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Patient Safety in the United Kingdom After COVID-19

By John Tingle

After the COVID-19 pandemic is over, a key issue remains for the United Kingdom’s National Health Service: Will there be less avoidable patient harm, fewer occurrences of “never events,” and fewer headline grabbing patient safety crises?

Prior to COVID-19, the general media in the U.K. was often rocked by banner headlines proclaiming major patient crises. I can see no reason why these headlines will not continue when the crisis has abated. It is a sad statement to make, but history has shown that major patient safety errors causing significant, avoidable patient harm regularly blot the NHS landscape. This is despite the very best efforts of government and many in the NHS to develop an ingrained patient safety culture.

The patient safety landscape after COVID-19

Peter Walsh, chief executive of the charity for patient safety and justice, AvMA (Action Against Medical Accidents) captures the issues well. In a blog post for AvMA, he writes:

“Many people have said things will never be the same after COVID-19. When it comes to patient safety, I hope they are right. If the country can rise to the challenge of COVID-19 and can come up with the billions of pounds being spent to do so, and achieve brilliant things like setting up emergency hospitals in a matter of weeks, it should be obvious that investing in our NHS to prevent the horrendous amount of avoidable  harm every year makes sense. Yes, it will cost money, but it will save lives — just like we are doing with the pandemic.”

To contextualize the issue, Walsh quotes statistics and research that suggests the death toll from avoidable harm in the NHS is around 9,000 per year in England alone. Also to this point, Randeep Ramesh, writing in The Guardian back in 2015, quoted the former Secretary of State for Health and Social Care Jeremy Hunt as saying “the rate of avoidable deaths in hospitals was the ‘biggest scandal in global healthcare’ and estimated that 1,000 patients died needlessly each month.”

A more recent report from NHS England and NHS Improvement published in 2020 offers an analysis of the patient safety incidents reported in England to the National Reporting and Learning System (NRLS) through September 2019. These most recent statistics capture the reported degree of harm a patient suffered as a direct result of a patient safety incident. The report finds that while most incidents were reported as causing no or low harm, 2.5%, or 53,839 cases, were reported as causing moderate harm, 0.3%, or 5,647 cases, were reported as causing severe harm, and 0.2%, or 4,283 cases, were reported as causing death.

These figures given for moderate and severe harm and death are very concerning and show the scale of the NHS patient safety problem.

The NHS has done remarkable things during the COVID-19 pandemic, and has spent a considerable amount of money investing in infrastructure and equipment, such as building emergency hospitals. This investment is needed to win the war against the virus. I agree with Peter Walsh that the same enthusiasm, resolve, commitment and resources should be waged against avoidable patient error, which also causes significant harm and death in large numbers in the U.K.

John Tingle

John Tingle is a regular contributor to the Bill of Health blog. I am a Lecturer in Law, Birmingham Law School, University of Birmingham, UK; and a Visiting Professor of Law, Loyola University Chicago, School of Law. I was a Visiting Scholar at Harvard Law School in November 2018 and 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, Clayton O'Neill, and Morgan Shimwell, Routledge 2018.

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