Counting the cost of mistakes in healthcare – human, financial and political

The scale of the financial provision required for clinical negligence claims, in particular birth injuries, brought against the NHS, has hit the headlines again. For 2019/2020, NHS Resolution needs to collect £718.7 million from its member trusts, just to pay out on maternity cases.

The big numbers referenced by the BBC recently following a Freedom of Information Act request are in fact, readily available to view on the NHS Resolution website, as are the positive steps it is taking to ensure that the biggest claims, i.e. adverse birth outcomes are reported and investigated early, with incentives for trusts to ensure that learning is identified and implemented. All cases are reviewed from a patient safety perspective; with the aim to reduce risk of recurrence and thereby the number of claims.

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Duty of candour prosecutions – is silence golden?

The statutory duty of candour has been hailed the greatest reform in patient rights in the modern era. It was brought in under the Health & Social Care Act 2008 (Regulated Activities) Regulations 2014 as amended, in response to the Mid Staffordshire Inquiry.

The regulation 20 duty of candour requirements are detailed and specific.  There is an overriding obligation to be open and transparent, coupled with clear requirements to notify patients and/or their families where there is any unintended or unexpected incident, whether this amounts to an error or not.  This notification must be prompt. Whilst the requirements are dependent upon the level of harm sustained, the underlying principles governing the provisions are focussed on ensuring that patients are kept properly informed and that errors and/or other unintended consequences are not ‘brushed under the carpet’.

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Care home operators under financial pressure

Recent reports in the media suggest severe financial difficulties being suffered by the UK’s care home sector.

The Advinia Group is apparently under scrutiny from the CQC in terms of its cash flow and financial management. Advinia operates 38 homes in England and Scotland including 22 homes that it took over from BUPA in 2018, and is the UK’s 10th largest care home operator.    It has been asked to submit to an independent audit of its finances under the CQC’s market oversight scheme. The Guardian newspaper reported on 6 October that leaked papers it had seen showed Advinia was not generating enough cash to meet capital and interest repayments, and had refused to submit to the independent audit.  The CQC notified local authorities at the end of August of its concerns regarding the Advinia Group.

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CQC report highlights failings in dental care across the care sector

The CQC has today released a review of oral health and dental care provided to those in care homes. The report concludes that this is poorly implemented in care homes.  The review is based on 100 visits to different care homes by dental inspectors and oral health specialists.

There are specific NICE (National Institute for Health and Care Excellence) guidelines to cover dental care for persons living in residential care but in the majority of cases these were not being followed.  Residents generally had their oral health assessed upon admission, but often care home staff were not aware of the NICE guidelines and had not had specific training on oral health.  More worryingly, over half of the care homes surveyed had no policy to promote oral health, and nearly three quarters of the care plans reviews did not cover oral health or only partly covered it.

The CQC comment in the foreword to the report highlights the fact that the elderly of today generally are more likely to retain their teeth than earlier generations.  Good oral care is essential for those in care homes to reduce pain and reduce the risk of malnutrition.  Oral care was also often not joined up meaning that when emergency dental treatment was required, the homes would call a GP, or 111, or send the person to A&E – thereby placing a strain on already overworked services.

The care sector should carefully consider this report with a view to future policies and management of residents’ oral health otherwise this may be an area that residents and families focus upon in terms of claiming for damages.

The CQC’s report can be found here:  https://www.cqc.org.uk/publications/major-report/smiling-matters-oral-health-care-care-homes


Written by Jennifer Johnston at BLM