World Patient Safety Day 2019

Up until recently, I was unaware that every year the 17 September is worldwide Patient Safety Day.

This has now been adopted by the World Health Organisation. The primary aim is to encourage everyone involved with the healthcare system to work together and improve patient safety. Nobody would disagree that such efforts should be encouraged – but can we do more?

Nick Gray, Head of our Clinical Negligence Department questions what role legal claims can play in helping to enhance patient safety.

In my experience most people are motivated to bring legal claims after suffering poor healthcare because of numerous reasons other than financial gain.  The most common is to prevent other patients going through what they have experienced and suffering similar avoidable harm.  Nevertheless, the way in which the legal process works is to keep them away from the healthcare practitioners who would learn the most when hearing directly from the patient about what went wrong.  One cannot imagine a more powerful way to deliver this message and ensure that patient safety remains at the forefront of everyone’s mind.

NHS Resolution, the organisation responsible for dealing with legal claims brought against the NHS for negligent healthcare, should be leading the way in finding any advocates to champion patient safety messages.

There is a ready supply of affected patients who I believe would only be willing to do so.  Unfortunately, they seem to be routinely excluded from the process.  Instead the legal claim is dealt with in a vacuum, with no opportunity for any of the healthcare staff to listen to the patient’s story in his/her own words.

One experience earlier this year stands out in my mind to demonstrate a lost opportunity to engage and involve an injured patient with any initiatives to help promote patient safety learning.  At a mediation meeting shortly before trial, my injured client made it very clear to the representatives of the Hospital concerned that she wanted to know what steps had been taken to prevent a similar event occurring again.  They made promises to obtain and share such information after the mediation.  Despite chasing this on her behalf regularly, no information was provided until almost 3 months later.

How could this have been dealt with better?  If she had been the chance to speak directly with the Hospital staff and/or record a video message to share the impact of the admitted negligent care I feel this would have resonated much more than any PowerPoint presentation.  It would also meet her objectives in being able to implement change and improve patient safety for others.

If I bring a successful legal claim for my avoidable injury, will this result in changes to promote better patient safety?

It is not currently possible to guarantee this will happen.  The responsibility for ensuring such learning occurs rests with NHS Resolution.  In the future, I feel those affected should be involved much more closely.

Are there any other ways to ensure patient safety is given priority?

The starting point is to investigate your care with the benefit of independent expert evidence.  Such an approach is adopted with legal claims.  If serious patient safety issues become apparent, these can be raised with the Defendant Trust responsible for the Hospital and a request that action be taken.

If a Coroner is involved, they have the power to issue a Regulation 28[1] report requiring an individual/organisation to take action in order to prevent further deaths from occurring.

If you would like assistance investigating poor patient safety please contact our experienced Medical Negligence team on 01482 323697. You can also use the form below.

[1] Pursuant to the Coroners (investigations) Regulations 2013