It found that investigations do not always meaningfully engage with those outside the senior management team, which limits learning opportunities, while a ‘blame culture’ exists within the NHS, which inhibits employees from speaking up. It recommends that clinicians receive training in how to respond to and learn from errors.
The report highlights that compensation based on finding fault does not have a deterrent effect by encouraging clinicians to practice more safely. ‘In practice it is the reverse: fear of litigation stifles learning which ultimately makes the system less safe for patients.’
It recommends implementing an alternative approach, used in other countries, where a threshold of ‘avoidability’ rather than ‘negligence’ is used as a basis for compensation.
Writing in this week’s NLJ, Lorin Lakasing, consultant in obstetrics and fetal medicine at St Mary’s Hospital, London, looks into some of the reasons why high value obstetric claims related to neonatal brain injury account for more than half of settlements paid out by the NHS. To put this percentage into perspective, the NHS paid £2.4bn in compensation in 2018-2019, with more than £83bn set aside for future claims. Legal fees make up about one third of total compensation paid out.
Lakasing writes that ‘escalation often occurs after the opportunity to be proactive was missed so emergency protocols are actioned…the countdown on the hypoxic ischaemic encephalopathy clock has begun. Whatever is said and done thereafter matters not’.
The ensuing investigation, requiring hours of interviews tends to examine intrapartum events [during labour and immediately after childbirth].
Lakasing writes: ‘The misapprehension of analysing poor outcomes by focusing solely on intrapartum events is born of laziness and a poor understanding of the service.
‘Precursors to poor outcomes lie in the antenatal period but these remain largely unscrutinised. To do so would be complex, unpopular and onerous.’
