Spending less money on “picking up the pieces” - culture change in the NHS

21 October 2014

Jeremy Hunt’s poster campaign launched to warn hospital staff of the cost of basic errors is laudable.  It is true that poor care is one of the “most wasteful and expensive” failings of hospitals.  As a clinical negligence lawyer, it is refreshing to note that although the, inevitable, comments about the rising cost of litigation are in the mix, there is also an important acknowledgement that it is poor care that leads to the unnecessary expense for example by producing longer stays for patients, many of whom have suffered from the most basic and avoidable problems.

In the article in The Telegraph last week, Mr Hunt is quoted as saying that improving care for patients means changing the way staff work, encouraging more openness, not more rules from Whitehall.  Rather than issuing ministerial decrees Mr Hunt is calling for “culture change” to make hospitals safer places in which staff speak out when patients are at risk.

The question is how to achieve the “culture change” that is constantly called for at the moment within the NHS.  How do you move away from a system where, in the past, mistakes/errors/blunders (whatever you wish to call them) may have been stigmatised and buried, denied and glossed over to one where they are acknowledged and avoided for the future?

How mistakes are dealt with is, I believe, fundamental to achieving the shift within the NHS that everybody acknowledges is necessary.  Safety is, of course, key to this.  How do you avoid errors happening?  That requires rigorous analysis - both prospective and retrospective - to create safe environments.

However, as a clinical negligence lawyer, I see that there are other key questions that need to be addressed to achieve and embed the shift.  One is how the mistake is dealt with in the moment and in the immediate aftermath:  How is the duty of candour discharged?  How is the affected patient or their family cared for and looked after and represented? As importantly, how are the involved staff dealt with? (And this may well involve an acknowledgment that they too may require support and representation.)

The second issue that needs to be addressed is how to deal with the consequences of the mistake.  From the patient’s perspective, this may be reassurances, compensation, acknowledgments.  For hospital staff, it must be learning first and foremost, feedback, and retraining if appropriate. The emphasis on learning permits a culture that promotes the collective taking of responsibility for allowing the mistake to happen in the first place and a commitment to ensuring that it never happens again.

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