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7-Day NHS ‘impossible’ under current financial strain

After Jeremy Hunt’s Department of Health established a link in 2015 between increased patient mortality rates and weekend-admissions, the Health Secretary set in motion plans to deliver a 7-day NHS that would seek to address this. The ‘Weekend Effect’ as it has since been labelled, was first commented on by Blackwater Law medical negligence solicitors in 2014, when we commented on the findings of a study into surgical procedures and survival rates published in the British Medical Journal. Click here to read the ‘Possible increased risk of clinical negligence on certain days of the week’ article.

Now though, according to Chief Executive of NHS Providers Chris Hopson, chronic underfunding has made the concept of a 7-day NHS an entirely unrealistic prospect, and under a government that seems more concerned with “pretend[ing] the gap doesn’t exist”, patients may be at risk of falling care standards. This, inevitably, increases the risk of clinical negligence faced by patients, and has many fearing they may need to rely on clinical negligence solicitors to seek recompense in an increasingly overstretched health system.

Figures examined by the BBC in the build-up to a September 2016 airing of the Andrew Marr programme indicate that the NHS is currently struggling under record waiting periods and delays in patient discharges. All this despite the government’s insistence that it has given NHS England a £10bn funding boost, and that patient care standards must be maintained as a result.

NHS Providers represents hospitals all across England, and now warns that unless significant additional funding is sourced quickly, it will have to introduce “draconian rationing” of treatment, particularly in reference to non-urgent surgery. The figures are indeed damning, as just three years ago only around 5% of England’s acute hospitals were run at a financial deficit, compared to a staggering 80% today. Mr Hopson summarised the seriousness of the situation in telling the BBC that the NHS was under the “greatest pressure that we’ve been for a generation”, and added:

“Jeremy Hunt and others have made a very strong case for seven-day services, but it seems to us it’s impossible on the current level of staff and the current money we have available.”

Hopson also tied the increasingly dire financial situation to systematic failures in the NHS’s governance – not management of individual trusts – intimating that frontline staff are already struggling to cope with current workloads under contemporary funding levels, and that without further investment NHS England simply could not continue to provide sufficient care standards under a 7-day rota. These comments will do little to quell the concerns of those that have suffered poor medical care themselves previously, or those of medical negligence solicitors who are acutely aware of the devastating impact poor medical care can have on patients and their families.

Hopson’s warnings come at a crucial time, with the Commons Health Select Committee considering the prospect of an inquiry into the state of the NHS. The wider financial context doesn’t look good either, with 50 English hospitals authorised by the government to miss key waiting times targets  in a bid to tackle severe financial difficulties. Our article ‘NHS trusts to be allowed to miss key waiting time targets’ discussed this issue shortly after it came to light.

Some hospitals are already discussing drastic measures, with the Vale of York Trust narrowly avoiding the implementation of plans to suspend non-urgent treatment for obese patients and smokers following an intervention by bosses.

Chief Executive at the think-tank The King’s Fund, Chris Ham, has weighed-in on the discussion, telling BBC reporters that the government needs to act swiftly to avoid a full-blown crisis, issuing the following statement:
“It is simply not realistic to expect hard-pressed staff to deliver new commitments like seven-day services while also meeting waiting time targets and reducing financial deficits.”
Shadow Health Secretary Diane Abbot adds:

“Years of Tory underfunding of the NHS has made it is impossible to provide the right quality of service and meet performance targets…The government needs to properly fund the NHS if it is to function properly.”

Hopson now warns of a serious decline in care comparable to that of the 1990s under John Major’s government, and highlights a “full-blown crisis in social care” prompted by cuts to town hall budgets. Unless further investment is found – and quickly it seems – NHS patients across the country may be at risk of cuts to medical service standards and an increase in the incidence of medical negligence.

Jason Brady, medical negligence solicitor at Blackwater Law, commented:

“It is clear that some medical professionals can be under significant pressure to service the increasing medical needs of the public. There could be a case to suggest that it is not only the doctors and nurses that suffer as a result of Trusts’ financial difficulties. There needs to be a careful analysis of the effects that any financial decisions have on patients as the public should not be open to paying the human cost of such decisions should they lead to a lower standard of care being provided.”

The cost of traumatic brain injury to the UK

The costs of Traumatic Brain Injury to the UK as a whole are not as well understood as its immediate consequences, in part due to difficulties in quantifying human emotional cost, and also because of how brain injuries affect some victims more severely than others. Nonetheless figures from a wider European study commissioned by the European Brain Council and summarised in Olesen et al. (2012) can be extracted to give some basic estimates of financial cost in the UK.

Traumatic brain injuries cost £5.1billion

Focusing on figures collated for a single year (2010) and accounting for both contemporary cases of traumatic brain injury and historical ones with lasting health implications for the victim(s), the study gives an insight into the annual costs of providing health and social care, plus economic output losses as a result of long term disability (but not premature mortality) of victims. When extrapolated from the wider European figure and converted from euros into pounds, the total annual cost was calculated to be in the region of £5.1 billion, allocated to 452,000 cases of traumatic brain injury. Of these cases, 145,000 were deemed “incident” cases occurring in 2010, with the remaining 307,000 having occurred at some point over the previous 20 years with lasting disability costs qualifying them as “prevalent” cases. Costs were calculated on the basis on the number of people admitted to hospital for treatment of a traumatic brain injury.

On an individual basis, this breaks down to an approximate cost of around £11,340 per year, per case. It was not possible to breakdown exactly how these costs were divided specifically for the UK, however in the broader European context around 31% of the costs related directly to healthcare, with care costs (including informal care) measured at around 10%, and economic output losses at 59%.

Relying too much on these average figures is reductive however, as the study’s authors note. “Incident” cases are likely to incur a far higher cost allocation in regards to healthcare for an immediate incident than “prevalent” cases, whose health costs are spread more evenly across a number of years. On the other hand, it’s also true that “prevalent” cases are comprised of more moderate to severe brain injury cases, as these are the ones more likely to incur lasting costs over a period of several years, whilst “incident” cases include costs for mild injuries that in time may no longer be a source of significant expense.

Costs of brain injury in UK may be lower than other countries

Detailed, up-to-date studies from other developed countries are hard to come by, so it’s difficult to assess just how the costs of traumatic brain injury in the UK compare, especially if population size inconsistencies are to be taken into account. Nonetheless, estimates from the Centre for Mental Health’s economic analysis; released July 2016, indicate that annual costs of traumatic brain injury in relation to national gross domestic product (GDP) stand at around 0.815% for the US, 0.351% for Australia and 0.328% for the UK.

Some studies however prefer to estimate costs based not on incidence rates recorded in terms of hospital in-patients, but on prevalence rates amongst the general population, which would shift the number of UK cases per year from 452,000 up to around 1.3million. When this approach is adopted, aggregate brain injury costs relative to UK GDP rise to 0.934%, with conservative estimates indicating this would amount to around £15million per year, again with the lion’s share allocated to a loss of economic output from victims.

Figures don’t provide for human cost of brain injury

Whichever approach is taken, incident of traumatic brain injury cost the UK economy billions of pounds every year, and this does not account for losses in terms of quality of life or bereavement to the individuals, families and friends involved, which should surely rank highly in any appraisal of their impact on the nation as a whole.

Essex NHS Trusts report 1035 Serious Incidents impacting care

NHS Trusts in Essex reported 1035 serious medical incidents and errors impacting patient care in the year 2015-16 according to official NHS data collated by medical negligence solicitors in Essex.

Following a Freedom of Information Act (2000) request, Blackwater Law medical negligence solicitors in Essex have discovered that the nine NHS Trusts operating in Essex reported a significant number of  ‘Serious Incidents’ having taken place in the reporting year 2015-16.

Breakdown of Serious Incidents at Essex NHS Trusts:

Below is a table presenting the number of Serious Incidents reported by Essex NHS Trusts across Essex.

Essex NHS TrustReported Serious Incidents 15/16
Barking Havering & Redbridge University Hospitals NHS Trust184
Basildon & Thurrock University Hospitals NHS Foundation Trust162
Colchester Hospital University NHS Foundation Trust147
East of England Ambulance Service NHS Trust83
Mid Essex Hospital Services NHS Trust134
North Essex University Partnership NHS Foundation Trust78
North Essex University Partnership NHS Foundation Trust62
Southend University Hospital NHS Foundation Trust124
The Princes Alexandra Hospital NHS Trust61

Serious Incidents are described by the NHS as:

“Serious Incidents include acts or omissions in care that result in; unexpected or avoidable death, unexpected or avoidable injury resulting in serious harm – including those where the injury required treatment to prevent death or serious harm, abuse, Never Events, incidents that prevent (or threaten to prevent) an organisation’s ability to continue to deliver an acceptable quality of healthcare services and incidents that cause widespread public concern resulting in a loss of confidence in healthcare services.”

(Serious Incident Framework: Supporting learning to prevent recurrence 7)

Whilst the NHS does not set out a definitive list of what is and is not a Serious Incident, such mistakes, errors and accidents include:

  • unexpected or avoidable death of a patient,
  • unexpected or avoidable injury leading to patient harm,
  • acts or omissions that constitute neglect of a patient,
  • unexpected or avoidable injury requiring additional healthcare treatment so as to prevent death or serious harm,
  • occurrence of a Never Event.

Where a Serious Incident is recorded, this may be an indication that medical negligence has occurred. Patients who have been the victim of medical negligence may be entitled to medical negligence compensation and should seek specialist legal advice from a solicitor such as those at Blackwater Law, based in Essex.

Comment from an Essex medical negligence solicitor:

Being based in Essex, Blackwater Law medical negligence solicitors are well positioned to comment on these worrying statistics. Jason Brady, Head of Blackwater Law’s specialist team of medical negligence solicitors, commented:

“These figures are a concern, mistakes and errors on the part of medical professionals can have a devastating impact on patients and their families. As a medical negligence solicitor, I see how patients’ lives are changed forever due to these mistakes and errors.

“It is crucial that in addition to simply reporting when Serious Incidents occur, Essex NHS Trusts take action to review and improve procedures so that mistakes and errors are minimised in the future.”

Why has Blackwater Law collated this Serious Incident data?

Data on the number of Serious Incidents reported by NHS Trusts across England and Wales is not published publicly and is therefore not accessible without making a request for this information under the Freedom of Information Act (2000).

We at Blackwater Law believe this information is critical to gauging performance levels of NHS Trusts. It is also important to identify those NHS Trusts reporting proportionately higher numbers of Serious Incidents as this may be an indicator of higher rates of medical negligence and lower quality patient care provision at these Trusts, which would be of public concern.

In addition to collating and reviewing data on reported Serious Incidents, Blackwater Law medical negligence solicitors also analyse data on Never Events reported by NHS Trusts across England and Wales. Never Events are the most critical of Serious Incidents and are so severe and such fundamental errors, that they should never occur.  Never events include errors made by medical professional s such as:

  • Performing a procedure on the wrong patient
  • Performing a procedure o the wrong part of a patient’s body
  • Leaving medical apparatus inside a patient’s body following a procedure

NHS Trusts in Essex reported a total of 12 Never Events in the year 2015-16. This is included in the figure of 1035 reported Serious Incidents, with these 12 being the most severe of such incidents.

Have you or a family member been the victim of a ‘Serious Incident’?

If a mistake or error was made in the delivery of your care, to the extent this would be classified by the Trust as a Serious Incident, you should have been notified by the Trust. If you have received such a notice, it may be that the mistake or error made constitutes medical negligence. Patients that have been the victim of medical negligence may be entitled to claim medical negligence compensation for the pain and suffering they went through as a result, as well as compensation for any loss of earnings, due to having to be off work for example.

It may be though that a Serious Incident was reported in relation to a mistake or error made in the delivery of your care but you were not notified. If you believe an error was made in delivering your care, whether or not you received notice of a Serious Incident having occurred from the Trust, you may be entitled to medical negligence compensation.

Free initial medical negligence compensation advice:

To find out whether you may be able to claim compensation, call Blackwater Law medical negligence solicitors today on 0800 083 5500. You will receive free initial advice from a specialist medical negligence solicitor.  Blackwater Law medical negligence solicitors advise and represent clients across England and Wales in making claims for medical negligence compensation. The specialist team at Blackwater Law is independently recognised by The Legal 500 – a directory of the UK’s top law firms – as being one of the leading sources of medical negligence claim advice in Essex.

91 Never Events reported by hospitals in three months

Statistics released by NHS England show that hospitals in England recorded 91 Never Events between January and March of this year.

‘Never Events’ are ‘serious, largely preventable patient safety incidents’ which occur in the delivery of medical services. Where a ‘Never Event’ takes place, it is often the result of clinical negligence. As the name suggests, the mistakes and clinical negligence involved in such incidents are so fundamental that they should simply never occur.

Never Events, as reported by NHS England, include patients having the wrong part of their body operated on, having medical apparatus left in their body after a surgical procedure and having the wrong implant or prosthesis implanted. In total, 91 Never Events were recorded by hospitals in England between January and March 2016. The most common mistakes were undertaking surgery on the wrong part of the body (39 incidents), leaving medical apparatus inside patients following surgery (23) and placing the wrong implant or prosthesis in patients (13).

70 NHS Trusts and private organisations reported ‘Never Events’ in the three month period January to March 2016. The worst performing organisations during the period were:

  • Birmingham Children’s Hospital NHS Foundation Trust with four incidents.
  • Salford Royal NHS Foundation Trust with three.
  • Imperial College Healthcare NHS Trust with three.
  • Great western Hospitals NHS Foundation Trust also with three.

Clinical negligence of course includes such serious and obvious clinical mistakes as Never Events, but many other medical errors which may be considered less severe, perhaps a misdiagnosis, also arise out of medical negligence and can cause significant suffering and distress.Commenting on the statistics reported by NHS England, Jason Brady, clinical negligence lawyer at Blackwater Law solicitors in Essex and Suffolk said:

“Never events are instances of clinical negligence that put patients’ lives at risk. As such incidents arise from human and process errors, all Never Events can and should be avoided.

“Trusts should try to learn from the mistakes and errors they make and take action to try to ensure such incidents do not occur again when presented with the same situation and circumstances.

“Patients, or family of patients that have been the victim of clinical negligence or Never Event, may be entitled to make a claim for compensation. We have found that sometimes it can take legal action to encourage the necessary focus in large organisations such as the NHS.”

Two Essex NHS Trusts Among Worst in Country for Serious Medical Errors

According to official NHS England statistics, two NHS Trusts in Essex were among the worst NHS Trusts in the country for the number of serious medical errors taking place at hospitals under their control. Such incidences put patients at unnecessary, and in some cases serious risk.

Colchester and Chelmsford Hospitals’ Serious Medical Errors

Following on from our previous article on the amount of “Never Events” occurring at Colchester Hospitl, figures published on 29th April 2015 (the most up to date annual figures available) suggest that Mid Essex Hospital Services NHS Trust (which operates Broomfield Hospital in Chelmsford) and Colchester Hospital University NHS Foundation Trust committed a combined total of 15 serious, avoidable medical errors between 1st April 2014 – 31st March 2015. Such incidents are called “Never Events” because it is argued that they are such basic errors that they should never occur. Such mistakes include operating on the wrong patient, leaving medical apparatus in patient’s bodies after surgery, or operating on the wrong part of a patient’s body.

Of concern to those living in the Colchester area, Colchester Hospital University NHS Foundation Trust was the worst performing Trust in the country, recording a total of 9 serious, avoidable medical mistakes. Mid Essex Hospital Services NHS Trust did not perform much better, recording a total of 7. Across England, a total of 308 serious and avoidable medical errors were recorded with the most common mistakes being operating on the wrong part of patients and accidently leaving medical apparatus inside patients. Of course, both pose significant risks to patients’ health.

Concern for Patients Living in Essex

Commenting on the news, Jason Brady, a clinical negligence solicitor at Essex based law firm Blackwater Law, said:

“It must be concerning for patients and families of patients in Essex that rely on and use these health care providers. We act for victims of medical negligence in Essex whose lives have been turned upside down because of the mistakes made by GPs and medical professionals at hospitals in Essex. Some of these cases are truly harrowing, not least because they may have been avoided.

“Often those that suffer because of a mistake made by their GP or hospital simply want answers as to why it happened. Whilst there are complaints procedures in place at all hospitals and GP practices, it is unfortunately sometimes the case that these answers are only forthcoming once you are represented by a solicitor as part of a clinical negligence compensation claim and once your solicitor begins in-depth investigation into the circumstances of your case and the care received on your behalf.”

Basildon and Thurrock Hospitals

Basildon and Thurrock University Hospitals NHS Foundation Trust was also reported to have committed two serious and avoidable medical mistakes during the period. This included a case of operating on the wrong part of a patient’s body and surgical placement of the wrong implant or prosthesis into the patient.

What if You or Your Family Have Been the Victim of a Serious Medical Error?

If you or family members have experienced poor care from a GP or hospital or have suffered a serious medical error that was avoidable, you may be entitled to compensation. Examples of cases you may be entitled to compensation for include:

  • Incorrect or misdiagnosis of a condition or illness
  • Late diagnosis of a condition, illness or injury
  • Surgical errors
  • Unnecessary delays in treatment
  • Given incorrect medical treatment/advice

Free Initial Advice

Get free initial advice from specialist clinical negligence lawyers at Blackwater Law Solicitors, based in Essex.

Call 0800 083 5500 to speak with a lawyer who will give you advice on whether you may be entitled to claim compensation for the care that you or a member of your family received. All accepted compensation claims are operated on a no win, no fee basis.

TAMBA and NCT Maternity Services Report Finds Serious Shortcomings in the Care Given To Multiple Births Across the UK

A November 2015 report issued by the Twins and Multiple Births Association (TAMBA) in conjunction with UK NCT Maternity Services has highlighted serious shortcomings in the care offered to mothers of multiple births in the UK. The news comes despite the introduction of new guidelines by the National Institute for Health and Care Excellence (NICE) in 2011. Blackwater Law clinical negligence solicitors now question whether more parents of multiple-birth children could now be eligible for birth injury compensation.

Multiple births (multiples) account for around 3% of UK pregnancies, although this figure is on the rise due to the increased use of assisted conception methods including the likes of IVF. It is well understood that prospective mothers of multiple children must face heightened health challenges and risks of complication – what concerns prospective parents and clinical negligence solicitors alike is that the stillborn rate for multiples stands at 1.07%; more than double that of singletons. What’s more, according to the latest statistics available, neonatal death rates stand at 11.5 per every 1000 live multiple births, compared with just 2.4 for singletons, with infant death rates measured at 14.5 per 1000 as compared to just 3.4 for singletons. Whilst these figures undoubtedly have a devastating emotional effect on the families concerned, they also have a deeply detrimental effect on our National Health Service as a whole; multiple births account for around 10% of all stillborn maternity clinical negligence claims raised in England, costing the NHS around £72 million between 2005 and 2014. With so many multiple birth mothers pursuing birth injury compensation claims, NHS administrators and clinical negligence solicitors alike are forced to consider what could be going wrong in our healthcare systems; and the TAMBA and NCT Maternity Services Report provides some answers.

The 2011 guidelines introduced by NICE outlined a range of measures seeking to transform the care of mothers expecting twins or triplets, reduce the number of stillborn multiples and give healthcare providers clear direction and support based on scientific, medical evidence. Three of the key measures to be employed amount to the following:

  • Mothers expecting a multiple birth should have access to multidisciplinary care teams comprised of a skilled midwife, obstetrician and sonographer – all of whom have expert knowledge of multiple birth scenarios
  • Said mothers should also have access to advice on referrals relating to when and where foetal medicine specialists are required
  • Additional antenatal education should be provided to prospective parents to prepare them for the additional challenges of multiple births / childcare

TAMBA / NCT’s report however, highlights some worrying trends in relation to performance of NHS Trusts against these guidelines. Approximately one in three mothers examined in the sample of 1338 respondents (taken from across the UK) (sampled as part of the report) indicated that they did not have access to a specialist obstetrician, whilst only 20% had access to a specialist midwife and 28% to a specialist sonographer. Blackwater Law clinical negligence solicitors also note that in some regions these figures were even worse, with only 7.8% of East Midlands patients having access to a specialist midwife. All of this culminates in the fact that twins or triplets are still twice as likely to be stillborn than single babies, and around five times as likely to pass away in neonatal care.

The report found the NHS to be failing prospective mothers in other areas too. Pregnant women in the UK (with the exception of Northern Ireland due to abortion laws) are routinely offered testing for Down’s syndrome during weeks 10-14 of their pregnancy, with those identified as high-risk supposedly offered further diagnostic testing along with an explanation of the risks involved. TAMBA & the NCT’s study found that only 81.7% of respondents were in fact offered screening for Down’s syndrome, some of whom were only offered ultrasound testing due to concerns that blood testing could return false positives in instances of multiple pregnancies. Of those tested, only 52.1% identified as being at high risk stated that they had the options and implications of diagnostic testing subsequently explained to them; illustrating a substandard level of patient care and suggesting a lack of staff education on the issue.

Examiners also found shortcomings in the provisions for multiple parents struggling to feed their new-borns in the preferred manner. 29.6% of respondents encountered difficulties relating to a lack of breast-feeding support, pressures to supplement with formula, problems feeding premature babies and separation from one or more children. In addition, only 42.1% of multiple parents stated they had been given advice on safe sleeping procedures for their children (i.e. co-bedding), illustrating a further need for staff education in relation to this issue also.

All in all, the report indicates a 10% increase in compliance with crucial NICE multiple birth guidelines over the four year period from 58.8% in 2010 / 11, up to 64.9% in 2013 / 14 and ultimately to 69.1% in 2014 / 15. Whilst this is noted as a positive step, it’s important to understand that at the current rate it will take another 12 years for rates to reach full compliance, in the meantime many thousands of UK multiple birth parents will be exposed to unnecessary risks due to human error and birth mismanagement.

Jason Brady, clinical negligence solicitor at Blackwater Law, said:

“It is not acceptable that so few expectant multiple parents are offered the specialist support they need. Given the increased risks that mothers and their unborn children face, it is crucial these parents have access to medical professionals with the necessary experience and expertise in managing multiple births. More needs to be done to fast-track the improvements in performance against the NICE multiple birth guidelines at Trusts across the country. Failure to do so may lead to unnecessary deaths.”

Patient satisfaction levels among multiple birth parents remain woefully low; with 47.6% of obstetrician advice on baby care rated as “poor” or “very poor”, as well as 44.1% of all prenatal education provided to prospective parents of multiple babies. It’s now estimated that around a third of multiple birth parents are dissatisfied with most areas of the care they receive from the NHS; raising the prospect of a great many more pursuing birth injury compensation claims or litigation relating to substandard care in upcoming years.

Are you entitled to claim birth injury compensation?

If you or a family member feel you have been subject to substandard care as a parent of multiple children, or that your children have suffered as a result of birth mismanagement on the part of your medical professionals, you may be able to pursue a clinical negligence compensation claim and / or birth injury compensation.

Blackwater Law clinical negligence solicitors today by phoning 0800 083 5500. You will receive free initial advice. All accepted cases are on a no win, no fee basis.