The National Health Service needs a completely new approach to patient safety. Once again, the public accounts committee, one of the oldest committees of MPs, has proved its value in identifying a problem of the wasteful spending of taxpayers’ money.
As usual, however, the committee is better at describing the problem than in coming up with a solution.
The problem is that the NHS spends far too much on compensation for medical mistakes. The public accounts committee says: “An astounding £58.2bn has been set aside to cover the potential cost of clinical negligence events in the latest accounts – the second largest liability across government after nuclear decommissioning.”
This is a dramatic way of stating the problem, although the £58.2bn figure is perhaps not the most useful one. It is not money that is actually “set aside”: it is simply a way of estimating future claims for long-term planning purposes.
What matters is the amount that is actually spent each year on clinical negligence claims: this was £2.8bn in the financial year 2023-24. That is nearly 2 per cent of annual NHS spending. It means that for every £50 spent on the NHS, it pays £1 to compensate patients or the families of patients for injuring them or killing them rather than making them better. This is unacceptable.
Lord Darzi, the doctor and Labour former minister who reviewed the NHS for the incoming government last year, said it is twice the share of health spending paid in negligence claims in New Zealand, 10 times that in Australia and 20 times that in Canada.
This is why the public accounts committee says that “huge improvements still need to be made to better protect both patients and public money”. As the committee says, “behind these jaw-dropping figures lie many tragic incidents of patient harm”. Each case of compensation is a family’s emotional trauma, a case of illness misdiagnosed or not spotted at all, or of treatment gone wrong, sometimes with fatal or life-changing consequences.
Year after year, well-meaning attempts have been made to get to grips with the problem. Jeremy Hunt – the long-serving health secretary in the Conservative government – to his great credit made patient safety one of his personal missions. He has even written a book about it, Zero: Eliminating unnecessary deaths in a post-pandemic NHS.
Mr Hunt achieved some useful reforms, for example changing the remit of the NHS Litigation Authority, now called NHS Resolution, so that it focuses on trying to resolve claims of negligence without going to court.
But that does not deal with the underlying cause of the problem, which is why medical mistakes are made in the first place.
This is where the entire NHS needs a change of culture. It needs to adopt an airline safety approach, which is to say that every mistake should be investigated in a no-blame environment where the only things that matter are learning the lessons and improving protocols to make specific errors less likely in future.
This may be hard for the general public to accept, because the usual demand whenever anything goes seriously wrong is for a public inquiry, often with the explicit purpose of apportioning blame – and often with the implicit assumption that those so blamed must go to prison.
These attitudes lead to a climate of fear and therefore a tendency to cover up mistakes and an institutional defensiveness that prevents lessons being learnt. The Independent has seen this pattern repeat itself time and again in public services in general, but in the NHS in particular – above all in specialisms such as maternity care.
This is a huge challenge for Wes Streeting, the current health secretary, who has made a brave start on the equally daunting task of clearing the coronavirus backlogs. But if the change cannot be achieved within the NHS in its current form, then other models of healthcare must be considered instead. The issue is too serious for sentimentality about the NHS, which Nigel Lawson, the chancellor in the 1980s, called the “national religion”, to get in the way.
