GOOD AFTERNOON and welcome to my patient safety update which this week looks at COVID, NHS litigation reform, the Patient Safety Commissioner and the backlog in elective care. 

COVID LATEST The ONS recent report estimated that an extraordinary 1 in 15 people in England (1 in 10 in London) had the virus in the last week of 2021. But with a pretty dramatic decline in daily new cases from nearly 250,000 on 4th January to 120,000 on 11th January there is a general sense that are past the peak and the NHS will just about get through it. The number of hospital admissions has increased quite sharply but is still only around half the peak a year ago. Optimists (and they need a few of those in Downing St right now) - including some serious academics such as  David Heymann at the London School of Hygiene and Tropical Medicine - think we are leading the Northern Hemisphere in the race to emerge from the pandemic. There has even been a slight decrease (admittedly from a very high level) in the number of covid related NHS staff absences. The BBC’s Nick Triggle has a nice summary of where we overall here but it does feel like sunshine is edging through the clouds.

LITIGATION REFORM is an area which Private Eye would call ‘boring but important.’ Readers of this newsletter knowing it is anything but boring for patient safety campaigners and we had an absolutely fascinating Select Committee session yesterday which is well worth checking out if you are looking for solutions to the problems of a blame culture and defensive medicine. Dr Pelle Gustafson from Sweden directly contradicted the UK government’s current view that Sweden’s less adversarial compensation system doesn’t contribute to their lower levels of neonatal deaths arguing it was a ‘major contributor’ to safer levels of care experienced there. Professor Shin Ushiro from Japan talked about the no-fault system they have for babies and the reduction in brain injuries and lawsuits since it was introduced in 2009. In response to worries about costs increasing if we introduced a blanket no fault system in New Zealand Michael Mercier from the New Zealand Accident Compensation Cooperation explained that they had seen a decrease in the most costly cases, presumably as better learning started to feed through the system. Remember if we had Sweden’s neonatal death rate 1000 more babies would survive every year. Their optimism about different ways of doing things was a very effective reproach to people who argue it has to be this way.

THE CASE AGAINST? Perhaps not quite that but the international evidence was probed in the second half of the session where we heard from the Guy Forster of Association of Personal Injury Lawyers and Peter Walsh from Action Against Medical Accidents. Their view was essentially that we would do better to prioritise other things than reforming the way litigation works. Of course we will continue to press the case for more obstetricians and midwives but I didn’t hear any in principle objections to our major suggestion which is that compensation should be paid if a mistake was avoidable and not only when there has been clinical negligence. Although it lowers the bar, the reduction in incidents will more than pay for it as evidence from Japan and Sweden indicates.

BACKLOG REPORT For those that missed it you can see the Select Committee’s report into clearing the Covid related backlog here. The main message was that the elective recovery plans are at risk of being thrown off course due to the lack of a serious workforce strategy. You can hear my interview with Martha Kearney on the Today programme (53 minutes in) here. There were some typically  thoughtful responses to this report from NHS Providers and the Health Foundation who summed up the scale of the challenge rather well saying 19,000 more nurses, 4,000 more doctors and £17bn is need to meet the backlog this parliament and get back to the 18 weeks standard for waiting times.

COMMISSIONER The recruitment process for the new position of Patient Safety Commissioner kicked off this week. You can see the job advert here. There has been some criticism of the narrowness of the job description and I do think the patient safety regulatory landscape is too complex. To be fair though the job spec comes directly from the legislation and all credit to Julia Cumberlege for forcing the government to do it.

THE HEALTH AND CARE BILL Is being debated this week by the House of Lords and amendment 170 on workforce planning should be discussed in the next day or so. Baroness Cumberlege has got cross party support for it including from a certain Lord Stevens of Birmingham so let’s hope the government listens more than they did to me in the House of Commons. More joy about the sinner that repents and all that…

THE ADMIN As ever you can sign up to receive this update via our website here and please tell any friends you think might enjoy it.

Jeremy Hunt