The NHS is currently awash with reports and reviews. Finally there seems to have been a general waking up to the problems patients face on a daily basis.
Currently the most extensive and hopefully thorough report is that of the Keogh review. It is taking place in stages, one of which has been completed. It is the review of urgent and emergency care. This is not restricted to the emergency departments of local hospitals but to walk in centres, GP practices, out-of-hours provision and the ambulance service.
It is widely accepted that emergency departments are seeing an increase in attendances. Reasons for this are numerous but amongst the more common listed are that GPs are not available and the telephone advice services such as 111 are viewed by some with suspicion. These services have been previously subject to considerable criticism and are limited in scope.
Emergency admissions to hospital in England are also increasing. It is estimated in the Keogh review that there has been a 40% rise between 2003/04 and 2010/11 (this includes short-stay and zero length of stay admissions).
The Keogh review suggests that admissions to hospital cost the NHS about £11bn and were increasing at a rate of about £83 million per annum.
This rise in admissions is greater than the rate of population growth so it suggests that there are different reasons for the rise other than simply more people needing the service.
In June 2013 a survey by the Royal College of GPs found 85% of GPs believed that they could not provide safe care for their patients. The Royal College of GPs report considerable dissatisfaction by GPs at the level of patient care they are able to provide.
It is not therefore a huge leap to consider that a proportion of the patients who present for emergency care and are admitted are as a result of the inability of GPs to provide a proper safe system of care for their patients at all times. No one thinks it good care for a patient to require emergency and more risky admission when a problem could have been resolved at an earlier stage within the community.
Keogh reports “the wide range of urgent care services available and lack of standardisation of services and labelling results in patient confusion over how to access the right healthcare quickly; this leads to duplication, delay, increased clinical risk and poor patient experience”.
The reasons for the Keogh report therefore were the inconsistent services, care, increasing the risk to patients. The problems identified are substantial. By any definition the issues that the Keogh report is addressing and that the Royal College of GPs are discussing are ones which affect a significant proportion of the care given within the NHS today.
All clinical negligence practitioners will represent clients who have suffered as a result of failures on urgent care, whether GP or hospital based. In many of the conversations with experts there will be references to resources, ever changing systems, poor administrative support and lack of funds. These are all issues which Keogh is keen to review.
So far so good. We can see the link between the problems that exist and the care afforded to clients which can cause harm. It is not the whole answer but it is highly relevant.
Contrast this with the announcement of the MDU recently. Based on figures provided by the NHSLA in its annual report, the increase in clinical negligence claims was deemed to be “astonishing”. It was, apparently fuelled by personal injury firms moving into the field of clinical negligence (and by implication) taking forward claims which would not otherwise have come to the attention of the NHSLA or MDU. The underlying suggestion is that these claims (whether handled well legally or not) are in some way less worthy, not quite right.
How it is that these personal injury firms have managed to miraculously find so many previously hidden claims is not explained.
Yet not within the outrage that clearly exists is there a mention of the problems of the NHS. The Keogh review, the Francis report, and the views of the Royal College of GPs are not mentioned. This increase in claims is, it seems, purely as a result of (presumably) greedy claimant lawyers persuading vulnerable people to take on the NHS.
It is not that claims management companies haven’t at some time provided poor service. It is not that some lawyers take on claims they shouldn’t do or handle ones badly from time to time. However, lawyers don’t make victims of negligence in the NHS. They may handle their claims badly but they do not cause clinical negligence. The NHS is responsible for this.
The MDU is a defendant organisation and no one would expect or want them to shred the reputation of their members or the NHS. But just occasionally and particularly in light of Keogh and Francis before, a bit of balance, a modicum of perspective wouldn’t go amiss. We are all on the same side in promoting safer and better patient care. Like it or not claimants are part of the discussion. It is so much easier to discuss issues when we do not close our eyes to the reality faced by the patients.