Review of BBC radio 4 programme, Doctor - Tell Me The Truth in which Professor James Reason explores how patient safety can be improved by doctors admitting to mistakes.

In case you missed it, you can listen to it again via BBC iplayer: Doctor – Tell Me the Truth

Programme Summary

Each year a significantly high number of people are injured or killed because of the medical treatment they receive. James Reason, Professor Emeritus at the University of Manchester, examined a more open and honest approach to dealing with these mistakes adopted in parts of the US, and asked whether such an approach could be adopted by health professionals in this country.

In the US between 45,000 and 98,000 Americans die each year because of the treatment they receive in hospital. In that country doctors are encouraged to admit their mistakes which has improved patient safety.

In the documentary we first hear the infamous case of ten-year-old Robert Powell who had been an inpatient at Morriston Hospital, Swansea in 1996. Roberts’s parents took him to hospital with symptoms at first thought to be gastroenteritis. The doctors responsible recognised his symptoms as similar to Addison’s disease, a serious yet treatable condition, but failed to order the appropriate tests that would have confirmed their suspicions. Robbie initially got better and was sent home but his conditions got worse and he was seen seven times by 5 doctors over a two week period, some of whom failed to read his medical notes. In the 2 weeks leading to Robert’s death his father protested that he should be admitted to hospital, on the day of his death the GP refused him admission twice. The Powells’ request for an ambulance was also refused resulting in them taking him themselves by car. Tragically, Robert died shortly after reaching hospital. His parents believe he didn’t have to die.

One in ten patients in acute care suffer injury or death as a result of their medical treatment and what compounds the injuries is the way doctors treat their medical mistakes.

The House of Lords subsequently agreed to consider whether getting access to medical records should be easier and if hospitals should be more open; the amendment known as the Duty of Candour, or Robbie’s Law, was subsequently defeated in 2011.

Professor Reason then shifts his attention to the U.S. where work has been underway to change the way doctors deal with errors, both human and organisational, from a confrontational approach between doctors and aggrieved patients to more confession, disclosure, apology and compensation. The professor then discusses what changes in attitude the NHS has made and what further changes may occur in the future.

One US study of New York hospitals found that between 45,000 and 100,000 patients died as a result of the care they received. Harvard University’s Professor Lucian Leape conducted the groundbreaking study which was largely ignored by medical circles at the time despite the shocking findings it describes.

When the report, entitled: To Ere Is Human, was finally publicised in 1999 is paved the way for the seemingly paradoxical notion in the arena of patient safety to be accepted that doctors were not infallible and that mistakes made were a personal shortcoming on their part possibly due to a lack in training. However, medical professionals see a vast array of conditions which are treated using a multitude of techniques, drugs and equipment and mistakes are inevitably going to be made as perfection is virtually impossible, it is argued.

With this understanding, when errors occur doctors should be encouraged to learn from them and not to deceive people as to the cause for fear of litigation.

The programme then visits Rick Boothman and Darrell Campbell at the University of Michigan, the creators of a programme where doctors have to be open about their errors. They describe how previous to their work surgeons would ‘burry their mistakes’, vigorously ‘deny-and-defend’ and stonewall any complaints made against them almost up until the point of a trial and then settle out of court – a costly and time consuming approach which would increase the anguish for patients and delay the implementation of any clinical learnings from cases. We then hear moving stories about face-to-face apologies from patients, doctors and lawyers.

Boothman and Campbell then contrast this with the present system in which investigations into errors can be started even before the patient comes round from their anaesthetic. How did telling patients that the hospital had made a mistake, even if the patient didn’t realise they had been harmed, affect the patients’ propensity to sue? Surprisingly, patients were far less likely to sue. By making an early admission of negligence and an early offer of compensation, the Michigan study found administrative costs were consequently reduced.

Could the US experience be tried here? One commentator suggest that this more open approach could be adopted in the UK because doctors are normally not personally and financially liable under the NHS umbrella which is in contrast to the US position where a doctor could be individually liable for any damages awarded.

Next Week’s Episode

In episode 2, to be aired on BBC Radio 4 on Monday 5th March at 8pm, Professor Reason will consider whether an open disclosure approach is worth trying in the NHS and do the authorities in this country have the power to insist doctors tell the truth?

The Advancing Quality Alliance (AQuA) show Pennine Acute Trust figures improve but treatment of heart failure still poor.

The third annual results, published by the Advancing Quality Alliance which is funded by North West healthcare organisations themselves, show improvements in key quality measures designed to drive up standards.

Under its flagship, Advancing Quality programme, the organisation aims to reduce complications, lengths of stay and readmissions for patients in regularly performed treatments including heart attacks, hip and knee surgery and heart failure by promoting consistent good practice.

Royal Oldham Hospital Results

Results in four clinical areas of Pennine Acute Trust, which runs the Royal Oldham Hospital, have been made available. The good news is that the trust did better for important clinical measures: in heart attacks (97 per cent), hip and knee replacement surgery (87 per cent) and pneumonia (84 per cent). All of which improved on the results the previous year’s results.

However despite the results improving by 3 percentage points on the previous year, in the heart failure category standards were met only 60 per cent of the time. Part of the poor result in heart failure treatment was due to low scores in advice given to patients upon discharge and adult smoking cessation advice and counselling.

the Trust’s associate medical director, Dr Christina Kenny, countered that she expected the heart failure treatment result to improve by at least 10 per cent in the next set of Advancing Quality Alliance figures.

A further £185m is required to cover the increased costs, especially in birth injury claims.

The reason for additional funds being made available by the Government has been put down to the increasing levels of high cost claims brought against the NHS for medical negligence compensation, especially for birth injury claims which require 24-hour care and compensation settlements often reaching £6m to cover those lifetime costs.

According to recent figures the amount of compensation paid out by The Authority, which handles medical negligence claims made against the NHS, has increased from £277m to nearly £1 billion in the last ten years.

The government has given the NHS Litigation Authority £185m until April to cover the cost of claims and legal fees.

Peter Walsh, chief executive of the charity Action against Medical Accidents, said most of the increased costs came from a judgment that injured children are entitled to more compensation.

‘The government and the NHSLA have known about this for a long time and it shouldn’t have come as a surprise.’

NHS managers have stated that one of the major reasons behind the increase is a rise in the number of birth injury claims which involve a high cost of lifetime care.

Birth Injury Claims

Official statistics from the NHSLA reveal that there are nearly 100 birth injury claims against the NHS each year, which involve new-born babies that suffer brain damage at birth. The medical negligence compensation paid out per child in such cases is around £6 million due to the  improvement in the survival rates and life expectancy of brain damaged babies.

Health Minister, Lord Howe has commented that the vast majority of NHS patients receive a high standard of care; however, when mistakes are made it is only right that medical negligence compensation should be paid.

Contacting Us

If you require legal advice on making a birth injury claim, or any other medical negligence claim, please contact us on 0161 785 3500 or at john.pollitt@phsolicitors.co.uk or contact us here.

The compensation will go towards paying for clinical care for the girl who is now 11 years old.

North Cumbria University Hospitals NHS Trust which runs Cumberland Infirmary in Carlisle has admitted negligence during her mother’s labour, which resulted in the baby suffered brain damage after delays at her birth causing the life changing injuries occurring.

After describing it as a “very, very severe case” Mr Justice Haddon-Cave ordered that the family be paid a £2.3m lump sum and index-linked payments of up to £200,000 a year for life.

The medical negligence compensation will go towards special modifications to the house as well as specialist equipment and support from a team of carers

The Court heard that the girl, whose life expectancy is also reduced, suffered extensive brain damage and will now require round the clock care from her parents and carers.

The BBC has reported ho medical staff missed signs that the girl’s mother had suffered a placental abruption before and during the girl’s birth which led to a delay in delivery. This caused the baby to suffer oxygen starvation of the brain.

Contact Us

To speak to a medical negligence compensation solicitor without obligation, please telephone 0161 785 3500,email John.Pollitt@phsolicitors.co.uk or contact us here

THE Pennine Acute Hospitals NHS Trust is reassuring the public that it does not and has not …

From the Action Against Medical Accidents (AvMA) blog

Download AVMA’s press release

Pearson Hinchliffe Solicitor’s Medical Negligence department head, John Pollitt, is a member of the AvMA Specialist Clinical Negligence Panel.

Contact us

To speak to John Pollitt about any matter relating to medical negligence, please contact him on 0161 785 3500 or email John.Pollitt@phsolicitors.co.uk for a free review of your case.

NHS Heywood, Middleton and Rochdale’s latest performance report states: “It was agreed that to assist with the reduction of ‘backlog’ patients that had waited over 18 weeks, 250 patients would be transferred to Independent Sector (IS) providers.

“The specialist ophthalmology patients have now been treated at IS providers as have most of the trauma and orthopaedic patients (the remainder being sent out in the next three weeks).”

Patients from the trusts general surgery backlog will also be sent to the private sector.

The report went on to say that although the trust had been told by NHS North West that it had to recover its position against waiting times targets by the end of September, targets for admitted patients had not been achieved in September or October.

Pennine Acute Trust’s latest performance report, to the end of October 2011, shows it has not met the target of 90 per cent of admitted patients treated within 18 weeks in any month of 2011-12. However, it shows improved performance in October, missing the target by just 0.2 per cent.

The PCT’s report states that Pennine Acute were delivering against the admitted waits target in 2010-11, but performance deteriorated in April 2011 and the position has not been recovered since.

Pennine Acute’s board report states that a “detailed recovery plan” has been submitted to the SHA, and “specific improvement trajectories for reduction of the 18 week backlog” agreed with PCTs.

It adds: “An 18 Week Recovery Group was established to ensure effective implementation of the improvement plan.

“There are senior operational representatives from organisations across the North East Sector. The Recovery Group meet weekly, reporting to the North East Sector Commissioning Board, and the Trust’s Performance Management Group (monthly).”

Performance report

Source: Health Service Journal

Staff have been ordered to improve standards by this Friday.

The Trust’s management was given a deadline of until Friday 6th January 2012 to comply with CQC inspectors’ concerns.

Tameside Hospital has faced long-standing criticisms over patient safety and standards of care going back nearly a decade.

The CQC originally uncovered the problems in a surprise visit in March 2011 followed up with another inspection in October. Among the issues were the way patients’ needs were documented, patient falls were inconsistently recorded or incomplete.

Campaigners have called for the board of directors to step down. Liz Degnen, who has been campaigning for improvements at Tameside since her mother died two years ago, said: “I’m appalled but not surprised by the CQC’s findings. This is another nail in the coffin for Christine Green and the board. The people who are being really let down are the patients and staff. They deserve better and it is time for the management to go.”

Tameside Hospital chairman Paul Connellan said: “I recognise the importance of the issues that the CQC review raises and I share the trust’s disappointment that standards are not being universally attained. Work is ongoing to address this.”

A spokesman for the trust said he believed the hospital was ‘safe’ and raising quality was its priority.

Dear Mr Pollitt

As our cases against East Lancashire Hospitals draw to a close I think it is now an appropriate time to thank you for the skill that you have used in dealing with my family […]

As you are fully aware the three years since we lost [our son] have been a harrowing period of time for the whole family in its widest scope, however, the way that you have conducted the cases has been thoughtful, sincere, never patronising and always highly professional.

As you are also aware the cases brought have never been about money but about “fair play”. This, I am positive, you have achieved.

Finally, I don’t know whether my family can eventually put this behind us, I suspect not, as it will be a part of our lives for ever.

John, once again thank you from the bottom of my heart.

Yours sincerely

David Wood

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