improve anytime soon. Ambulance workers voted for strike action in early December 2022. Industrial action on the 15 and 20 December affected a quarter of frontline services in England, and nearly all services in Wales and Northern Ireland.

Scotland remained unaffected, as unions suspended industrial action to consider a new pay offer.

While there are rules in place requiring ambulance services to provide emergency care, these strikes  served to make a bad situation even worse.

Why Are Ambulance Waiting Times Getting Longer?

The main reason ambulance waiting times are getting longer is due to the immense backlog the NHS is facing following two years of government lockdowns.

Because of this backlog, ambulance services are facing an increased demand. And though the paramedic workforce has increased, absences related to poor mental health have increased from 5% in March 2019 to 9% in March 2022.

Plus, despite the increased workforce, ambulance crews have less capacity, as ambulances now have to wait longer with patients outside hospitals. According to one Health Foundation report, more than 10% of ambulances had to wait for over an hour outside hospitals in July 2022.

And because the whole service is stretched, even the smallest increase in handover times can result in a larger increase in the average response times.

How is the NHS Responding to this Problem?

The Health Foundation has issued a series of recommendations for addressing the issue:

  • Focus on handover delays. Increase hospitals’ capacity and flow-through with more beds and staff. Sunak’s pledge to invest in social care along with other out-of-hospital services could make a difference here.
  • Further increase the number of paramedics and address the causes of poor mental health in the workforce to reduce sickness absence.
  • Work to reduce the demand. This might be achieved through greater investment in community services, with an emphasis on addressing health conditions as early as possible before they require an ambulance response.

Prime Minister Rishi Sunak has claimed he plans to “sit down with the NHS” to discuss ambulance waiting times. He’s also announced that the government has put more money into the NHS, and more money into social care. The idea is that funding social care will allow more people to move out of hospitals and back into their own homes.

How Long Before Ambulance Waiting Times Improve?

Unfortunately, it’s likely that UK patients will face lengthy ambulance waiting times for the foreseeable future.

The NHS backlog is not going to get any better anytime soon. So there will be a high demand for services for some time yet.

Also, no matter what plans the government and NHS put into place to address the issue, changes won’t come overnight. And the strike action in December 2022 may serve to delay the implementation of certain improvements.

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How Many Dentists Have Left the NHS?

In the past few years, thousands of dentists have left the NHS.

How Many NHS Dentists Are There?

According to one report, at the end of 2020 there were 23,733 dentists providing NHS care in England. By the end of January 2022, this figure had fallen to 21,544.

As each dentist manages a caseload of around 2,000 patients , this mass desertion has lead to the creation of “dental deserts”, leaving approximately four million people without access to dental care on the NHS.

It looks like the problem is only going to get worse, too. According to the British Dental Association (BDA), 75% of UK dentists are likely to reduce, or further reduce, their NHS commitment over the next 12 months. 45% claim they’re going to go fully private, and 47% suggest they’re either going to change career or seek early retirement.

Why Are So Many Dentists Leaving the NHS?

Shawn Charlwood, chair of the BDA’s General Dental Practice Committee, attributes the mass exodus to dentists feeling “overstretched and underfunded” during and after the recent Covid-19 pandemic.

According to BDA figures, 87% of UK dentists have experienced symptoms of stress, burnout and other mental health problems over the last 12 months. And it seems that patients, frustrated by the lack of available NHS dentist appointments, may be taking out their anger on staff. 86% of UK dentist report that colleagues in their practice have received physical or verbal abuse from patients.

What’s the Problem with the NHS Dental Contract?

The BDA argues that the current NHS dental contract, which has been in place since 2006, “puts government contracts ahead of patient need”.

For years, this contract set untenable incentives. For example, dentists would receive the same renumeration for doing one filling as they would for doing 10. It’s for such reasons that the Health Select Committee described the contract as “unfit for purpose”.

NHS Dental Contract Changes in 2022/23

In July 2022, the government announced a number of changes to the NHS dental contract. These included:

  • A new minimum payment for hitting targets.
  • A higher reward for treating three or more teeth.
  • Dental therapists can now accept patients for certain NHS treatments, freeing up dentists’ time for more urgent and complex procedures.
  • New payment rates for more complex treatments.
  • Updates to the NHS website and directory of services to help patients find dentists in their local area.

The BDA argued that these new contractual arrangements “do not even begin to address the system’s fundamental flaws… this is another attempt to conjure up more capacity without adding any new investment.”

The Collapse of Dentistry on the NHS?

In September 2022, NHS England released on update on the reforms their dental contract changes for 2022/2023.

The BDA, who previously claimed that “dentists are simply not seeing a future in the NHS”, seems cautiously optimistic that these changes may make a difference. However, they’ve also described these changes as “modest and marginal”, claiming that dentistry needs an immediate funding injection of £880m to stabilise the situation in the short-term.

Eddie Crouch, chairman of the BDA, called for “real commitment; root-and-branch reform and adequate funding.

And unless the government makes this “real commitment” soon, it seems that dentists will continue to leave the NHS, and those “dental deserts” will continue to grow.

A Message to Dental Patients

Despite the problems many are having seeing a dentist on the NHS, Chief Dental Officer for England Sara Hurley said that anyone experiencing tooth issues should contact their local dentist as usual.

She said: “Infection prevention and control measures to protect staff and patients were introduced during the pandemic. These limited the number of procedures NHS dentists could carry out.”

“However, these restrictions have now been lifted enabling practices to operate at full capacity for the first time in two years, so anyone with concerns about their dental health should contact their local dentist as they usually would or seek advice from NHS 111.”

A Message to Dental Surgeries

We know that the last few years have been difficult and that you’ve probably had to deal with higher levels of staff absences due to infection. We’d love you to see how,  by installing our Blueair air purifiers in your surgery, you can tacklethis issue and reduce illness. Why not get in touch with us to find out how we can support you?

Smoking Outside Hospitals: Bans, Laws & Guidelines

In March 2022, Scotland banned smoking outside hospital buildings.

Smoking Ban Outside Hospital Rules in Scotland

The new legislation aims to achieve the following:

  • To introduce an enforceable smoke-free perimeter of 15 metres outside of hospital buildings.
  • To support the denormalisation of smoking on hospital grounds. This, in turn, should help reduce tobacco use across the population.
  • To reinforce the NHS’s position as “an exemplar of health promotion within society”.
  • To support people in their efforts to stop smoking.

A secondary aim of the legislation is to prevent and reduce hospital staff and patients’ exposure to second-hand smoke at entrances, and near windows and vents.

The policy became law in September 2022. Now, anyone caught smoking within 15 metres of a hospital building in Scotland could be fined up to £1,000.

Smoking Outside Hospitals Rules Across the UK?

Scotland was not the first UK home nation to ban smoking outside hospitals. Northern Ireland banned smoking on the grounds of any hospital in 2016. However, the law allows for designated smoking rooms “with strict conditions” in care homes and hospices.

Wales introduced legislation in March 2021 requiring all hospital grounds to be smoke-free, with £100 fines for anyone found breaking the law.

England is yet to see an enforceable blanket ban on smoking outside hospitals. However, a 2019 Public Health England (PHE) report found that 69% of NHS trusts in England have banned smoking completely. So it may only be a matter of time before England joins the rest of the UK in outright banning smoking outside hospitals.

How to Improve Air Quality in and Around Hospitals

A recent report found that 25% of UK hospitals are situated in areas with dangerously high levels of air pollution. Improving air quality is a question of reducing the levels of pollutants and other hazardous substances in the atmosphere.

Preventing staff, patients and other visitors from smoking within a certain radius of a hospital can make a positive difference to air quality, as it makes it effectively impossible for harmful second-hand smoke to enter the hospital’s air via doors, windows or vents.

But this is just one strategy by which hospitals can improve the air quality on their premises:

  • Strict speed limits – Where possible, hospitals should aim to limit the amount of traffic allowed onsite. But as this may not be practical, they should instead enforce strict speed limits for all onsite traffic. The faster a vehicle travels, the more fuel it burns, and the more harmful emissions it creates. Read our full guide to how speed limits can make a difference to air quality.
  • Air quality consultations – Specialist air quality consultants can test the air quality in key locations in and around the hospital. As well as measuring for air pollution levels in public areas of the hospital, they can also test for staff and patient exposure to potentially harmful substances in clinical settings. Read our full guide to how air quality consultants can help reduce air pollution.
  • Air filtration and purification – Hospitals can use an advanced heating, ventilation and air conditioning (HVAC) system, along with high-efficiency particulate air (HEPA) filters to regulate airflow and improve air quality through removing viruses, bacteria, and other harmful substances from the atmosphere. Read our full guide to effective air filtration in healthcare settings.

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Book An Air Quality Consultation For Your Hospital

Unless you’re one of the few remaining NHS trusts in England who still allow for smoking outside hospitals, it’s very likely that your healthcare setting is already benefiting from a reduction in harmful second-hand smoke.

However, even with a smoking ban in place, your hospital may still be at risk from air pollution – particularly if you’re situated near a major road. On top of this, to meet your COSHH obligations, you also need to monitor your staff and patients’ exposure to certain hazardous substances within your hospital.

We offer specialist air quality monitoring for healthcare settings. Our consultants employ both continuous monitoring and personal sampling techniques to demonstrate how pollutant levels in your atmosphere vary over a specified period. As a result, we can produce comprehensive reports based on our findings, including actionable recommendations to help you make a positive difference to your onsite air quality.

Find out more about our Air Quality Monitoring Services or get in touch to talk to one of our experts.

Clearing the NHS Backlog in 2023: Plans and Estimates

The NHS is facing an unprecedented backlog. This is the care that the NHS would have delivered in a “normal” year, but which has been disrupted as a result of the COVID-19 pandemic and the resulting lockdowns.

What is the NHS backlog?

The NHS backlog includes patients:

  • On waiting lists for treatments who, ordinarily, would have been seen by now.
  • Who have not yet seen their GP to seek a referral, as they were worried about contracting COVID-19, or else overburdening the health service.
  • Who have had procedures or referrals delayed or cancelled, along with patients who have been refused referrals due to a lack of capacity.

The NHS Backlog in Numbers

According to the British Medical Association (BMA), as of July 2022 there were:

  • Over 6.84 million people waiting for treatment.
  • 6.7 million patients waiting more than 18 weeks for treatment.
  • Nearly 400,000 patients waiting more than a year for treatment (in July 2019, only 1,032 patients had to wait so long).
  • Median waiting times for treatments at around 13.3 weeks.

What is the Hidden Backlog?

The BMA also refers to a “hidden backlog” of patients who require care but who, for a number of reasons, have not yet found their way into the health system. On top of this, they warn that the backlog appears to be getting worse, and that it will take years to clear the backlog due to workforce shortages and the ongoing need for infection prevention and control measures.

You can read the latest BMA NHS backlog figures and analysis.

NHS Delivery Plan for Tackling the Backlog

The BMA analysis highlights how the healthcare sector will struggle with the backlog for the foreseeable future. Nonetheless, the NHS is implementing strategies for managing the unprecedented backlog.

A central aim of the delivery plan is to maximise the NHS’s capacity. The goal is to support systems to deliver around 30% more elective activity by 2024-2025 than before the pandemic.

Here are some key aspects of the delivery plan:

  • Significant development in the capacity and skills of NHS staff, while ensuring that the whole workforce has necessary support to deliver a high standard of service.
  • Separate elective and urgent care provision to free clinicians’ time for new patients, and for those with the most critical clinical needs.
  • Prioritise diagnosis and treatment for those with suspected cancer and other urgent conditions, while offering alternative locations to shorten waiting times.
  • Using digital tools to drive the delivery of services and to provide more convenient access to diagnostic and surgical procedures.
  • Give patients better information, providing an accessible and personalised service while they wait for diagnosis and treatment. Through making greater use of the NHS App, patients will have more control over how they manage their appointments, while a national hub model will allow patients with long waits greater choice at the point of referral.

You can read the full NHS delivery plan for tackling the COVID-19 backlog.

How to Improve Efficiency to Reduce Turnaround Times and Tackle the Backlog

A key aspect of the NHS delivery plan for reducing the backlog is to ensure that all staff have the skills and the support they need to deliver the highest possible standards of care. This could include auditing and streamlining working environments and practices to reduce waste and improve efficiency.

For an idea into how this might look in practice, take a look at The NHS Productive Operating Theatre strategy. This is a comprehensive series of resources designed to help healthcare teams work more effectively together to improve the quality of the patient experience, along with the safety and outcomes of surgical services.

The focus is on quality and safely, which can help theatres run more productively and, in turn, help reduce the backlog.

You can read our full guide to strategies and measures that can help improve quality in operating theatres.

Investing in Tech to Make Procedures Safer and More Efficient

The NHS delivery plan for reducing the backlog refers to using digital tools to drive the delivery of services and to provide more convenient access to diagnostic and surgical procedures.

But digital tools are not the only tech that can help improve efficiency in healthcare settings. To manage and reduce the NHS backlog, healthcare teams must assess every aspect of their operations to find ways to improve efficiency while reducing waste, all without compromising on quality of care.

We Can Help You Improve Quality and Efficiency in Healthcare Settings

Whether you want to reduce turnaround times in theatres, improve infection control measures or minimise the risk of staff exposure to toxic chemicals, our experts can help you find the solution.

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How Long is the Short Term Workplace Exposure Limit?

Control of Substances Hazardous to Health (COSHH) is a UK law requiring employers in all industries to prevent or reduce workers’ exposure to certain hazardous substances.

The law regulates workplace exposure limits (WELs) for around 500 hazardous substances. These are legal limits of exposure, measured in concentrations of the hazardous substances in the air (usually mg.m³), averaged over a given timeframe.

COSHH legislation requires that workers are only exposed to a certain amount of a hazardous substance in a specified period of time – the time weighted average (TWA).

What is the Short Term Workplace Exposure Limit?

The short term workplace exposure limit is 15 minutes. A short term exposure limit (STEL) is the concentration to which workers can be exposed continuously to a hazardous substance before it starts to affect their health.

What is the Long Term Workplace Exposure Limit?

The long term exposure limit (LTEL) considers an eight hour reference period. COSHH law requires that the short term exposure limit must take priority over the long term exposure limit.

Short Term vs. Long Term Exposure

The long term exposure limit is there to protect workers from concentrations of harmful substances – the sort of substances which, over an extended period of time, could result in long-term chronic health conditions.

On the other hand, the short term exposure limit is concerned with peak exposure incidents. It’s there to protect workers against immediate ill health effects, whether that’s nausea, dizziness, inflammation, or more serious conditions.

In any case, employers have a legal responsibility to ensure that every employee is not exposed to any concentration of any substance that exceeds the substance’s WELs. And if you run a school, a university or a healthcare establishment, you’ll also have to consider exposure risks for your students, patients, and other visitors.

Exposure Limits in Your Workplace

Many substances will list WEL values on their packaging. However, you must not assume that a substance that does not specify a WEL is necessarily safe to use in all environments for any period of time.

Potentially, all workplaces will make use of hazardous substances with WELs. For example, it’s common to find cleaning products in schools and offices which, if used for too long in a poorly ventilated area, can lead to a range of health problems.

But hazardous substances are so widespread in some sectors that workers may risk excess exposure as a matter of course. In healthcare, for example, employers must meet COSHH exposure regulations for a huge number of substances, including isoflurane, Entonox, formaldehyde, inhalable dust, and a wide range of hazardous chemicals too numerous to mention.

Meeting Your COSHH Obligations

All workers must pay attention to the WELs for every substance they work with. At the same time, you must supply your staff with adequate PPE for each task they undertake, while maintaining an adequate air ventilation system for your workplace.

Yet even with these measures in place, your workforce may still get exposed to dangerous concentrations of hazardous substances. Faulty equipment can lead to a leak. PPE can get damaged or compromised. And a small accident can lead to a substantial chemical spill, the effects of which could last long after the spill’s been cleaned.

But we can help you fulfil your COSHH obligations wherever your staff are exposed to hazardous substances with our bespoke workplace exposure monitoring report. Our comprehensive reports include clear and actionable recommendations, so you’ll know exactly what you’ll have to do to protect your staff.

We specialise in healthcare settings, where we can employ both continuous monitoring and personal sampling processes for operating theatres, endoscopy suites, pathology laboratories, maternity wards, fracture clinics, and more.

Head here to learn more about out workplace exposure monitoring services, and find out how we can help in your department.

Penthrox vs. Entonox for Long Term Exposure

Penthrox and Entonox are both used for pain management in healthcare – particularly in trauma or emergency settings.

In this post we’ll examine the benefits and risks of each.

What is Penthrox?

Penthrox is a disposable inhaler containing a drug called methoxyflurane. When you pour this drug into the device, a gauze inside soaks it up, allowing patients to inhale the vapours. Penthrox is mostly used to offer short-term relief from trauma pain until practitioners can establish a more long-term pain management solution.

It’s also useful for providing relief during brief, painful procedures, like wound dressing.

Penthrox inhalers weigh about 100g and are approximately 15cm long. And as they’re not pressurised, they can be transported on airplanes with no issue. As such, Penthrox is a lot more portable than other pain management solutions, which is why it’s often used in ambulances.

What is Entonox?

Entonox comes in a cannister containing 50% oxygen and 50% nitrous oxide (N₂O). Inhaling this gas mixture provides effective short-term pain relief during certain investigations and procedures.

Entonox cannisters are refillable, though they’re fitted with disposable mouthpieces that must be changed between use for better infection control. They contain built-in regulators, meaning that they can be set up and applied quickly in an emergency. All you have to do is attach a hose and a valve, and it’s ready to use.

What Are The Risks of Penthrox and Entonox?

Both Penthrox and Entonox are effective at providing pain relief. Which option you choose will depend on your budget, along with certain practical considerations, such as space and portability.

However, both Penthrox and Entonox pose certain risks, particularly when it comes to long-term exposure.

The Risks of Penthrox

Some people are hypersensitive to methoxyflurane, the drug contained in Penthrox. It can also pose risks to patients with underlying hepatic conditions, and to elderly or other patients with risk factors for renal disease.

Even small doses of Penthrox can cause dizziness, headaches, sleepiness and nausea. But excessive doses can lead to renal failure.

Maximum Dose of Penthrox

The manufacturers recommend that doses should not exceed 6ml in a day or 15ml in a week. But they also claim that “the frequency at which Penthrox can be safely used is not established”. You can read the full safety information for Penthrox on the manufacturer’s website.

The Risks of Entonox

Practitioners do not administer Entonox to patients suffering from certain conditions. For example, as Entonox can cause a rise in intracranial pressure, it’s not suitable for use with patients with head injuries. Nor should it be used if the patient has any air trapped in the body, such as with blocked bowels or restricted airways.

Short Term Exposure of Entonox

In the short-term, Entonox can cause dizziness, sleepiness, nausea, and even hallucinations. But these side effects usually stop quickly once the patient stops breathing the gas mixture.

Long Term Exposure to Entonox

Long-term exposure to Entonox can affect the body’s ability to absorb vitamin B12. This can result in damage to nerves and red blood cells.

So long as the patient uses controlled doses of Entonox only when needed, there should be no risk of any long-term effects. However, Entonox can pose an occupational risk to healthcare workers. Cannisters can leak, and some of the gas mixture may escape through the patient’s mouthpiece.

Risk to Hospital Staff

Entonox is often used in maternity wards to provide pain relief during labour. There have long been concerns about midwives’ occupational exposure to Entonox, and the long-term health risks this may pose.

How to Manage Penthrox and Entonox Risks In Your Hospital

When it comes to Penthrox, the manufacturers recommend that patients self-administer using an Activated Carbon (AC) Chamber, and that they always exhale through the inhaler’s mouthpiece. Yet even with these measures in place, some methoxyflurane may still escape, posing occupational risks to practitioners.

Similarly, you can reduce the occupational risks of Entonox through carefully controlling dosages, and through advising patients on safe and effective use. Though if patients are self-administering Entonox, they’ll be doing so while in a state of acute pain and stress. So it’s almost inevitable that some potentially-harmful N₂O may leak and circulate.

Test Staff Exposure Levels

So if you want to significantly reduce the occupational risks of Penthrox and Entonox, it’s best to test your staff’s exposure levels before establishing a reliable air purification system.

We specialise in exposure monitoring for healthcare settings. Using both continuous monitoring and personal sampling techniques, we’ll produce a comprehensive workplace exposure monitoring report for any hazardous substances in your hospital, including methoxyflurane and N₂O.

Get in touch to discuss how we can help you control the occupational risks in your healthcare setting.


Long-Term Effects of Chlorine Exposure

The chemical element chlorine has been used for years in sanitation, disinfection, and antisepsis.

What is Chlorine Used For?

In the form of hypochlorous acid, chlorine is used to kill bacteria in water treatment plants and public swimming pools. Chlorine is also a major element of disinfectants and bleach, so it can be found in many domestic, commercial, and industrial cleaning products.

But chlorine has also historically been used as a weapon. It was used on the battlefields of the First World War, and more recently as a chemical weapon in Iraq and Syria.

Despite its ubiquity and its life-saving role in sanitation and disinfection, chlorine is a highly toxic gas. Short-term exposure can cause certain health hazards. Long-term exposure can be lethal.

Short-Term Effects of Chlorine Exposure

You might have noticed the short-term effects of chlorine exposure from spending a little too long in a swimming pool: Blurred vision, a burning sensation in the eyes, throat or skin, a shortness of breath, chest pains, and nausea.

If chlorine can cause this much damage in the short-term, then imagine what it can do in the long-term.

The Long-Term Effects of Chlorine Exposure

The long-term effects of chlorine exposure can include the development of chronic lung problems, including bronchitis and asthma, and even some cancers.

Even a short, single exposure to high concentrations of chlorine can cause immediate lung damage, which could be irreparable. Breathing high concentrates can also lead to a build-up of fluid in the lungs, which can result in suffocation and death.

Who’s At Risk of Long-Term Chlorine Exposure?

Anyone who works in any industry that makes use of chlorine is at risk of exposure. This might include:

  • Commercial cleaning staff, and cleaning personnel in hospitals, schools, universities, and other public buildings.
  • Anyone who works around or near a swimming pool, including health club staff, lifeguards, and professional swimmers and their coaches.
  • Sewage treatment and water purification workers.
  • Workers involved in plastics manufacturing and bleach, chemical and pharmaceutical production.

How to Manage the Risks of Long-Term Chlorine Exposure

  • Learn to spot the signs. Chlorine has a distinctive, highly unpleasant smell, so you should have no trouble detecting a leak. But you should also be able to recognise the symptoms of both short- and long-term exposure, in both yourself and your colleagues.
  • Use adequate PPE. Ensure that anybody who handles chlorine in your workplace has adequate personal protection equipment (PPE) for the task at hand. Read our guide to choosing the right PPE.
  • Follow the procedures. Abide by the COSHH guidelines when it comes to short- and long-term exposure limits. And have a thorough cleaning and containment procedure in place in the event of a leak or spillage.
  • Keep things ventilated. A good air filtration system can cycle the air in a room, removing any potentially harmful gases. This can help reduce the risks of exposure from cleaning products, for example.

Chlorine Exposure Monitoring Services

For total peace of mind that you’re doing all you can to protect your staff from exposure to chemicals, we offer workplace exposure monitoring services.

We’ll employ both continuous monitoring and personal sampling processes to help you understand the exposure risks in your workplace. We’ll then produce a comprehensive report including clear and actionable recommendations, so you’ll know exactly what to do to safeguard your staff.

Head here to learn more about our workplace exposure monitoring services, and find out how we can help you manage the risks of chlorine in your organisation.