How they affect. Dr Mark Corcoran 8 th Feb 2013

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1 How they affect YOU! Dr Mark Corcoran 8 th Feb 2013

2

3 ACCOUNTABILITY Civil Liability Negligence Criminal Liability Assault and Battery Manslaughter Professional Accountability Disciplinary Hearings Complaints Procedure Inquests

4 THE NEW NHS General Trends Clinical Governance NICE Guidelines QuOF Harold Shipman; Colin Norris Practice Based Commissioning Laws of Consent Living Wills Fraser Guidelines Chaperone Policies Victoria Climbie; Baby P Information Technology Revalidation

5 LEGAL REFORM The Adversarial System Lord Woolf Out of Court Settlements No Win No Fee Lord Jackson No Fault Compensation

6 GENERAL TRENDS THE RULE OF FIVES

7 FROM 1989 to 1999 General Practitioners were 13 times more likely to be sued successfully General Practitioners were 33 times more likely to be involved in a spurious medico - legal claim

8 GMC Figures % increase in complaints from 3000 to , ,781 No evidence that this points to falling standards of practice NHS OMBUDSMAN upholds only a quarter of cases brought against GPs

9 NHS COMPLAINTS 16,337 in ,951 (18%) Against GPs 7,403 (45%) Against Hospital Trusts 2,247 (14%) Against PCTs

10 COST OF LITIGATION NHS Litigation Authority 9375 claims in 2004/5 Total payments 633m in 2007/8 Rising to 787m in 2009/10 Increase of 12% per annum

11 COST OF LITIGATION TIME STRESS

12 HOW NOT TO GET SUED Don t be a Doctor Don t be a Lawyer Don t be an Accountant DON T DO ANYTHING THAT INVOLVES TAKING RESPONSIBILITY FOR ANY ASPECT OF OTHER PEOPLE S LIVES

13 WHY ARE PATIENTS UNHAPPY? Publicity

14 PUBLICITY New cancer drug 'shows promise Hospital hails new arthritis drug Scientists claim sperm 'first'

15 PUBLICITY Rotten Apples Underperforming NHS

16 Stafford Hospital: Five more hospitals to be investigated Doctor's sorrow for Bailey's death Cauda equina syndrome misdiagnosis woman payout Former care home nurse struck off Medical trial surgeon played God, says widow Aberdeen doctor struck off over child pornography Hospital 'failed' man who choked to death on pill Nurse accused of using Facebook while caring for ill child Doctors 'missing cancer' in young people, says survey

17 WHY ARE PATIENTS UNHAPPY? Publicity Awareness of Health Issues / Rights

18

19 WHY ARE PATIENTS UNHAPPY? Publicity Awareness of Health Issues / Rights Raised Expectations IN ADDITION To Establish The Facts To Prevent Recurrence To Receive Compensation

20 WHY DO PATIENTS TAKE ACTION? Publicity Awareness of Health Issues / Rights Raised Expectations IN ADDITION To Establish The Facts To Prevent Recurrence To Receive Compensation

21 I have very strong views on the lawyers involvement in health care. Their proper place is on the operating table and certainly keeping doctors and nurses out of court and lawyers out of hospital seems to me to be the best working principle. Frank Dobson

22 Are Healthcare Professionals Blameless Or just misunderstood?

23

24 THE TEST OF NEGLIGENCE The Patient is owed a DUTY OF CARE The Duty of care is BREACHED As a direct result, the Patient suffers DAMAGE

25 THE DUTY OF CARE IN THE NHS This duty will usually exist without question

26 THE DUTY OF CARE Reasonable Foreseeability The NEIGHBOUR PRINCIPLE Donaghue -v- Stevenson (1932) Bourhill -v- Young (1942) Applied in a Medical Case :- Goodwill -v- BPAS (1996)

27 BREACH OF DUTY WHO DECIDES?? Bolam -v- Friern Barnet Hospital (1957) A Doctor is not negligent if he has acted in accordance with a practice accepted as proper by a responsible body of medical men skilled in that particular art...

28 BOLAM UNDER ATTACK A judge would be entitled to reject a unanimous medical view if he were satisfied that it was manifestly wrong. (Bolam, High Court ruling) Hucks -v- Cole (1993) CLINICAL GOVERNANCE NICE

29 DAMAGE IS CAUSED AS A RESULT OF THE BREACH Examples :- Kay -v- Ayrshire & Arran Health Board (1987) Barnett -v-chelsea & Kensington Hospital (1968) Hotson -v- East Berkshire Area HA (1987)

30 CAN WE AVOID LITIGATION? Are Healthcare Professionals Blameless Or just misunderstood?

31 Are Healthcare Professionals Blameless? MDU Analysis Failure or delay in diagnosis 51% Prescribing errors 23% Minor Surgery 7% Failure or delay in referral 4.5% Clinical Management 2%

32 Are Healthcare Professionals Blameless? MPS Analysis 60% of claims are due to System Failures Communication Problems Misunderstandings Data Management Referrals Monitoring of side-effects etc

33 ORAL COMMUNICATION Rudeness Lack of Explanation Uninformed Consent Communication Between Teams Breach of Confidentiality

34 HOW NOT TO GET SUED COMMUNICATION COMMUNICATION COMMUNICATION COMMUNICATION COMMUNICATION

35 WRITTEN COMMUINICATION Lack of Written Records is the Number One Problem

36 MDU ADVICE Good medical and nursing records are an indication of good practice. If you are sued it will be difficult to convince a Judge that you are a good Clinician or Nurse if your records are poor. Accurate, legible, comprehensive and contemporaneous notes are often the key to successful Defence of a medical negligence claim

37 WRITTEN COMMUINICATION Testicular atrophy - an uncommon but recognised complication of herniorrhaphy and as such there might have been a case which could be defended. However, the general level of care as indicated by the case records is of such a poor standard that I feel it would cast a shadow over any subsequent Court Proceeding. if they are unable to write adequate and accurate notes, can we trust them to perform a proper operation?

38 10 TOP TIPS Comprehensive and contemporaneous Accurate and legible Do not insult the patient Record all significant events Facts and not fiction Entries should clearly identify personnel State timing when it is relevant Declare post dated or corrected entries Indicate when advice of colleagues is sought Record complaints of patient or family

39 COMPLAINTS Local Resolution Practice PCT PALS NHS Ombudsman GMC

40 Talk to someone In practice Friend / mentor LMC (Safehouse) MDO What To Do? Respond promptly Don t be afraid to apologise

41 CONTROVERSIAL ABBREVIATIONS GOK FLK FLP VGLM LOLIAD PTOB NFD TTFO

42 That s How they affect YOU!

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