Thursday, July 06, 2006

Box Ticking Fails To Make NHS Safer


Hospitals are dangerous places. I know that because my Mum- a pre-NHS hospital nurse- kept telling us when we were kids. And today's shocking Public Accounts Committee report tells us just how dangerous today's NHS hospitals are with respect to medical errors:
  • One in ten patients is unintentionally harmed
  • There are a million "incidents" and "near misses" every year, including over 2,000 actual patient deaths
  • In addition there are an unknown number of unreported events: it is estimated that getting on for a quarter of "incidents" and a half of "near misses" go unreported

And it isn't just the suffering of the patients and their families: taxpayers have to foot the bill for putting things right. The cost is put at £2 bn pa in extra hospital bed days, and £400m pa in settled medical negligence claims.

But like my Mum said, hospitals are just dangerous places. The important question is how you tackle that?

The NHS response five years ago was to set up yet another new quango- The National Patient Safety Agency (NPSA). It employs over 300 people, and costs us £35m pa. The idea was to collect information on all those incidents at national level and somehow promulgate new safety procedures. And it has made just about every mistake in the top-down bureaucratic box-ticking book:

  • Reinventing the wheel - instead of taking reporting systems already in use abroad, it devised its own new "taxonomy" from scratch
  • Duplication - NPSA reporting duplicates existing local reporting arrangements which users prefer
  • Complexity - there are now no fewer than 30 different reporting lines for errors
  • Failing to engage with users- eg despite having been going since 2001, 60% of junior hospital doctors have still never heard of NPSA
  • Failing to make any coherent use of the stats collected- rendered pretty useless anyway by the lack of follow-through to ensure consistent reporting standards

Yes of course we understand that Whitehall is concerned to stop error-prone medicos covering-up. And there have been some widely reported horrors on that front over the years. But no amount of this box-ticking is going to achieve that.

And meanwhile, we're down another £35m pa.

The PAC said there is "question mark over value for money". How extraordinarily polite.

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