but they're really stretched trying to keep patients safe. are pharmacists at the uk's biggest pharmacy chain under too much pressure? dianne moore has spent the last five years fighting for justice for her father. in may 2012, douglas lamond died after he was given medication meant for someone else. the 86—year—old raf veteran had a heart condition and was registered as blind. he had trust that they would give him the right tablets. he would never have dreamt that the wrong tablets would have been sent out. suffolk police allowed us to film the tablets douglas was taking before he died. they were delivered by his local

boots pharmacy in this pack — a dosette box designed to make it easierfor him to take medicine at the right time. on the outside is douglas lamond's name. but on the inside, the prescriptions are for a mr lampard. douglas took more than 30 of mr lampard's tablets, including medication to reduce blood sugar levels, which he didn't need. to witness him going into heart failure and then to subsequent cardiac arrest — it's the most devastating and horrible thing to see. this is the pharmacy in felixstowe where the mistake was made. an error so serious, suffolk police considered a charge of corporate manslaughter. staff hadn't followed com pa ny safety procedures. i felt angry.

i felt i wanted to throw a brick through every single boots store that i saw. i blame boots for... ..for my father's death. in 2011, one manager had been concerned about pressure in boots pharmacies. greg lawton reported to the superintendent pharmacist at boots headquarters. as a clinical governance pharmacist, he thought the company wasn't giving pharmacies enough money for staff. this is the first time he's spoken publicly. when i came into the patient safety role in 2011, i wrote a paper for the superintendent's office, which set out those concerns, explained the issues with the staffing model and how that could put patient safety at risk. in 2012, in the same month as douglas's death, police investigated another serious dispensing error.

the boots uk board ordered an urgent investigation into more than 100 stores with the highest level of incidents. greg lawton was looking at the north region. we spoke to pharmacists, to store managers and to area managers, and what those people were saying, absolutely, staffing levels was flagged as an issue — poor staffing levels. there were issues with training that were identified, there were issues with the premises that were identified. the company told us that, after the investigation, it implemented a detailed action plan. it then commissioned academic research which, it says, found that pharmacies with higher levels of dispensing staff were associated with higher error rates. deaths following dispensing

errors are extremely rare. but six months after douglas, arlene devereaux died following a massive morphine overdose. it was her 71st birthday. she had osteoporosis. even her hands were painful, you know, so that's why she was on zomorph. this time, a boots pharmacy at chesterfield, in derbyshire, dispensed six times the strength of morphine tablets prescribed by arlene‘s gp. the coroner concluded that arlene‘s death was accidental and there were clear opportunities for the error to be corrected. the pharmacist in charge said he must have been interrupted. we don't know why. it was shocking, and it kind of reminded you of the importance of the job that you were doing and strengthened your resolve to try and make a difference. boots told us it dispensed more than 220 million prescription items ina year. there were just over 900 reported incidents where patients were harmed

in some way. that ranged from needing minor treatment to permanent damage. so, statistically, that kind of incident is very, very rare. and some might not have been the pharmacy‘s fault. boots says, compared to other pharmacy chains, it has one of the lowest levels of harm and an industry—leading approach to patient safety. the pharmacists' defence association union is the largest union representing the profession, with 25,000 members. mark pitt worked as a boots pharmacist for 20 years. the pdau supports a third of boots' 6,500 pharmacists and is involved in a legal battle to be recognised as a union there. pharmacists have told us, working for boots, that they're finding that, increasingly, there are less staff available, and that makes theirjob a lot more

difficult and more pressurised. they are concerned about speaking up about problems in the workplace because they fear the consequences of what will happen to them. boots uk pharmacy director is a qualified pharmacist who's worked for the company for 20 years. he spends a day a week out in its stores. that'sjust not something i recognise. i personally have been able to raise whatever i've needed, whenever. i know we have an open and honest culture. if they fear speaking up, they can ring me direct, i absolutely assure confidentiality on that, just like we do for our whistle— blowing hotline. they have a responsibility themselves as a pharmacist and a professional to speak up. the union says that many pharmacists it represents at boots are too frightened to speak out. they're scared they'll lose theirjobs. but two were prepared to be interviewed, as long as we protected their identity.

actors are speaking their words. some days, you would easily describe the team as being at breaking point. that's because simply the amount of work that has to be done, can't physically get done safely, and it can't physically get done without either working longer hours or working after the store's closed. mistakes may not be picked up on, and that could ultimately lead to somebody possibly dying. somebody missing medication, harm coming to people, small mix—ups, really, just one tablet for another tablet. in september 2013, boots told its pharmacists about two very serious dispensing errors in six days. they were warned not to cut corners with company procedures. two months later, there was another death. to find out what happened, i'm heading to the small highland town of kingussie. margaret forrest trusted her local

boots to supply the daily medicine she needed. instead, mrs forrest, an active and independent 86—year—old, was given a mrs frost's diabetes tablets. she had total belief in the system. she would have taken medicine given to her in total confidence that that was the right medicine that she had to take to protect herself — and it didn't. at the end of the day, we all know human error. we all make mistakes, we all do, but unfortunately some mistakes are very tragic ones, and this was the case with my mother. just like the cases of douglas and arlene, company safety procedures hadn't been followed in kingussie. understaffing wasn't found to have contributed to any of the deaths. 0ne mistake like this

is one mistake too many, and my absolute assurance is, despite having our industry—leading record, we will continue...continue to focus on minimising the chances of it happening again. boots told us there have been no further deaths linked to dispensing errors at its pharmacies since mrs forrest died. greg lawton wasn't investigating the deaths, but he'd been looking in detail at staffing and budgets and was concerned that pressure from understaffing in boots pharmacies could lead to serious mistakes. he told a senior patient—safety boss at company headquarters just how worried he was. i told her that i was terrified that something bad might happen to a patient, and the patient might be seriously harmed or a patient might die because of the inadequate staffing levels and the pressure that was placed on pharmacists and pharmacy teams. greg lawton thought the way the company calculated how many staff it needed was

fundamentally flawed. a few weeks later, he told management he was considering going to the pharmacy regulator. the information that i had and the things that i knew about the... ..staffing levels, i think that that was the biggest risk to patient safety that i'd come across within the company. his concerns were immediately escalated to the highest level with the boots board, and he was invited to take part in ongoing work on staffing. so, what's supposed to keep patients safe? well, as far as enforcing safe staffing goes, the only legal requirement is that, when a pharmacy is open, the pharmacist in charge, the responsible pharmacist, has to be there. all pharmacy companies must set their own safety rules, called standard

operating procedures. they're there to protect patients' safety, and staff should follow them. but boots pharmacists we've talked to say time pressures mean they sometimes take shortcuts. you don't have the correct amount of time. you don't even have the correct amount of staff to do things on time. the staffing thing is huge. at best, you'll barely have enough staff to just cope. we have standard operating procedures in place for all of our operational procedures and our dispensing process in boots. they're recognised as being really high—quality, industry—leading. a lot of work has gone in to finding the processes that minimise the risk to our patients. nobody should ever be in a position, and nobody should ever take the choice, to take any kind of shortcut. comments on boots' own pharmacy unscripted staff website in 2017, also show how concerned some pharmacy staff are. pharmacists at boots do an excellentjob, but often in very, very difficult circumstances. and considering it's the largest pharmacy company in america and europe... ..it shouldn't be like that.

boots told us its own survey suggests four in five pharmacists were either comfortable or neutral about their workload, which is better than the rest of the nhs. the pharmacy regulator, the general pharmaceutical council, told us it's inspected more than 2,000 boots pharmacies since november 2013. 26 didn't have enough qualified and skilled staff to provide a safe service. it says they're now up to standard. that means only 1.2% of boots pharmacies failed on the staffing standard, which compares favourably with all other pharmacies. i'm absolutely confident that the resource is there to deliver the patient care. i am confident that we have enough staff. community pharmacy is part of the nhs, and its funding

is being cut. more prescriptions are being dispensed than ever before — more than 1 billion a year. and as the population gets older, they're becoming more complex. i think my record is 37 medicines that they're on, and you have to check each one for suitability. you're trying to do that in a busy, hectic environment, and you've got all the other tasks to do. accuracy is crucial. boots says pharmacists should only check their own work as a last resort. but the pharmacists we spoke to told us, in their experience, when they're busy, that doesn't always happen. often, you end up having to self—check medication. 0ften, you're in a situation where you've got no staff at all and you're having to dispense medication and then self—check that medication. every day, there'll be an occasion where i've got to self—check on all of the shifts that i work. all our prescriptions are checked twice before they go out. less than 1% of the time, and 1% of the prescriptions

that we dispense, a pharmacist will return to their own work and check that prescription themselves. if we have pharmacists who think they're in situations where they are having to do that when they shouldn't, they must, they have a professional responsibility to raise that. if the pharmacist in charge thinks their pharmacy is unsafe, one option they have is to temporarily close. in a union survey of more than 400 boots pharmacists, 31 said they'd closed pharmacies because they'd been concerned about patient safety. more worryingly, 160 out of 212, who'd considered it, said they didn't close because they didn't believe their decision would be supported. you end up staying open in these unsafe situations and, out of your own goodwill, try to catch up on, maybe, backlogs or try to reorganise things. 160 is a very small sample, but it's an important sample. if we have got people who genuinely feel like that, then it does concern me, so please, please, please do come and speak to me and give me the

chance to sort it out. this is a very, very extreme circumstance. we will always support a local shop, whether that's with resource, whether that's with time, to be able to stay open. so how do pharmacies decide how many staff they need to keep patients safe? there's no regulation to say, if you dispense this many prescriptions, you have to have this many staff. to calculate the workload, boots uses a complex model, which includes the time it takes to dispense various prescriptions. injuly 2014, greg lawton was asked to be part of a team which recalculated those times. the work that we did on time standards was regarded as very robust work. it was done alongside external co nsulta nts, and they called it world—leading. the team reported back that boots needed to spend tens of millions more on its pharmacies. we calculated the amount

of investment from the time standards and from other operational considerations and to meet the expectations that the company had of pharmacy staff and its stores, and that was in excess of £100 million additional investment every year — that was required to fund that. boots says that only greg lawton held the view that in excess of £100 million a year was required. the company told us it did make significant additional investment in pharmacies following the time standards review, but says the specific figure is commercially sensitive. greg — his opinions and his concerns — left the business over two years ago and aren't relevant to boots today. we continue to invest in more people, more pharmacists, than ever before. that's into our shops and it's into our processes, helping to make things more safe. as the uk's biggest pharmacy chain, boots is providing a crucial nhs service. we asked the company to explain

exactly how it works out how many staff to put in almost 2,400 pharmacies. it refused. the company told us the time standards, which are part of the calculation, are a trade secret which could be copied by its competitors. lloyds, the uk's second largest pharmacy chain, has provided both its time standards and how they're used to work out staffing levels. boots says you can't compare one company with another, and it shares the principles of how it works out staffing budgets with line managers. j°y joy wingfield is a pharmacy law and and ethics expert who's trained the last two boots superintendents — the pharmacists in charge of patient safety. i don't really accept that they are trade secrets.

if they're confident that their staffing calculations do maintain patient safety, i don't see why they should be in may 2&6-th scotland.