The danger of headline spotting
17 June 2002
24 May 2013
19 July 2013
29 July 2013
12 July 2013
21 January 2014
Its reception illustrates the dangers of dealing with complex subjects without reference to how they will be handled by those looking for headlines.
Many people really do seem to suppose, like Keith Nightingale in his Opinion on 3 June 2002, that "£4.5 billion of the NHS £40 billion allocation" has been set aside to meet clinical negligence claims. In fact, £4.5 billion is the total valuation put on all clinical negligence claims, whenever they may have occurred. Whereas the total budget of the NHS is now £70 billion. There is no certainty that the £4.5 billion will ever be spent.
Annual expenditure is running at around £400 million, and of that money the vast majority is in respect of birth injuries. Because limitation does not apply to such cases, they could have occurred at any time over the past 50 years. Furthermore, the vast majority of such claims are in respect of the cost of care. Those bills will either be met through the clinical negligence budget or through the cost of care provided by the NHS in other ways.
Nor is it true that the average clinical negligence case now takes five years to complete, from start to finish. The NAO report concentrated on a cohort of cases being handled by the National Health Service Litigation Authority (NHSLA) under the Existing Liabilities Scheme (ELS). The ELS deals only with cases occurring before April 1995. Since the NAO report was written in 2000/01 it would only seem natural that the average settled case had been open for five years when looked at by NAO report.
Similarly, it was found that the average case worth less than £50,000 absorbed more in costs than damages. This figure was distorted because open and shut cases which had been settled more promptly escaped the reports cohort. This is not a criticism of the NAO which wished to scrutinise how one particular group of old cases was being dealt with. But it does mean that the exercise has more capacity to mislead than instruct; this is partly because for much of their history many of these cases had been dealt with under a different system and on the instructions of a different authority. It also does not give a fair picture of how cases of this sort have been dealt with. It was inevitably an historical examination.
The relationship between the increase in claims and the increase in complaints is difficult to understand. There is no doubt that complaints to the General Medical Council (GMC) have increased dramatically, by more than threefold in five years. Why this should be is unclear, although it may be because people are more aware of the GMC's willingness to take up almost any complaint against a doctor. As a result of the court's decision that complainants have a right to have their case taken up, the GMC finds it difficult to reject cases out of hand unless it is clear, for example, that the subject of the complaint is not on the Medical Register.
It may also be a paradoxical effect arising from the unprecedented confidence which people have in the medical profession. Television programmes not only portray doctors in a heroic light, but also give the impression that the art and science which they practise may deliver a safe remedy for every misfortune. There are 10 programmes describing the latest treatment for cancer for every one which portrays the grim and unheroic reality which is death from cancer.
A survey of opinion last month showed that doctors and nurses remain the professions held in the highest esteem by society. Thus it is likely that the rising level of complaints and claims reflect the disappointment of expectations which are unrealistically high. Rather than complaints about their colleagues being the consequence of publicity given to the cases of Bristol, Shipman and Ledward, the cases reflect an unrealistic demand of medical services.
Nor is it fair to say that patients are finding it harder than ever to find out what went wrong. There is good evidence that the medical profession and their employers are more willing than ever to provide detailed explanations when things go wrong. There is a Directive from the Litigation Authority that this should happen and there has been extensive advice from professional bodies over many years that doctors should own up to their mistakes.