UK: Patient safety commissioner: “A relentless focus on NHS finance and productivity is failing patient safety”

[Andy]

"Patients’ concerns about substandard care are the “canary in the coal mine” but too often go ignored, the patient safety commissioner, Henrietta Hughes, tells Erin Dean

When thinking about the difference patients can make in improving care, Henrietta Hughes recalls a recent visit to a stroke unit.

“One of the patients said, ‘In the toilets, it would be much better if you had toilet paper on both sides of the cubicle, because if you’ve had a stroke you’ve only got a 50% chance of being able to reach it,’” she says. “Now, the power of that story is that you can have a unit full of experts—clinical nurse specialists, professors, people with PhDs—and they know everything about stroke, but they’ve never been in a cubicle with a patient who’s had a stroke when they’re on the toilet.”

For Hughes, that one moment crystallises the kind of insight that only a patient can bring. However, evidence that NHS patients often aren’t listened to keeps on coming.

Hughes spoke to The BMJ in the same week that the public inquiry into the use of infected blood, which claimed more than 3000 lives, was published.1 This is one of a number of issues where patient led campaigns have demonstrated the devastating human cost of failures in patient safety.

“The patient’s anecdote is the canary in the coal mine,” says Hughes, who also works as a GP locum in London every week. “It’s the thing that tells us there’s something going wrong. But too often we hear about patients who have raised concerns being gaslighted, dismissed, and fobbed off.”"

https://www.bmj.com/content/386/bmj.q1301

 

[Andy]

NHS patients raising safety concerns too often ‘fobbed off’, says commissioner

"NHS patients raising safety concerns are too often “gaslighted”, “fobbed off” or dismissed as “difficult women”, according to England’s patient safety commissioner, who criticised health leaders for a “relentless focus” on finance and productivity.

Dr Henrietta Hughes said patients and loved ones sounding the alarm about substandard care should be an early indicator of danger or potential harm, but far too frequently they were completely ignored. NHS trusts focusing too much on budgets meant that “the culture becomes toxic, and we’re just on the road back to the Mid Staffs scandal”, she added.

Hughes was referring to the failures at Mid Staffordshire NHS foundation trust, where hundreds of patients were neglected, dismissed or ignored between 2005 and 2009. Some were left lying in their own urine, unable to eat, drink or take essential medication."

https://www.theguardian.com/society...safety-concerns-henrietta-hughes-commissioner

 

[JellyBabyKid]

Am I the only one thinking that we might want to be writing to Dr Henrietta Hughes?

 

[Nightsong]

Unfortunately the remit of the Patient Safety Commissioner seems somewhat limited:

The Commissioner’s core duties are to:

• promote the safety of patients with regard to the use of medicines and medical devices, and
• promote the importance of the views of patients and other members of the public in relation to the safety of medicines and medical devices.

From our perspective it would be very helpful if these duties could be widened to cover psychological and physiotherapy/exercise-based interventions, or simply to cover health service provision more widely, but I'm not sure if there's any governmental motivation for that.

 

[Keela Too]

Why are some NHS interventions omitted?

This is the same wording as the Yellow Card system which also excludes anything other than medicines and medical devices.

Surely if NHS money is being spent on delivering ANYTHING to patients then it should be subject to the same sort of safety scrutiny?

It almost feels intentional to narrow the list down like this so that some NHS delivered interventions can avoid proper scrutiny!

 

[Mij]

Patients, especially women, are being 'gaslighted, dismissed, and fobbed off' when they raise concerns about NHS care, England's Patient Safety Commissioner says.

Dr Henrietta Hughes said the 'patient's anecdote is the canary in the coal mine' of what is happening in the NHS and is 'the thing that tells us there's something going wrong'.

Her comments come after an extended catalogue of NHS care scandals, with multiple shocking inquiries into the state of maternity care at some Trusts.

In an interview with the British Medical Journal, Dr Hughes, who took up her role in 2022, said women in some cases had been patronized and had their concerns dismissed.

LINK

 

[Mij]

The harrowing reality of giving birth in NHS hospitals revealed: Mothers left in blood covered sheets and told to 'stop stressing' over their dead babies, finds damning report into scandal that traumatized Louise Thompson and hundreds of other women.

Pregnant women are being treated like a 'slab of 'meat, a damning report into the 'postcode lottery' of NHS maternity care ruled today.

The UK's first parliamentary inquiry into birth trauma has found there is 'shockingly poor quality' in maternity services, claiming good care is 'the exception rather than the rule'.

It heard evidence from more than 1,300 women, including new mothers who'd been left to lie in blood covered sheets for hours and even berated by midwives for having soiled themselves.

LINK

 

[rvallee]

A weird framing that caught my eye re-reading the title: the notion of productivity as being independent of patient safety. Which is quite absurd.

I don't think anyone would find that an airline shows high productivity if it gets passengers to their destination quicker and cheaper, but leading to more crashes, runway accidents, and the like. Although I guess it depends on whether it would affect their bottom line. Which it would, because those accidents are usually made public. Unlike in health care, where mistakes are privately buried, sometimes literally.

The same with a manufacturing process that puts out more products, but a significant % don't work, even though they passed quality assurance. That can't ever be more productive than a slower process that puts out working products, because products that don't work aren't just useless in themselves, the cost of their manufacture is wasted in that a working product that could have been manufactured wasn't, losing twice over.

Safety is obviously part of health care outcomes, has to be. It's obviously not productive to be quicker at producing bad outcomes. But the way they are used makes this contradiction somehow make sense.

We see something similar with (mostly) useless rehabilitation clinics that boast of seeing X number of patients, none of which will have received help more substantial than if they had gone to see a psychic. We saw this recently with a paper examining German rehabilitation clinics, which had seen 70K+ LC patients in less than 2 years, but effectively produced nothing of value from it.

There's nothing productive about this, because productivity is supposed to include quality of outcomes, and obviously lack of safety compromises this.

It amounts to a belief that only the numerator counts, that as long as you increase it you are more productive, even when the denominator drops down to zero, and indifferent to the fact that a true measure of productivity has to account for the ratio, not just the one number that makes it look productive.

It's a good encapsulation of many of the problems in health care, how the modern neoliberal thinking can often look more productive, while sometimes being essentially destructive.

 

[bobbler]

A weird framing that caught my eye re-reading the title: the notion of productivity as being independent of patient safety. Which is quite absurd.

I don't think anyone would find that an airline shows high productivity if it gets passengers to their destination quicker and cheaper, but leading to more crashes, runway accidents, and the like. Although I guess it depends on whether it would affect their bottom line. Which it would, because those accidents are usually made public. Unlike in health care, where mistakes are privately buried, sometimes literally.

The same with a manufacturing process that puts out more products, but a significant % don't work, even though they passed quality assurance. That can't ever be more productive than a slower process that puts out working products, because products that don't work aren't just useless in themselves, the cost of their manufacture is wasted in that a working product that could have been manufactured wasn't, losing twice over.

Safety is obviously part of health care outcomes, has to be. It's obviously not productive to be quicker at producing bad outcomes. But the way they are used makes this contradiction somehow make sense.

We see something similar with (mostly) useless rehabilitation clinics that boast of seeing X number of patients, none of which will have received help more substantial than if they had gone to see a psychic. We saw this recently with a paper examining German rehabilitation clinics, which had seen 70K+ LC patients in less than 2 years, but effectively produced nothing of value from it.

There's nothing productive about this, because productivity is supposed to include quality of outcomes, and obviously lack of safety compromises this.

It amounts to a belief that only the numerator counts, that as long as you increase it you are more productive, even when the denominator drops down to zero, and indifferent to the fact that a true measure of productivity has to account for the ratio, not just the one number that makes it look productive.

It's a good encapsulation of many of the problems in health care, how the modern neoliberal thinking can often look more productive, while sometimes being essentially destructive.

Maternity payouts cost NHS twice the price of care itself (thetimes.com)

The cost of compensating mothers and their families for harm caused by NHS maternity services is more than double what the health service spends on such care each year, analysis shows.

The total cost of harm from clinical negligence was £13.6 billion in the 2021-22 reporting year, according to an annual report from NHS Resolution, the arm of the Department of Health and Social Care that handles litigation. Sixty per cent of the cost of harm was for maternity claims, amounting to £8.2 billion for the year. NHS England spends £3 billion annually on maternity and neonatal services, a board paper published in March confirmed.

The cost of harm, which is defined as the current value of the estimated cost of claims expected or received from incidents in the financial year, includes an estimate of the lump sum owed for claims, future periodic payments and legal costs.

 

[bobbler]

Maternity payouts cost NHS twice the price of care itself (thetimes.com)

For balance the following website says that is an overestimate, and it is just over £1bn: NHS in England not paying out £8 billion a year in maternity negligence compensation – Full Fact

Which would only be a third of the actual budget for maternity

Either way it seems that @rvallee you are not the only one who is spotting this issue with separation of these budgets/amounts leading to 'false economies'

 

[bobbler]

For balance the following website says that is an overestimate, and it is just over £1bn: NHS in England not paying out £8 billion a year in maternity negligence compensation – Full Fact

Which would only be a third of the actual budget for maternity

Either way it seems that @rvallee you are not the only one who is spotting this issue with separation of these budgets/amounts leading to 'false economies'

and of course as per the following article: Nottingham hospitals: NHS paid out £101m over maternity failings - BBC News

you have the situation where it is made/is hard to get any diagnoses and then get through a legal case, probably limiting who can complete them and of course delaying payment so perhaps the budget-holder knows they might have moved on by the time they complete

- I don't know enough about how the internal systems work to know whether the person making budget decisions has these potential payouts and risks flagged or is even allowed to change what they spend anyway whether they exist or not.

One single mother, who cannot be named for legal reasons, sued the trust over mistakes made during her son's care which left him with cerebral palsy.

She described her legal battle as a "laborious process" during which she felt she faced prejudice for taking the NHS to court.

"Getting any sort of diagnosis for [him] when he was younger was a battle," she said.

"As he got older, it became a thing that was brought up every time by professionals, that 'she is suing the NHS'."

Solicitor Tami Frenkel, who specialises in clinical negligence cases, believes that hospital trusts should put more resources into learning from their mistakes.

"[Hospital staff] do a hard job, sometimes in really difficult circumstances," she said.

"But they are the ones relied on, and if they get it wrong, and the implications for someone are as awful as they can be, then it is only right compensation is paid.

"That is all missed opportunities - and opportunities that should not have been missed.

"[The NHS] is a self-insurer, and it's the same as any insurer. Why don't they put their money into learning and prevention, instead of into having to pay people for injuries caused time and time again?"

All this comes at a time when Nottingham's maternity services are under intense scrutiny, with 1,800 families now involved in senior midwife Donna Ockenden's review into the failings.

She spoke to the BBC about the figures, and added: "What I would say is no amount of money can put lives back together to the way they were before [the parents'] baby was injured"......

.........."When they come and talk to me I can only describe these families as grey with exhaustion. So behind the numbers, what is a huge sum of money are terrible, terrible stories of local families who have suffered so much.

"Mothers who thought they would go on and have a successful career outside the home have told me 'I had to give up work'. Some relationships don't make it through that extra pressure. I've met some families who come and see me separately. The sadness is just immense."

 

[rvallee]

I'm surprised that anyone is even compensated. Seeing how cover-ups and denial are systemic, those must be egregious mistakes for them to agree that, yeah, they screwed up.

Learning from their mistakes, though, what a concept. I home someone tries that one day, but it almost always involves financial losses that someone wants to avoid in the future, usually with the knowledge that if those continue, everyone is out of a job. That's a problem with a job that can never go away, there's no amount of failing that will end it.

 

[bobbler]

I'm surprised that anyone is even compensated. Seeing how cover-ups and denial are systemic, those must be egregious mistakes for them to agree that, yeah, they screwed up.

Learning from their mistakes, though, what a concept. I home someone tries that one day, but it almost always involves financial losses that someone wants to avoid in the future, usually with the knowledge that if those continue, everyone is out of a job. That's a problem with a job that can never go away, there's no amount of failing that will end it.

Indeed.

I too don't know whether indeed it is a tip of the iceberg where it is those who are financially or well-connected or with a great support network who are managing to get to the end of most of the actual cases.

I have no idea whether anyone 'just' not being fed and generally neglected vs the maternity cases that you might hear about ever really get any sort of compensation or justice.

what you read is often things that are pretty unarguable, but who knows if it is that only those get in the media. It feels like things are beyond the canary in the coalmine examples and a complaint has the issue of 'can't' change things being the response of those who actually read it ie I don't know whether they get anywhere near those who 'could' do the things that would eg cause more or better staff, or just at best sits at a ward level with someone who may or may not ask for different behaviour.

I think where there were finally inquiries then I'd hope that is a bit different so including all. But obviously by that point there are so many really bad cases ..


I have no idea what might be context-specific to NHS concept eg comparing to other countries like USA or Canada or European countries with other systems whether it is more difficult, and if so how much more difficult, vs set-ups where hospitals mightn't be under the same system and different litigation processes there. And also the vote with feet / choice.

And indeed what that changes cycling back - ie does it lead to better care (if cost is unrestricted or law suits are easier) or if 'lawyers getting involved' leads sometimes to the first thing being to fix the issue so it doesn't repeat itself, ie if that gets listened to.

The theoretical irony there is that could be asking turkeys to do a lot of work to vote for christmas because if there are less legal cases and that's their business because they are external [and not internal legal reps who might have remit for reducing long term] firms brought in only for such situations and cases.