I support Mark McDonald’s submission that the Thirlwall recommendations will lead to more blame and suspicion in the NHS (17 October). We often hear of hospital scandals where trusts are intent on preserving their reputations, internal inquiries go nowhere, defensive clinical staff deflect blame on to others, non‑disclosure to patients of errors and “lessons learned” rhetoric that is quickly forgotten. There is also an industry of ambulance-chasing lawyers.
None of this is conducive to a no-blame, honest, open culture in healthcare. The Thirlwall recommendations of more surveillance will make it worse. Most of my professional life as a hospital consultant, clinical director and deputy chief medical officer has been spent in New Zealand, whose publicly funded NHS is the same model as the UK’s – but with a major difference.
In the 1970s, New Zealanders lost their right to sue for damages for medical accidents or injury through the public court system with the Accident Compensation Act. This got rid of the grievance culture and ambulance-chasers, and the system provided remedial care for any injury. In the 80s, after a huge scandal regarding medical investigations, the Cartwright inquiry ushered in the creation of the independent Health and Disability Commissioner (HDC) and overriding principles of patient safety, interests and consent.
All complaints – from patients, public and staff – about any health facility, organisation or practitioner go first to the office of the HDC for investigation. If the HDC deems it necessary, it goes to the various professional disciplinary bodies or to the Medical Council of New Zealand. HDC reports on complaints are publicly available.
In 2005, the government passed its “no fault, no blame” legislation. This brought in a duty to report “any risk of harm to the public from authorities responsible for patient safety”. This freed clinicians to engage with any compensation cases with openness.
The system has its critics, but overall works well. Dr Pamela S Melding St Helens, Merseyside Mark McDonald’s column is a breath of common sense. The Criminal Cases Review Commission is still considering Lucy Letby’s convictions, yet Lady Justice Kathryn Thirlwall has constructed a programme of reform on the assumption that the central conclusion of the case is beyond question.
Extract — continue reading at the source.
