Michael White: time to address costly preventable failures

Having watched him make a painful apology for failing to communicate his vision four times (just to be on the safe side) at the Royal College of Nursing conference, it seems kinder to allow him an Easter “pause” – to use the government’s health verb of choice.

Where else to turn? Am I alone in noticing the media starting to turn up the volume again on NHS failings, the oh so familiar cycle that highlights the botched operation or unnecessary death? 

Or is it more about the NHS’s failure to match rising public expectations at a time of renewed stringency, not the same thing at all? 

Or even the public’s expectation that risk can be eliminated from dangerous activities – like having babies – so that when things go wrong someone must be blamed and compensation paid? Probably a bit of all three.

Ken Clarke is trying to curb the no win, no fee claims culture to cap lawyers’ bills and require NHS ambulance chasers to be paid from the claimant’s settlement, not in addition to it.

Despite predictable squeals, that seems fair: a generation ago litigation was rare (too rare?) in the NHS, nowadays it is too opportunist.

Not all claims warrant that description, but some do.

What is new to this stage of the cycle of complaint is fear of the emerging healthcare market dictating clinical judgement.

This week an open letter from the 15,000-strong Federation of Surgical Specialty Associations claimed operations are being delayed or downgraded as being of “limited value” to save cash.

How much of this is real or just routine special pleading is hard to say.

But a ready and eager media will ensure such claims are widely believed.

Yet underlying reality is bad enough. I was astonished to read that Lancet survey suggesting Britain has 4,000 stillbirths a year. It is one of the highest rates in Europe, 3.5 per 1,000 births against 3.7 in Austria and 3.9 in France – an odd anomaly for its famed Rolls Royce health system.

Imagine it! Eleven little coffins bringing life-changing trauma to British families every day, most of them preventable if more could be done to identify risk. One in three is traceable to smoking, overweight and age, but problems identified a decade ago as poor NHS maternity care still account for a substantial number.

Do politicians get the point? In my experience infant mortality does not excite MPs in the way that cancer, drug or alcohol abuse does.

Admittedly the cost and number are far higher, but a dead baby is an awful thing.

Gordon Brown set up a commission on nursing and midwifery, which reported last year before the election, urging better standards and training. The DH responded last week.

Meanwhile, the NHS Litigation Authority reports that the cost of lawsuits arising from misread scans by midwives or obstetricians (500 babies die as a result) has risen from £11.8m in 2006 to £85.8m last year. The overall cost is far higher.

I am not persuaded that money is an appropriate remedy for grief; it is not as if ongoing care costs are involved here.

What is needed, surely, is better midwife training. So I was pleased to see the Nursing and Midwifery Council supporting a High Court bid to overturn a fitness to practise ruling on a negligent midwife that it deemed “too lenient”. Bring it on.