NHS building

NHS Patient Safety: Reflections and Looking Forward

By John Tingle

In patient safety terms in the NHS England, there have been positives and negatives over the past year to reflect on, and for 2022 there are interesting developments on the horizon. In this post I will discuss a small number of patient safety matters of major impact.

A crisis in maternity care 

Unsafe maternity care has been a constant theme in the inspection reports of the Care Quality Commission (CQC), our independent regulator of health and social care in 2021. This is one of the patient safety negatives of 2021.

In the English health care system, most large hospitals offering comprehensive health services, including maternity care, are public ones — NHS hospitals.

People will normally attend their local NHS hospital for the birth of their child. The fact that poor maternity care is in the spotlight does weaken the public’s confidence in the NHS.

Whilst there are many excellent maternity units providing care, the CQC states:

“We remain concerned that there has not been enough learning from good and outstanding services—or enough support for that learning from the wider system. Issues such as the quality of staff training; poor working relationships between obstetric and midwifery teams, and hospital and community-based midwifery teams; a lack of robust risk assessment; and a failure to engage with, learn from and listen to the needs of local women all continue to affect the safety of some hospital maternity services.”

This does seem to be a deep-rooted NHS patient safety problem, and this year has seen a steady stream of adverse CQC inspection reports of hospitals across the country. The Parliamentary Health and Social Care Committee has also investigated the issue. It is an issue that needs to be fully addressed as soon as possible.

WHO Global Patient Safety Action Plan

A patient safety positive in 2021 was the publication by the World Health Organization (WHO) of their Global Patient Safety Action Plan 2021-2030. This is a clearly worded and well-researched document that should be read by all those concerned with patient safety and health quality across the world. It is a deep dive into fundamental issues of patient safety and provides a structure within which to help develop a proper culture in the area. I particularly like strategic objective (SO) 1 of the Global Patient Safety Action Plan, which states:

  •  SO1: Make zero avoidable harm to patients a state of mind and a rule of engagement in the planning and delivery of health care everywhere.

Many people may take issue with this objective on the basis that it is unrealistic as a mindset. Human beings are essential to the delivery of health care services, therefore some degree of error is going to be inevitable, as nobody is infallible. But it is a good proactive starting point to adopt in patient safety policy development and practice.

NHS Patient Safety Syllabus

Another positive was the NHS Patient safety syllabus 2.0 and the fact that this version now includes good discussion of legal matters. Section 1.6 deals with medico-legal education and professional responsibilities, and includes sections on:

  • Ethical and clinical issues involved with patient care, including the withholding or withdrawal of care, and the rights of the patient to refuse care
  • Legal requirements in patient confidentiality and information governance
  • Legal issues surrounding clinical negligence, compensation, and the accountability of individual practitioners

The Rising Cost of Clinical Negligence

Another negative in 2021 was the increasing cost of clinical negligence to the NHS. NHS Resolution states:

” …the cost of clinical negligence is expected to continue to rise without wider reform – we are still incurring around £8 billion annually for the cost of clinical negligence.”

Yes, taxpayers are footing the bill for clinical negligence claims and the money may well have been better spent on providing more doctors and nurses, but we should never forget the patient’s perspective. A patient has been avoidably injured by those who were meant to care for them and money is always going to be a poor compensator for the loss of a faculty, amenity, or life. There are always going to be incalculable emotional and physical costs to claimant patients that need to be factored into any cost equation.

Looking forward to 2022: Tort Reform

Clinical negligence compensation system review

A review has been promised into our tort-based clinical negligence compensation system, and the Government is looking into no-fault based liability schemes. John Hyde writing in the Law Society Gazette states:

“Ministers are working on a total overhaul of the ‘outdated’ system of clinical negligence compensation within the NHS, it was revealed today. Health minister Nadine Dorries told the health and social care committee that a review of the system was going ‘at pace’ and could involve all claims against the NHS.”

I doubt very much whether this review will result in much change to our present system. There has often been discussion through the years about changes, but nothing much has happened. No fault-based liability systems have the potential to be very expensive when the high NHS current clinical negligence liability levels are considered. The Government, in its deliberations, does need to go back to basics and ask what they want a compensation system to achieve, to identify the underlying conceptual foundations.

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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