Patient Safety at the Crossroads

By John Tingle

The NHS (National Health Service) in the UK is 70 next year: it was founded on 5th July 1948 and celebrations are being planned. Clearly a lot has changed since it was founded. Our concept of wellness has changed, we go to the doctor for reasons that would never have been considered appropriate in 1948. Health today is not just about the absence of physical diseases.

What is clear is that ever since 1948 the NHS has been shortage of resources in the face of a seemingly insatiable demand for its services. Balancing finite resources against near infinite demands is no easy task. Seventy years on, it is most concerning that a vast amount of money in the NHS is now being spent on clinical negligence claims. In their latest annual report and accounts, NHS Resolution estimates the total amount for clinical negligence claims it owes is £65 Billion. Damages paid to patients rose significantly from £950.4 million to £1,083.0 million, an increase of 14%. The high cost of clinical negligence is not sustainable and something must be urgently done to reduce the number of claims against the NHS. The issues were recently considered by the National Audit Office (NAO), which found:

  • The cost of clinical negligence claims is rising at a faster rate year-on-year, than NHS funding.
  • Even if successful, NHS Resolution and the Department’s current actions are unlikely to stop the growth in the cost of clinical negligence claims.
  • The government lacks a coherent cross-government strategy, underpinned by policy, to support measures to tackle the rising cost of clinical negligence.

On the patient safety side, there is little more for the NHS to celebrate. There have been improvements but patient safety in hospitals  is still the main concern for the NHS health and social care regulator, the CQC (Care Quality Commission). They say in their latest report that they have seen a clear improvement overall in safety and across each of the sectors they regulate and rate since the introduction of their new system of regulation. However, there is still a large amount of variation in the quality of care of services across the NHS, within individual hospitals and between hospitals in the same NHS acute trust (hospital). At hospital level, 40% of acute hospitals were rated as good and 6% were rated as outstanding. Just under half of hospitals (49%) were rated as requires improvement with 5% rated as inadequate. Overall, they say this is a slightly improved picture compared with last year, although variation in the quality of care remains. Seven per cent of NHS acute hospitals were rated as inadequate for safety.

In a recent article on patient safety, the Secretary of State for Health, Jeremy Hunt has pondered as to whether the NHS has reached a patient safety crossroads. We must say that even after sustained efforts to improve patient, there is a lot still to do, we cannot rest on our laurels. He provides an excellent overview of the NHS patient safety agenda.

John Tingle

John Tingle

Visiting Lecturer,Birmingham Law School,University of Birmingham, UK,Visiting Professor of Law,Loyola University Chicago, School of Law.I was a Visiting Scholar at Harvard Law School in November 2018. Formerly Associate Professor at Nottingham Law School, Nottingham Trent University in the UK. I have a fortnightly magazine column in the British Journal of Nursing where I focus on patient safety and the legal aspects of nursing and medicine. I have published over 500 articles and a number of leading texts in patient safety and nursing law .My current research interests are in global patient safety, policy and practice particularly in African health care systems.My most recent publication is: Global Patient-Safety Law Policy and Practice edited by John Tingle, Claytion O'neill and Morgan Shimwell, Routledge 2018.

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