Medical Accidents in Women’s Healthcare: the Patient’s Perspective PETER WALSH, CEO,

WHAT IS AvMA? An independent charity established 1982 Promotes patient safety and justice for those who suffer medical accidents Provides advice to individuals affected by a medical accident Accredits and monitors specialist solicitors Maintains / develops medical expert database Promotes good practice

Some Common Myths Patients are Litigious Health Professionals will not report incidents if there are implications for them The health service can not afford to compensate injured patients

“Patients are litigious” DoH estimates circa 1 million medical errors in English hospitals alone each year, about half of which are potentially ‘negligent’ Number of new claims made to the NHS Litigation Authority last year: under 6,000! Most patients turn to litigation as a last resort to get to the truth, or because it is the only way of getting the compensation they need

“Health professionals will not report incidents if implications for them If true, all of our health professions are unfit to practice under current criteria! (see GMC, Good medical Practice) Will always be some who put own interests before injured patients but do not tarnish everyone Anonymous reporting systems a safety net, but no substitute for ethical behaviour

“The NHS can not afford compensation” £500 million a year could buy a lot extra treatment, but… At well under 1% of budget is much cheaper than insurance premiums would be Human cost is the real cost but extra bed days and treatment outweigh compensation Best way to reduce costs is to prevent errors – not deny justice Would there be the current emphasis on safety if it were not for the added incentive of litigation costs?

What patients want… Patient Safety and Justice

‘PATIENT SAFETY’ First do no harm Benefits outweigh risks Qualified, competent practitioners Evidence base Safe environment Checks Lessons learned

Issues in Obs & Gynae Obs: 25% claims – 65% cost of claims Most serious and emotive incidents – children Not about illness – deprived joy Shortage of midwives & consultants when you need them Interface between midwives & doctors Late intervention / analysis of monitoring equipment / tears

Issues in Obs & Gynae (cont) Still births Listening to parents and Involvement of parents in investigation when things go wrong – parents make great witnesses! Adding insult to injury – denial and putting ‘blame’ on mother

WHAT DO PATIENTS WANT WHEN THINGS DO GO WRONG? Latest evidence (DoH, Making Amends, 2003) : Of those affected by medical injury: -34% wanted apology/explanation -23% an enquiry into causes -17% support in coping with result -11% financial compensation -6% disciplinary action

‘JUSTICE’ “Fairness” Information Explanation Apology (if appropriate and real) Action to prevent re-occurrence Compensation

Is there a better way to deliver patient safety & justice? So called ‘no-fault’ compensation schemes: No such thing as ‘no-fault’ compensation – and why should there be? Most schemes designed in response to ‘no blame’ culture calls, and perceived need to limit compensation – not justice CMO’s proposals in Making Amends widely criticised and dropped Every child deserves high quality treatment – ‘compensation’ an entirely different issue

Alternative Proposals Widen the definition of liability: for example, Denmark. An “ avoidability test” Join up patient safety issues with issues of redress Build independence and specialist representation into the proposals

The NHS Redress Bill Claims under £20,000 in ‘value’ NHS determines its own negligence No specialist representation for patients Missed opportunity for joining up processes – improving safety Mounting pressure to address these weaknesses in the Bill – watch this space!

Patients and Doctors want the same thing ‘A Charter of Understanding between Doctors and People affected by Medical Accidents’

Appreciation of Risk “ The practice of medicine and undergoing medical treatment carry with them risks. These risks should be fully explained..There will be occasions when an adverse outcome is unavoidable. “

Treatment should not be affected by a Dispute “Patients’ physical and mental health should be the paramount concern of any treating doctor, whether or not there is a clinical dispute over treatment or a medical error is alleged to have been made”

Doctors are only human “ Committing an error is not in itself an indication of incompetence or negligence. A doctor should be supported in (indeed applauded for) reporting errors openly and honestly without fear of unreasonable consequences”

The Right to know “Avoidable injury may also be caused by human error on the part of doctors, or others assisting doctors in the care of a patient. When it appears this has occurred, the patient..should be informed and have the circumstances fully explained” See also, ‘Being Open’, NPSA ‘Good Medical Practice’, GMC

Right to Redress “Medical accidents have a real and deep impact on people’s lives. Patients who have been affected by a medical accident have a perfectly reasonable right to explanations and to seek apologies, assurances and/or financial compensation for injuries caused, where appropriate” See also ‘Making Amends’

THANK YOU! Any questions or comments? To sign up to the Charter or for further information visit: