Published: 21/03/2002, Volume II2, No. 5797 Page 19
I was doing a little website research in response to a Commons debate instigated by my old chum Dr Ian Gibson, Labour MP for Norwich North, when I got a bit of a jolt.
There among the Department of Health's 'hot topics' was patient safety in the sense I was seeking - the drive to curb medical liability claims. But it was lurking alongside HIV/AIDS, smoking, the MMR row, CJD and, yes, bio-terrorism.
That puts it into some sort of perspective, I suppose. In the course of his usual busy week, health minister John Hutton chaired an international conference at the Foreign Office to consider better ways to protect us all against biological, chemical and what the official communiqué called 'radio-nuclear attack' - though it did not say from whom.
My own hunch is that the current BushBlair sabre-rattling is designed to frighten Saddam Hussein (does he frighten? ) into letting UN inspectors back into Iraq and that there will be no serious US military action during 2002, a US election year. Meanwhile, ministers will try harder to exchange information and 'share plans on preparedness' on what is a very real threat.
Another burden for harassed managers, I hear you murmur. Meanwhile, Dr Gibson was asking the Commons what could be done both to reduce medical error and to improve conflict resolution when things do go wrong. An old chestnut, I realise. I can remember when there were very few cases in the NHS, unlike the litigious US. Consumer champion Ralph Nader once told me that litigants rarely win, but that suing 'keeps American doctors honest'. I didn't believe that 20 years ago - and still do not.
As early as 1995 the NHS launched pilot mediation schemes.When he was health secretary, Frank Dobson used to rail regularly against predatory lawyers inciting patients to sue (so, more quietly, does Alan Milburn). Last year ministers acted to implement An Organisation with a Memory, the report of an expert group on learning from adverse incidents in an effort improve reporting of them.
The National Patient Safety Agency is in place to curb the blame culture and encourage openness. Doctors' performance is now being assessed regularly.Chief medical officer Professor Sir Liam Donaldson is chairing a committee to consider (among others) the Kiwi no-fault compensation approach.
Much of this was acknowledged by Yvette Cooper, the duty minister. Since May 2000, solicitors involved in NHS cases have been obliged to offer 'mediation in appropriate cases', she reminded MPs. Staggered payments are under consideration. But it still cost the NHS£373m last year - with legal costs, Dobbo please note, often outstripping the patient's settlement.
Dr Gibson, a shrewd biochemist, always makes shrewd points.Amid the welter of new bodies (I have omitted mention of CHI, patients advice and liaison services and the Council for the Regulation of Health Care Professionals), he suggested that needle manufacturers could prevent 10 lethal tragedies a year which occur when the cancer drugs vincristine and methotrexate get mixed up.
A simple redesign would ensure that 'only intra-spinal drug syringes could be used with intra-spinal needles', the MP suggested, which I take to be the equivalent of different nozzles for petrol and diesel on the forecourt. But he also stressed the still-primitive state of IT in the NHS - life-saving information 'hidden away among stacks of irrelevant and sometimes decades-old correspondence. . in a documentation system that has changed little in two centuries'.
The solution, the MP believes, is not just electronic patient record systems - his local oncology unit has had one for eight years - but a national medical record system, using common, non-proprietary datasets. In short, an NHS information superhighway - this despite the IT horrors inflicted on other Whitehall departments, Dr Gibson adds. 'It sends a shiver down my spine.'
IT costs lotsa money, so naturally Ms Cooper was less eloquent on that point.One consoling thought from me. The latest data I can find suggests that people are more concerned that the NHS admit fault, prevent a recurrence of the error on others (52 per cent stress this) and apologise (44 per cent) than want hard cash (30 per cent).Much as was true a generation ago, despite ambulance-chasing lawyers and Labour's own no win/no fee reforms.
Yet the current defensive emphasis on money-saving risk-avoidance inhibits effective remedies - and fairness. Everyone loses, including NHS staff morale.