By John Tingle
Two key NHS (National Health Service) organisations have recently produced reports. NHS Resolution has produced its annual report and accounts.The Care Quality Commission (CQC) has produced a report on the experiences of adult in -patients in NHS hospitals.These reports are excellent for real-time trend analysis and important patient safety and clinical negligence trends are identified.
NHS Resolution is the new operating name for the NHS LA (National Health Service Litigation Authority). It has several functions which include managing negligence and other claims against the NHS (National Health Service) in England on behalf of its member organisations which include all NHS Trusts (hospitals) in England.The Care Quality Commission (CQC) is the independent regulator of health and social care in England.
NHS Resolution in its latest annual report and accounts states that claimant patient legal costs fell for the first time in recent years, by £31.8 million (6.4%).They received in 2017/18, 10,673 new clinical negligence claims, compared to 10, 686 in 2016/17, trends suggests a plateauing of claims.NHS Resolution mediated more claims in a single year that in its entire history.
In terms of how much NHS Resolution thinks it owes for claims.The provision for liabilities has increased from £65 billion at 31 March 2017 by £12 billion, to £77 billion at the end of this financial year.The NHS paid out more than £1.63 billion in damages to claimants in 2017/18,an increase from £1.08 billion on the previous year. A reason behind these increases is changes in the way damage awards are calculated.
In 2017/18 NHS Resolution reports a change in the main clinical speciality that attracts the most claims. In a change to previous years, it received the majority of claims in terms of number from the Emergency Room (Casualty/A & E speciality). Traditionally orthopaedic surgery was the main clinical speciality source of claims.
The CQC Adult inpatient survey 2017
Overall the CQC reports positive findings. The majority of people who stayed as an inpatient in NHS hospitals were happy with the care that they received.
Improvements over time
A notable good finding in the report is a consistent improvement in patient answers to questions on how well doctors and nurses cared for them:
“A higher proportion of patients said they ‘always’ had confidence in nurses this year (78% in 2017 compared with 72% in 2009, with an increase of one percentage point since 2016) and doctors (80% in 2017 compared with 78% in 2009). Fewer patients in 2017 told us that doctors had spoken in front of them ‘as if they weren’t there’ compared with 2009 (23% compared with 29% in 2009) and fewer said the same of nurses (17% in 2017 compared with 23% in 2009)”. (p2)
Preparation for, and information around discharge from hospital remains a consistent problem and is still one of the weakest patient experience areas. Nineteen per cent of report respondents thought hospital staff did not take their family or home situation in to account when planning their discharge.
A quarter (25%) of patients thought their family or someone else close to them were not given enough information of their care and less than two thirds of patients (62%) left hospital with written care information.
Information given to patients about new medications prescribed while in hospital remains a problem. Nine per cent of patients were not told about the purpose of new medications in a way they could ‘completely’ understand. Patients not being informed of the side effects of new medication remain high at 43%.
There are a number of important other findings in the report.
Both reports contain some good news stories but these are eclipsed by the on-going problems reported. The reports are all very clearly written, contain a lot of useful information and should be read by all those concerned with patient safety and health quality.