has taken centre stage as one of the major political issues of the forthcoming
General Election in May. This is hardly surprising given its cost: the NHS
budget for 2014/15 is £113bn. For that the taxpayer gets a (largely)
nationalised health service (mainly) free at the point of delivery. The NHS employs
1.7 million people (1) and treats more than 1 million people every 36 hours. People make mistakes in
all walks of life and when you have 1.7 million people dealing with the complex
health care issues of another million patients on a daily basis, avoidable
mistakes are inevitable.
are often criticised for facilitating claims for compensation against the NHS
but as a senior MP remarked to me last week, “if you didn’t sue them they would
patient safety lawyer and during my 10 years as a member and president of APIL’s
executive committee I have constantly had to defend the rights of patients to
pursue claims where they have suffered injury from negligent medical treatment.
But where a treating doctor or nurse provides care that is so poor that no
responsible medical practitioner can justify or defend it then surely it is
right that they should be entitled to some form of redress? There may be debates
to be had about the appropriate levels of damages and costs for such claims but
the principle of redress must be a fundamental one.
NHS’ own figures suggest there are a million reported patient safety incidents
each year and of these over 60,000 adverse incidents result in significant harm
to patients. Yet last year the NHSLA (which deals with claims against the NHS)
received fewer than 12,000 claims (2). This suggests that far from there being a “compensation culture”, as is often
alleged, what we really have is a significant access to justice issue.
for the NHS is to learn from the errors it makes and implement systems and protocols
to ensure those mistakes are not repeated. That way patient safety is improved
and fewer patients are harmed and need to consider bringing a claim. Yet the
NHS seems reluctant to truly embrace an open approach to patient safety and
the start of October we have had the much heralded “duty of candour” which imposes statutory, contractual and
professional responsibilities on medical staff and hospital Trusts to be open when things go wrong, to provide an
explanation as to why they did go wrong and, where appropriate, to make an
apology to the patient and/or their family. This is a welcome start but we will
need to see if it will really make a difference in practice. We have already
seen a potential dilution of the duty in terms of how it is likely to be enforced
by the regulator. The Care Quality Commission (CQC) has stated “We expect to
use the new regulations on candour to confirm or encourage good practice
through the ratings we give, rather than to enforce them directly”
system is also unsatisfactory with a recent finding that more than 40 per cent
of NHS investigations into patient complaints are not good enough, according to
a review by the office of the Health Service Ombudsman.
So it is, perhaps,
no surprise that patients sometimes feel they have to turn to lawyers to ensure
that what has happened to them doesn’t happen to anyone else and to try to
ensure that the NHS learns from its mistakes.