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NHS needs to improve collaboration and feedback to avoid clinical errors

It was recently revealed that NHS England faces paying out £4.3bn in legal fees to settle outstanding claims of clinical negligence, with the Department of Health claiming an “unsustainable rise” in litigation costs.

There are several ways to drive down the cost of clinical negligence legal fees but one that remains out of the limelight is what is being done to tackle the causes of errors.

Why do claims come about? For some patients, the trigger is not because they want money to help pay for private care or cover financial losses, but because their complaint did not bring about the answers or apology that they felt they deserved.

Many unsatisfied patients say that the complaint handling was inadequate or didn’t address what mattered most to them; they feel they were not heard or if they did get an apology it was insincere or impersonal.

The real issue though is the prevention of the reason for complaint.

One area I feel the system fails is communication between specialisms, particularly where a patient suffers from complex comorbidities. Some of these incidents are frankly complex and only in hindsight can the error be seen.

It is these cases where a safety incident identifies how and why the incident happened that should be an easy source of information to feedback to all relevant staff to put better systemic barriers in place.

I had the privilege of attending a hospital audit and presented several case examples to medical professionals. One case involved a client being told lessons were learned and that all hospitals in the UK would be informed of the error and update their policies to ensure it was not repeated. Needless to say, they did not know of the case but fortunately already practiced the better method.

I recently presented to and discussed some cases to an audience of about 80 radiologists and radiographers. I relayed the headline statistics for diagnostic imaging (42.7million imaging tests reported in England) to demonstrate the enormous contribution they have to the NHS.

I showed an example of delayed diagnosis where radiology had reported an incidental finding but the requesting clinician missed the information due to being too busy to read the full report. This opened a debate on how to ensure users of a radiology service utilise the report and are alerted to unexpected findings.

We have come a long way from the introduction of the NHS in 1948. We have three times as many nurses and 9.8 times as many doctors caring for patients in a quarter of the bed count.

This is only achievable by working increasingly fast. Many clinicians and nurses note this pressure to increase throughput of patients, sending them home to rehabilitate, potentially increases the risk of errors.

The NHS needs to increase collaboration and promptly provide feedback so all affected can learn from mistakes. I believe team appreciation and staff retention, working well with others within the organisation or those adding to patient care, is less likely to create an environment that acts as a magnet for incidents of error.

Catherine Leong, Solicitor in Lime Solicitors’ Clinical Negligence team

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