NHS building

The Enormity of the Patient Safety Challenges Facing the NHS in England

By John Tingle

Adding to the enormity of the challenges facing the NHS in developing a patient safety-focused culture, NHS Resolution and the Care Quality Commission (CQC) have recently produced important reports on NHS litigation and poor care. The analysis of these reports will help to reveal the full nature and extent of the NHS’s patient safety problems.

NHS Resolution

This organization occupies a unique position in the NHS, as one of its several functions includes managing litigation claims brought against the NHS organizations. This position gives it a unique overview of NHS clinical negligence complaints and patient safety trends, challenges, and opportunities.

NHS Resolution 2019/2020 Annual Report

NHS Resolution provides in its annual report a financial estimate of liabilities for current and future expected legal claims. The latest figure given is £84.1 billion.

Facts and figures

  • In 2019/20 NHS Resolution received 11,682 new clinical negligence claims and reported incidents, compared to 10,684 in 2018/19, an increase of 998 (9.3%).
  • As to settled claims, the report states that in 2019/20, 15,550 claims were settled, with 71.5% settled without proceedings, 27.9% with proceedings, and 0.6% at trial.
  • The top three categories of clinical claims received in 2019/20 by value and number are Obstetrics, Emergency Medicine and Orthopedic Surgery.
  • Maternity claims once again stand out as the highest claims value specialty: “Obstetrics claims remain the largest proportion, 50% of the total estimated value, while only representing 9% of the volume of claims received,” the report states. A case discussed by JMW solicitors also highlights the high claims value of obstetric negligence. In this case, which the firm handled, failures by maternity staff resulted in brain damage to a baby. The £26 million compensation awarded by the court will have to cover lifetime specialist care and provide financial security .

CQC Reports

The CQC have just published two new reports, which make for uncomfortable reading. It is hard to understand why the failings that have been identified occurred in a modern-day, post-Mid Staffordshire care crisis NHS, and why poor care issues have not been properly dealt with.

Extracts from the report show the dire nature of the issues reported by the CQC:

“Staff did not keep detailed records of patients’ care and treatment. Records were not always clear or up-to-date. This meant that care staff could not easily identify care to be given to individual patients. This had not improved since the last inspection. However, records were stored securely and easily available to all staff providing care.”

The report states that staff did not always report incidents, and the service did not always manage patient safety incidents well.

Mid and South Essex NHS Foundation Trust: Basildon University Hospital

The recent, unannounced CQC inspection on maternity services at Basildon University hospital was carried out to follow up concerns raised by a whistleblower. Some examples of good practice were found, but there were several serious failings identified:

“CQC found several concerns, including; high risk women giving birth in the low risk area, insufficient numbers of staff with the relevant skills and experience to keep women safe and provide the right care and treatment, and dysfunctional multidisciplinary team working which had impacted on the increased number of safety incidents reported.”


Taken together, these reports starkly reveal the seemingly insurmountable nature of the problems and challenges that the NHS must face in order to develop a sustainable, ingrained patient safety culture which puts the patient first.

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.

Leave a Reply

This site uses Akismet to reduce spam. Learn how your comment data is processed.