Every autumn, without fail, there are reports of despair from the NHS front line as an increasingly creaky service tries – and fails – to keep up with the needs of a growing, aging population. This year, the pressure has been ratcheted up by several notches.
A recent report on overcrowding in A&E departments from the Royal College of Emergency Medicine (RCEM) is a stark reminder of the challenges faced by hospitals throughout the country, describing the extreme pressure on A&E as ‘a major threat to public health’. Excessive waiting times (12 hours to be admitted is not uncommon), use of ‘trolley wards’, and ambulances stacking up for hours at a time are all contributing to real concerns that errors will increase and patients will be harmed.
Patient safety compromised by lack of beds…
Patient safety has been recurring theme in my recent blogs but it seems, increasingly, like a circle that cannot be squared. The pandemic has obviously caused a seismic upheaval in the ability of the health service to deliver, but Covid has simply exacerbated an already difficult situation. According to the RCEM report, over 8,300 beds were lost between 2010/11 and 2019/20: in 2000 there were 4.1 beds per 1000 people, by 2020 there were 2.4 beds. Add in the required Covid-related distancing and the average bed occupancy across the NHS has risen to 90.9% meaning that it doesn’t take much to gum up the whole system, causing crowding issues elsewhere in the hospital, particularly in A&E.
...and staff shortages
The RCEM report highlights three main issues contributing to the problem: people using A&E because of a perceived difficulty in accessing GP care, staff shortages and an inability to discharge patients who no longer require medical intervention due to the lack of integration between the health and social care systems. The report acknowledges that long term outcomes for patients are being directly impacted: elective patients unable to receive timely treatment end up becoming acute cases; and there is causal link between excessive waiting times to be admitted and increased patient mortality. There is already hard evidence that patients are being harmed because the NHS can’t cope: the cost of medical negligence claims as result of errors in emergency medicine now accounts for 14% of the running costs of A&E.
Radical plans needed to relieve pressure on NHS
It is clear that the NHS is currently stuck between rock and a hard place. If there aren’t enough staff to cope, the system has no choice but to rely on those who are available and hope that they get through their shifts without a major crisis. This situation is having a negative impact on staff morale and mental health and, because of the length of time it takes to train doctors and nurses and the current difficulty of recruiting from outside the UK, this situation will not be resolved any time soon. Likewise, the staffing crisis in the care sector is also having an impact on patient ‘throughput’ with nursing homes struggling to accommodate patients who are frail and vulnerable but no longer need medical care.
The government has been sufficiently spooked by the impending catastrophe of patients either dying needlessly or being permanently harmed by lack of timely medical care, that it has ordered NHS England to come up with radical plans to clear the mounting elective backlog. So far, there have been suggestions to send elective patients to hospitals that have capacity to treat them, regardless of area, and cut the number of follow up appointments drastically.
Avoidable errors likely to increase
There is no doubt that the likelihood of patients being irreparably hurt through avoidable error is growing – even though the vast majority of medical practitioners will be straining every sinew to give their patients the right care. But tiredness and overwork will inevitably take its toll unless drastic action is taken quickly. Nonetheless, I hope I can offer some consolation for beleaguered staff: medical error does not necessarily lead to litigation – in most cases there will be no case to answer because a reasonable body of medical opinion will concur that they would have made a similar decision. Where negligence claims will succeed is where the reasonable body of medical opinion agrees that the action taken was not of the standard expected.
Litigation is rarely a first option for patients
Taking on a claim as a patient is not for the faint-hearted. In my experience, people will only come to me as a last resort – and I will only take on their claim if it has merit: more than 85% of our initial enquiries from patients fail the test and are rejected (and these in turn represent a very small minority of patients who have been treated). There is not a compensation culture when it comes to medical mistakes. There cannot be – experienced medical negligence lawyers know how finely judged many medical decisions are and know that negligence is very rarely the reason for making a wrong call.
Operating under the current pressures, staff will, inevitably, be worried about making a mistake. However, if I can impart one piece of advice then it is this: be transparent about what has happened, explain why it happened, and then apologise. This is more likely than anything else to head off a complaint. Patients only tend to turn to lawyers when their voices are simply not being heard and they are cut out of the information loop. Simple, really.