The NHS’ Lost Metric and How to Improve it

William and his mother, Christine. Image courtesy of BBC

“William was a funny, caring little boy who liked to make jokes and had a heart of gold. He was adored by his friends”. These were words from Christine Hui about her son, William Gray, who passed away from an asthma attack aged just 10. 

Last November, the coroner’s report named the chief reason for the young boy’s tragic passing - medical negligence. William always suffered from acute asthma, enduring a particularly severe episode almost a year before his passing. However, despite being “as near to death as possible without dying” at that time, the GP he was admitted to elected to release him just 4 hours later, then failing to conduct adequate follow-ups to ensure his health remained stable.

Negligence is not a rare phenomenon in the United Kingdom. Legally, it is defined as when substandard care is provided to a patient by a medical practitioner, which is an offense the former party can seek compensation for. Just this year, over 13 500 new cases were filed against the NHS by aggrieved patients.

This statistic can be used to gauge the quality of a healthcare system, so how do negligence figures compare to other headline metrics for the NHS’ effectiveness? Over the last 10 years, new negligence cases increased by 28%. Although not an ideal scenario, this statistic paints a significantly more positive image than waiting list figures, which have more than doubled over the same period. 

A more mixed outlook is noticed when the UK’s negligence figures are compared to those of other OECD economies. Most severely, medical malpractice takes the lives of 250 000 people every year,  on average, in the USA, making it the third largest cause of death in the country. Germany and France, on the other hand, experience comparable numbers of negligence cases with the NHS, despite treating more patients.

Therefore, also accounting for negligence statistics, the UK is less of the “sick man of Europe” that many consider it to be when it comes to healthcare. However, there is still plenty the government can do to make sure the NHS provides care to the standard it aims to. Policies to do so could also pay off in the long run, with the NHS spending 3.3 billion pounds to pay out victims of malpractice in 2023 alone.

A first step would be to identify the areas in which negligence occurs more often. NHS Resolution, the health service’s legal arm, states that Obstetrics, the sector tasked with providing care to women before, during and after childbirth, is to blame for more than 50% of the cost of patient claims. Urology, on the other hand, is responsible for just 0.2%.

The House of Commons Health and Social Care committee has thus named measures to curb this cost in April 2022. But, they center only around streamlining the claims process for specific sectors, improving patients’ access to justice and ensuring less of the eventual reward ends up in lawyers’ pockets. Although significant, this does not address the problem at its core.

What is truly required is a change of culture in regards to training to avoid the harm being done in the first place. In the period of 2008-18, more than 30 education programs took place for NHS doctors, with only few being rigorously evaluated to see whether they yielded positive results. A shift to a learning-based approach, in contrast to merely accepting mistakes will always happen, could facilitate the designing of incentive schemes that push staff to not only comply with existing training schemes, but actively engage in them to improve their skills. 

However, there could be limits to what can be achieved without solving the overarching ailments plaguing the NHS. It could be argued that a large portion of negligence occurrences are indirectly caused by the service’s consistent underfunding, leading to substandard equipment and understaffing, resulting in doctors spending less time on each patient. Naturally, this makes them more prone to making mistakes.

Although these eventual limits might exist, NHS executives should by no means adopt a defeatist attitude. A change of attitude towards employee training is undoubtedly the most cost-efficient and immediate way to stop negligence in its tracks. Not to mention that more trained doctors are also more accurate in their prescriptions, avoiding needless surgical procedures which would otherwise increase the growth rate of backlogs.

With these changes, one can only hope needless suffering can be avoided. According to his mother, William Grey “was always committed to helping others” and “dreamt of being a doctor”. Perhaps lessons learnt from his passing will be able to save more patients in the future than he ever could.