Category Archives: Medical negligence

New safer maternity care plan aims to reduce medical negligence claims

maternity-nhs

Within the last month, seven NHS sites throughout England were named early adopters of specific recommendations laid out through the Safer Maternity Care plan. A combination of more personalised care plans for expectant mothers and their newborn children, greater access to care at a single location, and community collaboration to better manage growing caseloads were all prescribed as trial approaches under the plan, on the wings of a recent Better Births report. In the telling report, advocates for quality maternity care highlighted the need for greater transparency and a clearer focus on protecting a high-need patient population.

In addition to the provisions for increased maternity care services throughout NHS trusts, the Safer Maternity Care plan brings attention to one glaring issue plaguing the nation’s healthcare system: the cost and time-consuming process of bringing a claim against a provider when avoidable harm has occurred. A new rapid resolution and redress scheme (RRR) aims to reduce the litigation culture by allowing families who have faced issues during a pregnancy or delivery to go through a more streamlined process to get not only financial support but answers to why an incident took place. Overall, the RRR has the potential to lend a necessary hand by providing greater transparency while also reducing costs for the NHS – but some concerns exist.

The problem in combatting litigation culture

Each year in England, nearly 1,000 newborns die or are diagnosed with severe brain injuries due to avoidable harm experienced during the mother’s pregnancy. Through the current claims process, families who have suffered these insurmountable losses don’t see any sort of resolution for 11.5 years, on average, and the NHS is left with a significant, burdensome bill that tops half a billion pounds each year. The rapid resolution and redress scheme included in the Safer Maternity Care plan may be a step in the right direction toward reducing these losses for all parties involved by fast-tracking complaints to determine if avoidable harm was a factor and if so, what compensation should be paid to the family to offset these burdens.

A solicitor from Patient Claim Line, a medical negligence law firm that deals with cases of poor care during pregnancy or errors made during the birth explains the worry surrounding the RRR compensation scheme as part of the Better Births recommendations. “In the large number of maternity care cases we see, it is rare that financial compensation is the motivating factor behind bringing a claim. Instead, families want to understand who holds the responsibility for avoidable harm, and they want open and honest communication with the healthcare system throughout the process.” A rapid resolution and redress scheme has the potential to push claims through the funnel at a speed that doesn’t allow for a sound solution to what truly burdens the families who have suffered due to lacking maternity or post-natal care. Additionally, with setting the courts out to be a choice of last resort for suffering families, it may be a challenge to determine if the compensation received through the RRR scheme is enough to cover expenses associated with life-altering outcomes of poor maternity care.

Instead of focusing its efforts on speeding up the process of compensation, the NHS may serve maternity care patients better by focusing on prevention of avoidable harm cases from the start. The Safer Maternity Care plan does address some of these concerns, with recommendations that include adding a funding mechanism for NHS-wide training as well as an innovation fund that promotes the discussion of new ways to go about providing maternity care to a growing patient population. In addition, the recommendations suggest the creation of safe spaces for doctors and medical staff where sharing of information relating to best practices and new ideas for care can be done without barriers or judgment.

While the rapid resolution and redress scheme holds promise for reducing the rising cost of litigation on the side of NHS trusts, families stand to lose overall if the claims process is reduced to a singular focus of quickness. Transparency, instead, needs to be at the forefront of changes to maternity care across the board, with a clear focus on providing suffering families true and accurate answers to their pressing questions, in addition to offering the full financial support they need to move ahead with their lives.

Highlights of the NHS Litigation Authority 2014/15 annual report

The recent annual report of the NHS Litigation Authority has targeted the rising costs of clinical negligence claims. According to the report, 1% of the annual NHS budget was spent on claimant legal costs.

The amount of damages and costs are rising, but so too are the number of accidents, and the Association of Personal Injury Lawyers is urging the government to focus on reducing the number of accidents rather than going after claimant costs. The NHS LA has set aside £26bn to cover outstanding liabilities, and introducing fixed costs could save around £80m. However, personal injury lawyers believe while the focus on reducing accidents is a worthwhile one, it may be misguided due to the number of meritorious and legitimate claims that still exist. Without the possibility of claims against negligent providers, real change in practices may not occur.

NHS report

The increase in the number of reported incidents that the NHS LA raises could be a positive shift that it indicates a better reporting culture aimed at improving patient safety. According to a research carried out this year by Patient Claim Line, a specialist medical malpractice team, 14% of people claiming for medical negligence injuries are ultimately persuaded to do so by a medical professional.

In 2014/15, 66% of clinical negligence expenditure went on damages, 25% on claimant costs and 9% on defendant costs. Claimants in all claims resolved in 2014/15 collectively sought £326m in legal costs, but either settled for, or were ordered by the court to accept, £219m. This means the NHS LA reduced costs by a third on average.

The proposal to cap legal costs has been met with strong opposition from claimant lawyers. Jonathan Wheeler, president of the Association of Personal Injury Lawyers, said: “Savings could be made if the NHS LA were to admit liability where is it obviously due, rather than defend until the door of the court and then settle at the last minute, having run up huge costs on both sides along the way. The NHS would help the NHS LA in its commitment to defend public funds if it was to steer its focus on preventing harm in the first place and righting wrongs when they happen.

“The NHS LA is a ferocious defender and is clearly proud that 64% of claims are successfully defended in court. But just because the NHS did not have to pay any compensation does not mean that the claimants did not have valid cases, or that they are deceitful for pursuing claims. … While the NHS LA should rightly protect the public purse, it is unfair to suggest that unsuccessful claims were ever ‘unmeritorious’.”

The annual report identified a number of “potential drivers” of clinical negligence, including an increase of the number of patients being treated by the NHS, reported incidents and lower value claims. The NHS LA has also flagged that there are some cases in which claimant legal costs have been disproportionate in relation to the value of the claims; while this may be true, there are numerous reasons why. For example, claimant legal costs arise when being required to establish the evidence of clinical negligence, and more time being spent undertaking significant investigatory work.

Breast augmentation surgery claims guide by Mike Saul

Breast augmentation (breast enlargement) is the most popular cosmetic surgery in the UK, with over 25,000 women having undergone the surgery in the past year. Despite its popularity however, the surgery is not always a simple procedure. Serious, life-threatening complications can occur because of cosmetic surgery negligence.

Because of this risk, we’ve compiled a list of must-know questions and answers to make sure you have a clear understanding of the breast enlargement procedure, including the associated negligence risks.

What does breast implant surgery involve?

Breast augmentation surgery involves being given a general anaesthetic. You will be in the hospital for a number of hours. An incision is made in order to fit the implant, which is then inserted and repositioned accordingly, and the stitches are then closed.

Are there multiple techniques to this type of surgery?

Yes. Breast enlargement can be performed using one of three techniques: an inframmamary breast augmentation, a transaxillary breast augmentation or a transumbillical breast augmentation (TUBA).

What happens during each different surgery type?

TUBA Breast Augmentation

An incision is made in the umbilicus (the navel), before an implant is inserted through the incision and repositioned under the breast tissue.

Once you’ve received a general anaesthetic, your surgeon will make an incision around your umbilicus and insert the implant. It’s then transferred into its correct positioning underneath the pectoral tissue and the incision is closed.

What risks or signs of negligence do I need to be aware of?

Positioning the implant is a lot harder with this technique, increasing the risk of complications. There’s also an increased risk of the breast tissue being damaged.

Inframmamary Breast Augmentation

An incision is made underneath the breast, along the fold as the tissue meets the chest wall. The tissue is lifted and either a silicone or saline implant is inserted.

After you’ve been given anaesthetic, the incision is made. Then, the breast tissue and in some cases, the pectoral muscle, is lifted so the implant can be inserted beneath both the nipples, before the incision is stitched closed.

What risks or negligence signs do I need to be aware of?

Be mindful of infection in the breast area, and / or leaking from the implant – this may mean that the implant has to be taken out.

Transaxillary Breast Augmentation

This technique often results in less scarring due to the incision being made in a different place – the incisions are made in the upper outer chest area, very close to the armpit.

After the general anaesthetic has set in, a small incision is made close to the armpits in the outer region of the breasts. The implant is then inserted and repositioned below the pectoral muscle, before the stitches are closed.

What risks or negligence signs should I be aware of?

Ripples from the implant itself can occasionally be seen underneath the skin. This occurs more often in women who had very small breasts to begin with. In rare cases an abnormal scar tissue can form around the implant itself (known as ‘capsular contracture’). It is a painful complication and you may need another operation to rectify the issue.

Your surgeon will inform you of the technique best suited to you. Make sure you are entirely happy with this decision before the surgery goes ahead.

When will I be able to go home?

Providing the surgery process goes according to plan, you should be able to go home the same day or the day after your surgery.

What happens if I think I’ve been a victim of negligent cosmetic surgery?

If, after the surgery is completed, you are concerned that you’ve suffered at the hand of a negligent cosmetic surgeon, arrange a call with a cosmetic negligence solicitor at Cosmetic Surgery Solicitors, who will gladly assist you with any queries you may have.

Michael Saul
Head of Cosmetic Negligence at TJL Solicitors LLP

Website: www.cosmeticsurgerysolicitors.co.uk
Freephone: 0808 256 1667

Clinical negligence compensation statistics

In the UK alone the NHS treat 1 million people every 36 hours and carry out a huge 10.595 million operations in 2012/2013. Out of this huge number it is inevitable that a number of these are going to have complications and problems that occur. When complication and errors happen and the NHS is at fault, people could be entitled to make claims using personal injury solicitors such as Blackwater Law. The majority of clinical negligence claims are for misdiagnosis, surgical errors, death, overdose of medication and poor treatment resulting in worsening of illness.

Clinical negligence compensation claims have a restricted time limit for people to make their claim, after which clients may not be able to make a successful claim. There is a 3 year window to make a claim from the date of injury or the date the patient noticed injury. This time period is extended in special circumstances, for instance if the patient is a child, if it is a birth injury and it takes longer to notice any symptoms, if the patient is mentally ill or if it take longer from when the patient realised the injury. With these sort of claims particularly birth injuries, symptoms of injury may not show themselves for several years or maybe not until adulthood, in these cases personal injury solicitors maybe able to provide advice on whether you are still eligible to make a clinical negligence claim.

Between the years 2011 / 12 there were 9,143 clinical claims made against the NHS which is a 67 per cent rise from 5 years previous and between 2013/14 the NHS set aside a staggering 22.7 billion pounds in to cover medical negligence liabilities.

Clinical negligence specialists from Blackwater Law have created the infographic below to look at compensation facts and figures.

Cancer must be detected in darker skins too

It’s a common misconception that only white people, especially the fair-skinned, risk developing skin cancer.

Advice about high-factor sunblock, seeking shade and covering up are most vigorously targeted at people who do not tan or have many freckles or moles.

Yet, this widespread advice, while helpful to many, could inadvertently have created a deadly myth.

Dark skin is also at risk of developing melanoma, the type of skin cancer most likely to kill. In fact, one particularly aggressive cancer – acral lentiginous melanoma (ALM) – is found in African-Caribbean and other dark-skinned people more often than in white and pale-skinned people.

Usually, the ALM is on the sole of the foot, the nail bed or the palm of the hand – once again, a detail not usually mentioned in public advice, which stresses the legs and the back as the most commonly affected parts of the body.

Another common message about skin cancer is that the earlier it is found and treated, the better the chances of a full recovery.

In the UK, survival rates for malignant melanoma continue to increase, with 84 per cent of men and 92 per cent of women surviving for at least five years after diagnosis, according to Cancer Research UK. When treated at the earliest stage, the survival rate is 100 per cent.

This ought to be great news. Unfortunately, for many people with ALM, the belief that melanoma is a “white person’s cancer” could mean a lack of diagnosis until the disease is at a stage that is more difficult, or impossible, to treat successfully.

More than 13,000 people a year in the UK are diagnosed with malignant melanoma skin cancer, over five times the number in the 1970s, according to Cancer Research UK. About 16.5 per cent of those die as a result of the disease.

Education can help drive down the tragic death toll by encouraging people to seek diagnosis as soon as possible. But it is time to stop minimising the risks to black and other dark-skinned people from skin cancer advice.

As long as people with dark skin are told melanoma is something for fair-skinned, pale-eyed people to worry about, they risk missing early signs.

As medical negligence solicitors, we want to see GPs go beyond the clichéd advice when informing and diagnosing patients.

Otherwise, not only could cancer misdiagnosis claims continue to increase, but, tragically, people may die unnecessarily.

At Hudgell Solicitors, we have a dedicated, sympathetic team of medical negligence and personal injury solicitors who have experience of more than 20 years’ experience in dealing with various complex cases.

Special measures and NHS hospitals

The worst hospitals are costing us millions. What happens to them?

Recently released figures from the NHS Litigation Authority have shown that hospitals at the centre of recent medical negligence scandals have cost the NHS almost £300 million in damages since 2009. In total 14 hospitals were investigated over their high death rates, and 9 of those have cost the health service more than £291 million in medical negligence claims. This figure far outweighs the amount of money the hospitals were paying into the NHS insurance scheme.

Last year the NHS paid out over £1.3 billion in compensation and legal fees for thousands of people affected by poor standards of care. The worst hospitals are put into special measures to address the concerns over the quality of care they provide to patients. We have taken a closer look at these measures to highlight exactly what will be happening in 11 underperforming trusts throughout the UK.

What happens to a trust in special measures?

Improvement plan

A trust will publish an improvement plan which lays out the measures taken by the trust to improve their services as well as detailing who is in responsible for specific actions with the trust. Plans must be updated on a regular basis because they are free for public viewing. This allows patients and the general public to see what progress is being made to improve their local NHS services.

Leadership review

If necessary, changes to trust management could be made to ensure that those in charge are capable of making the required improvements set out in the plan.

Suspension of freedoms

Foundation Trusts can have some of their freedoms suspended. This include the freedom to decide who sits on the executive board, the freedom to decide how to make improvements to services, and the freedom to decide how they spend their budget. The decision to suspend certain freedoms is made on a case-by-case basis.

Support and scrutiny

Trusts are given a significant range of support depending on their specific needs. Some trusts will receive help from high performing trusts in the form of partners, whilst others will get further support from commissions and access to local health science networks. Underperforming hospitals will also be placed under intense scrutiny with regular monitoring to ensure that planned improvement actions are actually taking place. Each trust is allocated an improvement director who keeps a close eye on all the progress being made.

The role of improvement directors

Improvement directors are embedded within trusts to scrutinise the daily progress being made in hospitals. They play an important role, acting on behalf of the NHS Trust Development Authority to provide advice and support to leadership, whilst challenging those in charge to take the necessary action to achieve improvement in patient care. They are also key figures in the establishment of strong and productive working relationships within the trust and with external stakeholders.

The future for failing hospitals

It is up to the chief inspector of hospitals to evaluate specific trusts before they can be declared free of special measures. With the number of medical negligence claims being made set to increase to around 12,000 by the end of 2014 there is still a lot of work that needs to be done to improve the situation. Hopefully, over the coming months and years, the chief inspector will be able to take several trusts out of special measures and rebuild public trust in the NHS as a whole.

Hospital Negligence is a law firm specialising in claims for those who have suffered medical or clinical negligence.