Publishing outcomes based information can help trusts to nip problems in the bud before they escalate into a crisis, says Jeanette Whyman

Mid Stafford hospital sign

The Mid Staffordshire scandal is ‘the most egregious example of accepted standards of clinical care being ignored’

The sharing of information on best practice – and the identification of meaningful trends gleaned from data – can only be good for an organisation, and none more so than the NHS.

‘Policies and procedures governing best practice may be in place but individuals circumvent them’

Therefore, it might seem obvious that sharing the background to a medical negligence claim could only be beneficial, enabling others to avoid it happening in their hospital. But, in my experience, it is rarely that simple.

Medical mistakes occur for a number of reasons. Time and time again, I encounter situations where policies and procedures governing best practice are in place but people choose to circumvent them for a variety of reasons, and the hospital management is too weak to prevent them from doing so.

The Mid Staffordshire scandal is the most egregious example of accepted standards of clinical care being ignored by both medical and nursing practitioners and management, allowing institutional neglect to flourish.

Pinpointing areas of concern

The Francis inquiry into what went wrong at Mid Staffordshire resulted in 290 recommendations being made to stop such widespread abuse and neglect of patients happening again.

‘Too many claims have arisen because of an unwillingness to confront the error, no acceptance of responsibility and no apology’

Since the report’s publication, a number of reforming initiatives have been announced, all designed to focus on the importance of hospitals establishing a patient centric approach by inculcating a positive safety culture in which the needs of the patient are paramount.

The government’s voluntary Sign up for Safety initiative, endorsed by the NHS Litigation Authority, was launched specifically to help trusts reduce the number of medical errors by a third.

The authority, in turn, has moved from assessing its members’ risk management standards – on the basis that the existence of a risk management system, of itself, doesn’t mean the trust is safe – to an outcomes based approach, in order to help members identify and address areas of concern.

This data will be published on an extranet, accessible to member trusts, with the intention of helping them “prioritise local activity in areas where they have a high number of claims”. 

In addition, it has launched a Safety and Learning Service to help trusts learn from their mistakes.

Enforceable duty of candour

One of the main recommendations of the Francis report, a statutory duty of candour – obliging honest and open dialogue with patients and their families – is coming into effect.

‘If complaints were dealt with promptly, it would reduce the number of medical negligence claims by 70 per cent’

There is a view in some quarters of the medical profession that a legal obligation of candour is unnecessary: doctors have always been subject to an ethical duty of candour that should not need legal enforcement.

I disagree; I have been instructed on too many claims that have arisen because of an unwillingness to confront the error, no acceptance of responsibility and no apology. A statutory duty of candour will legally require organisations to be open, honest and transparent in all their dealings with patients.

Michael Powers QC once said that if complaints were dealt with promptly and appropriately, it would reduce the number of medical negligence claims by 70 per cent.

Cutting medical errors

Apart from in rare instances of criminal behaviour, the majority of medical practitioners do not deliberately set out to hurt their patients.

The publishing of data and information relating to outcome based information can help trusts to address problems before they become crises.

Initiatives such as Sign up to Safety should help to prevent avoidable harm to patients by, as the NHS Litigation Authority says, “shining a light on high risk, high volume and high value claims”.

However, the danger posed by rogue practitioners will always be present and so it is imperative that all staff, when encountering such instances, are able to speak up without fear, supported both by their management team and by their legal duty of candour.

Jeanette Whyman is partner and head of medical negligence at Wright Hassall

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