In an interview with The Sunday Telegraph on 29 October 2017 Professor Sir Bruce Keogh, NHS National Medical Director, said that patients were being left in danger because of the absence of any central NHS system ordering changes in practice on safety grounds. Patients are being left at risk of suffering needless harm, including amputations, devastating maternity complications and in some circumstances, death. All this because a lack of action to protect patients from known risks.
It is commendable that Professor Keogh felt able to speak out in what is an unprecedented comment for someone in his position dealing with the major issue of patient safety. I admire Professor Keogh's intervention although it is unfortunate that it takes someone of his standing to go public with such concerns. Professor Keogh's intervention is the latest in a growing voice of concerns (both from the medical and legal professions) on the NHS’ ability to learn from mistakes and improve patient safety.
On 14 September 2017, while writing in The Times, I commented on what I saw was a wasted opportunity by the National Audit Office to consider the cost of medical negligence litigation, and whether learning from mistakes is actively being achieved. I said what many medical negligence practitioners see on an on-going basis, “the primary way to tackle burgeoning spend on clinical negligence litigation is to learn from clinical mistakes and put into place procedures to prevent - as far as possible - re-occurring errors." It is a shame that two months later the failure to learn from mistakes and improve patient safety again hits the national press, this time comments from a senior member of the NHS.
My thoughts on Professor Keogh's comments, from a claimant medical negligence practitioner prospective, are:
- Patient safety is paramount. I would much rather see a system where there is an honest review and appraisal between patient, doctor and the NHS Trust concerned to identify what went wrong and the lessons to be learned.
- During this honest and rigorous review process, support should be given to the patient and their family, but also the doctors and medical professionals involved. The impact on medical professionals involved in a claim for medical negligence is often given insufficient consideration.
- Litigation against the NHS should be viewed as an opportunity to obtain peer review of standards and treatment (via the medico-legal experts) and facilitate a collaborative approach between NHS safety boards, NHS Resolution and medico-legal experts to identify lessons to be learned and how practises can be improved.
- NHS Resolution has, of late, commissioned or produced reports dealing with trends in litigation and in particular the causes of birth injury claims. Such reviews should take place on an annual basis and should not be limited to the high-value claims involving brain and spinal injury. All categories of claim should be reviewed to identify any re-occurring trends and reported back to the NHS as a whole.
- The debate should move away from lawyers being the problem and focus on the central issue. Whenever the "annual medical negligence bill" is referred to within the press the debate always transcends to lawyers being the problem. This misses the obvious point! Reduce re-occurring events, minimise harm – as far as possible – caused to patients, learn from mistakes, improve patient safety and then there will be a dramatic reduction in the number of claims for medical negligence brought against the NHS.
It should be remembered that the NHS is a national institution. There is national pride in the NHS and the excellent service it provides on a daily basis. Individuals do not take to suing the NHS lightly. However, when encountering a culture of silence or feeling as though the medical profession are closing ranks when patient or family members seek answers following adverse outcomes, it is understandable why people turn to litigation. I have said in the past, and I am sure I will continue to say for many years to come - collaboration and mediation is the answer.
If you would like to read the article that first appeared in The Times on 14 September 2017 please click here.