Tackling the cost of medical negligence

The Department of Health, Social Services and Public Safety, and health and social care trusts must do more to avoid harm to patients, encourage staff to report incidents and reduce the cost of negligence claims. agendaNi reports.

The Health Service must eradicate the ‘blame culture’ which prevents many staff from reporting adverse incidents that could potentially harm patient safety. High quality information on patients, trends and underlying causes of harm should be available on a regional level so that incidents can be anticipated and lessons learned.

These were some of the recommendations from the report by the Comptroller and Auditor General, Kieran Donnelly, examining the safety of health services in the five health trusts.

Approximately 83,000 adverse incidents are reported each year by health and social care organisations in Northern Ireland. In addition, 633 medical negligence claims were lodged in 2011-2012.

Since 2007, the Department of Health, Social Services and Public Safety has paid out £116 million to settle claims for clinical and social care negligence, £77 million in compensation and £39 million in legal and administrative costs. It is estimated that a further £136 million will be needed to meet the compensation costs of the 2,670 active clinical and social care negligence cases that were in the system in April 2011.

Since May 2010, 528 serious adverse incidents were reported, 35 per cent of which were related to maternity care, family and childcare services and infection control. Examples include the Clostridium difficile outbreak, linked to 31 deaths in 2007 and 2008, and the deaths of four babies (three in the Royal Victoria Hospital and one in Altnagelvin) from a pseudomonas bug. The next most common incident was suicide (34 per cent), followed by violence and abuse (13 per cent), unexpected or unexplained death (8 per cent), information governance incidents (5 per cent), and the loss or theft of prescriptions from GPs (4 per cent).

The Northern Ireland Audit Office report recognised that “a regional process for reporting, managing, analysing and learning from serious adverse incidents is in place.” However, it criticised the lack of a “cohesive management information reporting system capable of delivering, at a regional level, high-quality, routinely available information.”

Other recommendations included:

• all HSC staff should be assessed on a regular basis to avoid poor performance;

• trusts should encourage a culture of openness so that reporting levels increase e.g. by providing prompts for staff on areas to consider when filling out reports and informing staff about changes that have been made because of incidents they report;

• the information emerging from patient safety data should be more directly linked to establishing regional reduction targets and goals;

• reports on serious adverse incidents should be produced on a consistent and more timely basis and made publicly available; and

• the department should develop a formal dispute resolution procedure as a viable alternative to litigation (as injured parties currently have to take legal action in order to get compensation, an explanation or an apology.)

The report also stated that, in 2010, one claim had been live for 27 years. In September 2011, 36 claims were still live after 15 years and there were a total of 414 live claims.

Sinn Féin’s Sue Ramsey, Chair of the Assembly’s Health Committee, questioned the high level of incidents involving women i.e. 25 per cent of medical negligence claims at 31 March 2011 related to obstetrics and gynaecology.

“I have been calling for a women’s and children’s hospital, which is women-centred,” she said. “The Minister needs to answer questions on why this is happening and reassure that services are fit-for-purpose.”

DUP MEP Diane Dodds noted that “the human aspect of this can never, ever be under-estimated.” She has worked with a number of families “and it has been very difficult either to understand or accept what’s happened.” Dodds insists that “families want clarity” and “people want to feel safe.”

The cost of negligence claims shocked Alliance Health Spokesman Kieran McCarthy. “With growing pressures on our Health Service and increasing waiting lists, I am sure that this money could have been better spent,” he said.

Edwin Poots “must urgently look at this report and see what changes he can make to cut down on these claims,” he advised. “Is this bill so high because of genuine mistakes, a lack of training, too much pressure on staff or poor equipment?” McCarthy asked.

The department’s Quality 2020 safety strategy is “an important initial step reduce the level of patients and clients who experience harm while in a clinical or social care setting,” the report notes. It also recognises that the department is attempting to raise awareness among the trusts of the need to ensure more openness and honesty when things go wrong. “However, while levels of reporting are increasing, there continues to be under-reporting, particularly within hospitals,” it states.

An inadequate information reporting system limits the ability of health and social care services to monitor performance and improve patient safety. Trusts, it concludes, have been unable to benchmark against other trusts and regional sharing of ‘lessons learned’, except for serious adverse incidents,” has not been as structured and comprehensive as it could be.

*1,374 claims were closed between 2009 – 2011, of which 326 (24 per cent) resulted in compensation