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NHS culture must change to reduce medical negligence and claims against the NHS


    Despite the key recommendations of the public inquiry into the suffering of hundreds of patients at Stafford Hospital, it seems that basic patient needs are still being neglected.

    By Kerstin Kubiak

The Times Health Correspondent Chris Smyth reported this month in an article that ‘little progress is being made in organising care around patients rather than bureaucracies’.

The article goes on to state that it is anticipated that standards will get worse before they get better in the opinions of a significant number of NHS Trust chief executives and senior managers.  However, only 29% of chief executives responded to the NHS Confederation survey which some say suggests an unacceptable complacency at board level in many NHS organisations with regard to patient safety.

The Times article does state that ‘more than two thirds of bosses approved of .. a legal duty to admit mistakes and more hands-on training for nurses’. This is a start, but unfortunately does not deal with the issue that much of day to day nursing care is being delegated by health boards and managers to health care assistants, who only have basic training.

Failure to monitor fluid levels and dehydration

Our own caseload shows that present healthcare systems are continuing to fail vulnerable patients, particularly the elderly.  Following a 6 day inquest into the death of a patient at Selly Oak Hospital in Birmingham it was found that basic observations were not carried out and there was a failure to monitor hydration levels and IV fluids were not provided which contributed to the patients death.  Inadequate nursing notes meant that the deteriorating situation was not recognised until too late.

Leicester Royal Infirmary also apologised to the family of an elderly lady in June 2013 following her death which was caused by renal failure due to dehydration following her 4 week admission to hospital.

Missed deteriorating vital signs

This was also a contributing factor in a case in Cardiff where, because nurses rarely saw the patient twice, her fatal eclampsia was unrecognised until she suffered a brain haemorrhage and died.

Still no duty of candour

Sadly, despite ongoing campaigns for a duty of candour and openness following mistakes in medical treatment, and apparent support for this within the NHS, it seems that these mistakes are still rarely acknowledged by healthcare providers and explanations and apologies given to patients and their families at early stages.

Instead arguments after often made that basic checks ‘must have’ been made.  This is even when there is no record to confirm this assertion, and the patient’s deteriorating condition would have been noticed and corrective treatment given if the necessary monitoring and checks genuinely had been undertaken.  This leaves patients and their families in the dark about what really happened during treatment.

Legal costs on both sides would be considerably reduced if the healthcare providers admitted straight away when a detailed assessment of medical records showed failures to monitor vital signs correctly, or there are no records at all to show that necessary routine checks were regularly undertaken.

Because of this apparent reluctance to openly admit when systems have failed and led to injury or death it is essential that patients or their families affected by such tragedies consult specialist medical negligence solicitors who are experienced in investigating these issues in medical care.

A culture change is needed in terms of managing patient care and also in relation to openness following mistakes before there will be a reduction in medical negligence and claims against the NHS.

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