Good afternoon and welcome to my patient safety update (to quote a topical phrase from Sue Gray) in which we discuss maternity investigations, clinical negligence reform, mandatory vaccinations and of course Covid.  

MATERNITY INVESTIGATIONS Some really welcome news amidst the chaos at Westminster: the government is going to establish a Special Health Authority to carry out the independent maternity investigations that HSIB currently do. I would have been happy for HSIB to continue them although there have been some criticisms of the way they have been delivered, but the key thing for patient safety campaigners is that independent investigations will continue. There had been rumours they would be abolished which would have been a big step backwards - many families simply do not believe trusts do adequate investigations into some of the most terrible tragedies and will only have confidence in an independent process. That said many (including me) would be happy if the trusts were more involved in the investigations than they have been under HSIB so that we can have more confidence safety lessons will truly be learned and implemented. The new authority will be established from 2022-23 for an initial period of five years and provide “independent, standardised, and family-focused investigations of maternity cases.” It will also share learning from its investigations by examining trends and identifying areas where there is lack of improvement. It also needs to decide whether mistakes were made, about which there was some equivocation by Matthew Style at yesterday’s select committee, but I am sure on reflection the government will accept that as essential. Overall thank you DHSC for listening on this one - it might seem a small issue in the context of a pandemic but for safety campaigners it is vitally important.

LITIGATION REFORM The Select Committee held another fascinating session on litigation reform yesterday, this time with the Minister for Patient Safety Maria Caulfield and NHS Resolution. Ahead of the meeting the Department had provided with an updated table comparing the costs of various systems from around the world. England did not compare well, to say the least. We spend twice as much on clinical negligence claims compared to the other countries measured which included Sweden and New Zealand. Even other countries with tort systems such as Scotland and Australia do better. The Department is now doing some further analysis but if you want lower cost and safer care the government’s own figures show clearly we need to move to a non-adversarial system like Sweden or New Zealand. We would also save literally billions which would go back into the NHS budget. Maria Caulfield seemed to be open to radical change so I hope the government really is bold on this one. 

LEGAL FEES Some tinkering is happening with a consultation launched on Monday to introduce a cap on legal costs for lower value compensation claims. This is aimed at tackling what the government calls “disproportionate” legal fees in cases worth less than £25,000 in compensation. They are also consulting on a “new streamlined process to ensure claims are processed more quickly”. I understand the logic but AVMA have some reasonable concerns not least that legal fees are only paid when the government loses a case so there is a risk that these changes will inadvertently encourage a culture of denial for lower value cases on the basis that patients will not be able to secure no win no fee representation in such cases. ‘Lower value’ incidentally includes deaths caused by medical error so this is far from a trivial issue. 

(NOT SO) MANDATORY VACCINATIONS A screeching u-turn took place on Monday when the government announced they intend to scrap the regulations making vaccines a condition of deployment for health and social care staff. As I explain here I think this is the wrong decision for a number of reasons. Firstly, it should be non-negotiable that staff working with vulnerable people do everything they can to protect those people from disease unless they have a medical exemption. It is a basic issue of patient safety which most NHS bosses strongly support as Alastair Maclellan writes powerfully in today’s HSJ. Secondly, having made the right call and I think won the argument who will now believe the government when they say they’ll introduce something similar for either another new strain, the flu, or some other unknown disease? As I said to the Health Secretary, the only reason they are being forced into this position is because they haven’t gripped the workforce crisis. Something I’ll keep banging on about.…

ANNUAL ACCOUNTS From the DHSC have been published and eagle eyed Robert Peston spotted that they have incurred £8.7bn of losses on the £12.1 bn of PPE they bought in 2020/21. More than half of this (£4.7bn) is simply because the market price for PPE has now dropped – global PPE prices obviously rocketed when it was in demand during the height of the pandemic – and so the stocks of equipment are worth less. I’m more concerned about the £2.6bn of equipment that was bought that can’t be used in a healthcare setting - 20% of all the PPE they bought. Some mistakes are understandable considering the pressures to buy life saving kit but that is surely too high? 

COVID Government data continues to show things slowly moving in the right direction. The ONS estimates that 1 in 20 people had the virus in the week ending 22nd January, the same number as the week before. The government dashboard notes a 2% decrease in cases, 12% decrease in deaths and 12% decrease in admissions over the last 7 days. However the Zoe Symptom tracker is suggesting cases have gone back up again and this is far more recent data  than the ONS so we are not out of the woods. Although interestingly they state that 1 in 29 people in England have symptomatic Covid vs the ONS estimate of 1 in 20 in the community. One to keep a close eye on.  

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. Patient safety is more important than parties! 

Jeremy Hunt