Belfast Telegraph

Monday 21 April 2014

£80,000 a day: the cost of foul-ups in the NHS

Scathing medical negligence report reveals biggest bill is for errors affecting women and says lessons aren’t being learnt

Auditors found that in some cases legal costs exceeded the amount of damages ultimately paid out

Madical negligence is costing our health service a shocking £80,000 a day — with women bearing the brunt of hospital blunders, according to a damning new report.

Around £116m has been paid out in the last five years to settle cases following clinical and social care errors, with the highest bill for mistakes made against women in obstetrics and gynaecology care.

And a further £136m may be needed to compensate active negligence claims still in the system, the Audit Office found. It means the total bill will top £250m.

Yet despite the huge costs, the watchdog concluded that key lessons and trends are not being shared, limiting health trusts’ ability to improve patient safety.

Many staff have not been properly appraised while incidents still go unreported, its report added.

The Audit Office also notes:

  • Some £28.5m was paid out in negligence cases during 2011/12 — equivalent to £80,000 a day;
  • Women’s issues including obstetrics and gynaecology accounted for a third of payouts in the last two years — around £16m;
  • Over 500 serious incidents were reported to the Health and Social Care Board (HSCB) in the last two years, yet a “blame culture” means staff are reluctant to raise concerns;
  • Cases are dragging on with one claim lasting 27 years and 36 still outstanding after 15 years;
  • Legal and admin costs are adding to the spiralling bill, accounting for a third of the £116m paid out since 2007, and can exceed compensation;
  • Half of all staff — including 93% of paramedics — had not been appraised in the previous 12 months.

Northern Ireland’s hospitals deal with around 1.5 million outpatient cases a year, with another 700,000 accident and emergencies and 500,000 inpatient or day case admissions.

Although the vast majority of patients are treated without incident, in some cases things go wrong.

Some 633 medical negligence claims were lodged during 2011/12, with 3,304 cases submitted in the last five years.

The total cost of settling claims in that period topped £116m, including £39m spent on legal and admin fees.

More than £500,000 was awarded in compensation 10 times in the last two years. However, the Department of Health estimates it will spend another £136m to cover cases which have yet to be settled.

Yet the actual impact will be even higher since the figures do not include the costs of remedying the mistakes.

A breakdown of claims and payouts from 2009 to 2011 shows the largest number related to obstetrics and gynaecology. Compensation totalling £16m was awarded in this area during that period.

Sue Ramsey, Sinn Fein chair of the Assembly's health committee, said the health minister needed to explain why the number of incidents involving women was so high.

She said: “I have been calling for years for a new women's and children hospital, which is women-centred.

“So the minister needs to answer why there is the high level of payouts in this area. The minister needs to answer questions on why this is happening and reassure the services are fit-for-purpose.”

Diane Dodds, DUP MEP, added: “The human aspect of this can never, ever be under-estimated.

“I know because I have worked with a number of families in that situation and it has been very difficult either to understand or accept what's happened.

“Families need clarity. People want to feel safe.”

The next costliest category was accident and emergency issues (14%) with over £4m made in payouts.

The report said 83,000 adverse incidents are reported annually.

More serious errors, known as Serious Adverse Incidents, are reported to the HSCB, and 528 occurred between May 2010 and March 2012.

Recent examples include the pseudomonas outbreak which resulted in the deaths of four babies last winter, and the clostridium difficile infection linked to 31 deaths in 2007/08.

The report questions if enough has been done to learn from mistakes.

It notes the absence of an effective regional reporting system capable of delivering high-quality, routine information on patterns and trends.

“Trusts have, therefore, been unable to benchmark against other Trusts and regional sharing of ‘lessons learned’ has not been as structured and comprehensive as it could be.”

The report claims some serious incidents continue to go unreported.

It refers to the “persistence of a perceived blame culture”, which can undermine staff’s willingness to come forward.

Human tragedies that lie behind a stark tally of statistics

The majority of Serious Adverse Incidents recorded in Northern Ireland involved the suicide of a patient or client.

A total of 528 SAIs were reported between May 2010 and March 2012, 34% of which related to someone taking their own life.

In most cases they were patients or clients who were living in the community but who had been in contact with mental health services within two years of the incident occurring.

An example — not referred to in the Audit Office report — was the deaths of a couple found in a vehicle which had exploded in flames in a field near Ravernet, outside Lisburn, last September.

It is understood the woman had been receiving inpatient and outpatient psychiatric care from the South Eastern Trust. An SAI report was subsequently carried out on the tragedy.

Unexplained or unexpected deaths accounted for 8% of SAIs.

An example is the death of a patient living in the community who was known to the health services for drug or alcohol addiction, but whose cause of death could not be determined.

Violence and abuse accounted for another 13% of cases.

Other SAIs were incidents from acute services, maternity services and infection control.

One example referred to by the Audit Office was the pseudomonas outbreak last winter which resulted in the deaths of four babies.

One of the babies died in the neo-natal unit of Altnagelvin Hospital while three babies died at the Royal Victoria Hospital.

Five per cent of SAIs related to information governance, for example the loss or theft of patient records.

In July the Belfast Telegraph revealed a series of alarming breaches in patients’ data, including one woman whose medical details were posted on Facebook after being left on the wrong answering machine.

Another example was the independent inquiry at Belfast School of Dentistry which concluded there had been a significant problem with the availability and completeness of patient records.

The issue of SAIs in our health service was first investigated by the Belfast Telegraph last September.

Among the incidents uncovered by this newspaper was a woman whose death was linked to faulty dialysis treatment and a patient who died after falling out of a window.

In another case a vulnerable woman, who was supposed to be supervised during a cigarette break, was found on fire by a hospital visitor.

These three cases are not mentioned in Tuesday’s report.

  • The claim that dragged on for an incredible 27 years

The process of settling medical negligence claims needs to speed up, with one case allowed to drag on for 27 years.

Last September, 36 cases were outstanding for more than 15 years, with another 76 aged between 11 and 15 years.

A further 302 cases had dragged on for between five and 10 years.

The Audit Office looked at a sample of cases, including 20 which had recently been settled.

It said the time taken to resolve claims can vary considerably due to a range of factors. These include delays with cases involving legal aid because of eligibility and merit tests, timescales allowed for lodging claims and delays in producing patients’ records.

In 2010, after the Assembly raised concerns about delays in dealing with cases, a review was commissioned of those ongoing for more than 10 years.

The review resulted in the closure of 35 cases. In 23 of them, the plaintiff did not pursue the case. In the remaining 12 cases, settlement was reached and compensation payments were made.

An ongoing review of cases has resulted in a 46% fall in cases running for over five years, from 769 to 414, the Audit Office said.

The report refers to the “substantial” cost of defending and settling claims. In 2011/12, the cost of cases was £28.5m, with £10.4m spent on legal and other costs. The report warns that vast costs can even exceed the compensation awarded.

  • ‘Blame culture’ results in staff too afraid to speak out

Some medical blunders and mishaps are still going unreported because staff are too afraid to speak out, the Audit Office said.

It noted the persistence of a perceived “blame culture” which can undermine willingness to notify managers of incidents.

The report refers to a HSC staff survey in 2010 which showed that 12% of respondents felt their organisation blamed or punished people involved in errors.

Only 41% said they felt there was no blame attached.

The Audit Office asked the Royal College of Nursing in Northern Ireland whether its members felt comfortable raising concerns about patient safety.

“While it assured us that Northern Ireland nurses are fully aware of their professional responsibility to raise concerns about patient safety and standards of care, it told us that, in its view, there remains a certain level of reluctance about raising concerns among nursing staff,” the report said.

“However, the department told us that, in accordance with HSC terms and conditions ... all employees working in the HSC have a contractual right and duty to raise genuine concerns they have with their employer about patient safety, malpractice, financial impropriety or any other serious risks they consider to be in the public interest.”

  • Shroud of secrecy over mistakes should be lifted

The public should be more aware of serious errors which occur in our health service, the Audit Office states.

Over 500 Serious Adverse Incidents (SAI) were recorded in the last two years — but none of the reports was ever published.

The Belfast Telegraph investigated the issue last year, and accessed the reports using the Freedom of Information Act.

Yet, in many cases, the reports were heavily redacted, often revealing little or no details about the incident.

Recently this newspaper attempted to access SAI reports from the last year. However, all five trusts have refused to release them, claiming that to do so would breach confidentiality.

The Audit Office said reports should be more accessible.

“We recognise the benefits in highlighting risks and identifying good practice through the regular reporting of SAIs,” the report said. “Given their value to learning and improving care and safety, we recommend the reports on SAIs, in their current form, are produced on a consistent and more timely basis and are made publicly available.”

According to the report, the Department of Health accepted the recommendation and will ensure that in future all learning reports are made publicly available.

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