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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.

‘Never Events’ Continue to Elevate Risk of Clinical Negligence in UK Hospitals

According to data released by health watchdog NHS Improvements, July 2016 saw a continuance in upward trend of “never event” occurrence in UK hospitals, highlighting a worrying trend towards greater risks of clinical negligence facing hospital patients. “Never events” represent critical, catastrophic failures in the delivery of care that rank so seriously they should never in fact be allowed to happen. When they do, patients are left in a position where they may be entitled to clinical negligence compensation as recompense for unnecessary suffering and loss, making it all the more important for a cash-strapped NHS to prevent them, if prevention of suffering is not reason enough. Nonetheless, NHS Improvements recorded no fewer than 31 July Never Events; up three on the preceding month and averaging one for every day of the month.

NHS Trusts Across the UK Continue to Make Serious Errors

Failures serious enough to be classified as Never Events include the likes of surgery being performed on the wrong part of the body, patients foreign objects being left inside patients post-surgery, incorrect medication administration and more. Whilst seemingly fundamental errors to make, it seems that NHS trusts across the UK continue to fail patients in these ways at an alarming rate. July saw a staggering 15 incidents of surgery at the wrong location on patients’ bodies, 4 patients retaining a foreign object post-surgery, 4 incidents of patients being fitted with the wrong implant or prosthesis, 3 incorrect methods of medication administration, 2 incidences of misplaced naso or orogastric tubes, an insulin overdose, 1 count of potassium being administered instead of saline and even a patient overdose of methotrexate whilst undergoing non-cancer treatment. Each one of the incidents represents a potential for clinical negligence, given the serious failing of staff in their duty of care towards the patient(s).

Multiple Surgical Errors Made at UK Hospitals

July’s most notable finding was for Barts Health NHS Trust; which recorded 1 incidence of surgery at the wrong site, and 1 of incorrect medication administration, and the Pennine Acute Hospitals NHS Trust; which saw one patient fitted with an incorrect implant / prosthesis and another retain a foreign object post-surgery. The remaining 27 Never Events occurred at hospitals situated across the country, indicating a growing nationwide trend sure to concern patients and clinical negligence solicitors alike. More worrying still, 3 further failures judged to be deserving of Never Event status were reported during July, but were later found to have occurred outside the dates under examination.

July Increase in ‘Never Events’ Suggests a Worrying Trend

July’s increase in rate of “never events” follows on from a similar increase in June 2016, and paints a concerning picture of an NHS struggling to cope, and to provide the necessary standards of care. The incidents cited are fundamental errors indicative of a failure to deliver a reasonable level of care we all would expect as a minimum.
If you or a family member has been affected by a “never event” at your local healthcare provider, you could be entitled to claim clinical negligence compensation. Contact Blackwater Law clinical negligence solicitors on 0800 083 5500, and receive specialist and free initial legal advice from a clinical negligence lawyer.

High Rate of ‘Never Events’ Recorded in Quarter 1 2016

A total of 91 never events were recorded between January and March of 2016, and the high rate of “never events” recorded in Quarter 1 2016 by health watchdog NHS Improvements suggests a worrying trend towards high rates of “never events” happening in NHS hospitals across the country. Defined as failures in care provision so serious and fundamental that they should in fact never happen, “never events” represent a concern not just to patients – who suffer unnecessarily as a result of them – but to healthcare providers and to clinical negligence solicitors, as victims may be entitled to claim medical negligence compensation as a result of their undue suffering and any financial loss. Despite this, the period ranging from the beginning of April to end of June 2016 has seen high rates of never events, to the point where they occurred at least two in every three days on average; a figure that still shows no indication of slowing.

28 ‘Never Events’ Recorded in April

Although much lower than the 38 “never events” that were recorded in October 2015, April records show 28 “never events” occurring in UK hospitals, with the most occurring at Barts Health NHS Trust and Northern Devon Healthcare NHS Trust, who both logged two. Surgery at the wrong site was the most commonly perpetrated failure for this month (eight counts), followed by improper administration of medication (six counts).

22 ‘Never Events’ Logged in May

May saw a total of 22 “never events”, with the worst-offending trusts noted as being Buckinghamshire Healthcare NHS Trust and Luton and Dunstable University Hospital NHS Foundation Trust, who both recorded two “never events”. The most common form of “never event” during April was again related to surgical errors, with surgery being performed on the wrong part of a patient’s body (10 counts) the most common error, with patient retention of a foreign object post-surgery coming in second (four counts).

28 ‘Never Events’ in June

June figures show a total of 28 “never event” occurrences; returning to April’s levels and dismissing the notion that May’s reduction in numbers could be indicative of a trend towards improvement. Sandwell and West Birmingham Hospitals NHS Trust and York Teaching Hospital NHS Foundation Trust stood out with two “never events” each, whilst the most common failures were surgery performed at the wrong site (eight counts), and again; patient retention of a foreign object (seven counts).

High Rate of ‘Never Events’ Recorded in Quarter 1 2016 are Cause for Concern

The figures, gathered from trusts up and down the country, illustrate a nationwide problem that shows no sign of abating, with problems relating to surgery at the wrong body-site and the retention of foreign objects showing up consistently across different regions. Whilst it’s worth remembering these figures form only a small proportion of the total number of operations the NHS carries out every month, the fact that failures deemed so fundamental as to be “never” acceptable continue to happen at rates which are not reducing, is justifiably enough to worry patients, and spur clinical negligence claims to seek medical negligence compensation.

If you or a family member is concerned about the care you have received and the suffering this has caused, contact Blackwater Law Clinical Negligence Solicitors on 0800 083 5500. If you’ve been a victim of poor care from a hospital or GP, you will receive free initial legal advice regarding your potential eligibility to seek clinical negligence compensation.

High Rate of Delayed Diagnoses Amongst Bowel Cancer Patients

A September 2016 study released by the British Journal of Cancer suggests that as many as one in five UK bowel cancer patients identified through emergency diagnoses are exhibiting “red flag symptoms” that should have been picked up at an earlier stage of medical examination. This suggests that there is a high rate of delayed diagnoses amongst bowel cancer patients. As many as 16% are also thought to have seen their GP at least 3 times in the build up to their delayed diagnosis of cancer, implying many patients could potentially be eligible for clinical negligence compensation where GPs may be reasonably culpable for the delayed diagnosis of cancers.

GPs Fail to Identify 35% of Colon Cancer Cases

Researchers from the University College London and the London School of Hygiene and Tropical Medicine looked at diagnoses collated from English patients from 2005 to 2006, focusing particularly on the five years preceding their eventual diagnoses of cancer. Amongst a sample size of 1,606 patients gathered from more than 200 nationwide GP practices, it was found that 35% of colon cancers and 15% of rectal cancers were only identified as a result of an emergency presentation, rather than being picked up on by GPs in the years preceding. Of these, 17.5% of colon cancer patients and 23% suffering from rectal cancer were found to be displaying “red flag symptoms”, known to include rectal bleeding, blood in stools, significant changes in bowel habits and sustained stomach pain.

Researchers Claim Delayed Diagnosis of Cancer Could Have Been Avoided

Researchers emphasise that had these red flags been picked up on sooner, patients could have avoided delayed diagnoses of cancer, and had a greater chance of successful treatment; a point iterated by head researcher Cristina Renzi, before issuing the following statement to the BBC:

“…in most cases they [patients] visit their doctor for various reasons multiple times during the months leading up to their diagnosis, which could represent opportunities to diagnose the cancer earlier…”It’s important to find ways to ensure these patients can be diagnosed at an early stage…And this study highlights the need to support GPs and give them the tools to diagnose and refer patients promptly when they feel it’s necessary.”

Opportunities for Early Diagnosis Wasted

As Renzi’s statement highlights, most patients did in fact visit their GP in the period leading up to their diagnosis, regardless of whether or not it would prove to be an emergency one. This supports the notion that the opportunities for an earlier diagnosis may have existed, and that there is indeed a high rate of delayed diagnoses amongst bowel cancer patients across the UK.

Head of Patient Information and Health at Cancer Research UK Dr Julie Sharp also issued the following statement, observing the fact that GPs may often struggle to diagnose the kind of cancers examined in the study because of ambiguous symptoms:

“…research like this, to understand more about people’s symptom histories, is crucial to find better ways to diagnose the disease at an early stage, when treatment is more likely to be successful.”

With such instances of potential misdiagnosis or delayed diagnosis of cancer amongst some patient demographics, some may understandably worried.

Our Thoughts on the High Rate of Delayed Diagnoses Amongst Bowel Cancer Patients

Commenting on the findings, Jason Brady, clinical negligence solicitor at Blackwater Law in Essex, said:
“It is concerning to see such a high number of cancer diagnoses resulting from emergency presentations when there may have been opportunities to diagnose at an earlier stage.”

If you or a loved one has suffered unnecessarily as a result of delayed diagnosis or misdiagnosis, you may be entitled to claim clinical negligence compensation. Contact Blackwater Law clinical negligence solicitors today on 0800 083 5500, for free initial legal advice from a specialist solicitor.