[jfw]

could the propensity for error also be linked to the paucity of funding

i.e. stretch resources too thinly and cock ups happen

[lagerstarfish]

I can't be expected to formulate theories that are consistent with actual data. I'm not a scientist

[Sloper]

could the propensity for error also be linked to the paucity of funding

i.e. stretch resources too thinly and cock ups happen

It absolutely could, and this is not to be dimissed, but clin neg claims usually have a lag time of three / four years between the index event and settlement (and about two years from index event to proceedings) so I don't think we'll see whether there has been any effect until say 2017/18 9as the spending rate for the NHS until about 2012 was I think steady with the previous government's settlements.

What is however clear is that the graph, in terms of claims was going up even when money was, if you accept that it was and that is open for debate, pouring into the NHS, so that funding didn't depress the claims.

[drdeath]

The most logical suggestion I've heard is that the underlying case is the WTD and the changes to hospital doctors' training, i.e. Drs are now less experienced than before and consequently make more and more serious errors.

Hmm....I am no sure that's the case for a few reasons...

1 -
I worked both before the EWTD and after and in my experience people are far more aware of patient safety/the  possibility of negligence than they used to be, and practice accordingly...but that's just anecdotal, so not worth much...on the flipside I saw people get away with offering scandalously dangerous/poor treatment in the late 90's that I wouldn't expect to be tolerated now...maybe I'm just a starry-eyed optimist...

2 -
EWDT and changes to training were identical across both Scotland and England, and Scotland has seen nowhere near the level of payouts that England has...the budget for clinical negligence claims in Scotland is around £24 million. a year. If multiplied by 10 to get the UK estimate that would be £240 million - nowhere near the 1.25 Billion predicted for the UK.

I can't explain that disparity  -  and I have seen no reasonable explanation offered elsewhere.

[Sloper]

While the costs are different apparently the upwards trend is very similar dor the year 2010/11 i.e. before there were any 'savage cuts'  to the NHS (18% Scotland) (20% England) http://www.smj.org.uk/tag/negligence/  and the suggested cause, at least superficially is that such claims are harder to pursue in Scotland.

[drdeath]

They're not just 'different', they would be predicted to be around £125 million...they're 20% of that...

And I don't believe the rise is due to savage cuts...

But I do agree with you that the likely biggest factor (in any increase/difference) is the access to/usage of the legal system as a means of redress...for better or worse...

D

[Sloper]

Sorry, I think we're broadly ad idem, the costs and n of claims are probably due to the different legal systems (I don't even know how the assess damages in Scotland): however my point was that while the costs of the claims is much lower the trend line is pretty consistent and as such given the disparity between the systems the cause of the rise in England and Scotland is likely to be broadly similar.

Since the systems are so different (and the barriers to making a claim so significant) it is reasonable to suggest that the rise is not due to increased ease of access in England & Wales (as this has remained constant since 1997 and yet in 2007/8 we've seen a significant increase in claims (i.e. for events that probably occurred in 2004-5.

My point about cuts was slightly disingenuous. 

[GCW]

The number of claims is difficult to quantify, Tom. The reasons for the increase in claims are mulifactorial. Media crap plays a huge part. Look at all the bollocks about GPs not referring cancers soon enough. Really? I respectfully suggest that we follow NICE guidance and the specific 2 week referral pathways. Oh hang on, that's what we are doing. And the hospitals are now complaining that we refer too much as potential cancer and they can't cope unless their funding increases. Ha ha.

Anyway, claims go up because every other advert is about how shit your NHS care is, it's cheap,to have a go (no win no fee). My most recent complaint was a guy that lives in southport that we took off the list because he lives over 20 miles outside our boundary.  I'd love to repeat the personal abuse, but that wouldn't be professional. PS thanks for wishing the deaths of my children, but you still need to register with a new GP.

I'm almost looking forward to the day that the government makes primary care collapse, and then privatise it. Let's see how the general public react when they realise what they've thrown away.

[Sloper]

The claims numbers come from the NHSLA so I think they're pretty accurate.

Should we allow for the solicitors to provide incentives for people to claim e.g. have a free ipad when your claim is accepted? Absolutely not and why it isn't banned escapes me entirely. (note we don't offer incentives)

Should we allow advertising, that's a more difficult one to address.

I'm sure the rise of the number of claims is complex and don't suggest that I have an answer or indeed can suggest the leading causes: however it is clear from the data that funding is not the prime cause i.e. funding goes up, the number of claims is at least flat / rising.

[GCW]

An unprecedented third round of GP trainee recruitment by Health Education England (HEE) cost £113,000 and filled just 72 out of 451 posts that remained vacant after the first two rounds, official data show.

GP workforce crisis could force 600 practices to close, warns RCGP

What was that the parties said about increasing numbers?   

[Sloper]

One of the benefits of the market is if you can't recruit at £x + benefits you'll have to offer more £ or better terms,

Since you're here Doc, I've got a cold, can I have some antibiotics  (actually I've also now got a cough and green snot but I expect that too is viral and will pass)

[GCW]

One of the benefits of the market is if you can't recruit at £x + benefits you'll have to offer more £ or better terms

Yeah, or get bailed out by someone on enough better terms than that!

[Sloper]

Well if the desire is to have the state 100% i/c of the NHS and they say GP's should work 7 days a week for £40k surely those who rail against the 'privatisation' of the NHS should applaud this and encourage the GPs to 'suck it up', after all we can't "stuff Doctors mouths with gold" forever can we?

Or is it the case that Dr's want the benefits of a free market aspect within the NHS when it suits them?

[GCW]

To the anonymous person who wrote in to complain that I shouldn't be wearing a watch whilst seeing patients: balls to you. How do you want me to check your pulse?  FFS.

[tomtom]

Get a fuck off big hourglass (set to 5 min of sand) and make a big point of turning it over when a patient comes in

[Sloper]

To the anonymous person who wrote in to complain that I shouldn't be wearing a watch whilst seeing patients: balls to you. How do you want me to check your pulse?  FFS.

Isn't there a machine that does that?  PS the patient is obviously a cock.  I hope their complaint received the response 'thank you for your letter. We have considered the same.  We will take no further action. Yours Sincerely'

[webbo]

More likely it will be " we accept that Dr Lanky Punter was not following infection control procedures to letter. In that although he followed correct hand washing procedure and had bare arms to the elbow, he was wearing a wrist watch. Therefore we accept your claim that you have been extremely traumatised by this and willing to offer you £1,000,000 for your troubles"

[Sloper]

Sadly you're probably closer to the truth than I am.

When dealing with client complaints (about 1 or 2 a week) when we've screwed up we accept it and look to resolve things sensibly and move on, if we're in the clear I won't sell our staff short.

We had a cvnt complaining that 'a fucking school child could do that, you're shit' and some other less coherent nonsense (and stuff that I have to maintain confidentiality on), I asked him to apologise, he said no, so I told him we were terminating the retainer and even though it was 'no win, no fee' we could send him a bill and we would, and if he didn't pay we'd sue him.

The twat phone me and started having a go, and I offered to reduce our bill by £5 (to £1195) and if he didn't like it he could go to the Ombudsman,

If the NHS can't deal with twats properly then its a lack of political will within the trusts.

[petejh]

The NHS could contract special lawyers as consultants to help them deal with these sort of issues... in fact outsourcing all complaints to a specialist team of case handlers would perhaps free up blah blah blah...

[Sloper]

Yes they could and it would cost a fair bit, whether it would cost less than their in house fucktards is another question entirely.

If it was truly independent then the scandals would be laid bare (here's an example that pretty much all concerned must have been aware of http://www.theguardian.com/society/2014/nov/14/colchester-hospital-sedation-restraint-cqc-nhs-crisis and it would be significantly more likely than not that there would have been complaints that would have been "investigated" and "not substantiated")and dealt with and the frivolous fuckwits would be told go fuck off, a win win situation if there ever was one: however wouldn't this be creeping privatisation and therefore bad?

Having a complaints system that backs the clincians would I imagine result in a massive boost of confidence in the staff in the system and a real help with morale.

[webbo]

The NHS works on the premiss that if it's cheaper to settle out of court even if we are in the right then fuck backing the Clinician.

[petejh]

Yes they could and it would cost a fair bit, whether it would cost less than their in house fucktards is another question entirely.

If it was truly independent then the scandals would be laid bare (here's an example that pretty much all concerned must have been aware of http://www.theguardian.com/society/2014/nov/14/colchester-hospital-sedation-restraint-cqc-nhs-crisis and it would be significantly more likely than not that there would have been complaints that would have been "investigated" and "not substantiated")and dealt with and the frivolous fuckwits would be told go fuck off, a win win situation if there ever was one: however wouldn't this be creeping privatisation and therefore bad?

Having a complaints system that backs the clincians would I imagine result in a massive boost of confidence in the staff in the system and a real help with morale.

I don't have a view either way other than: either way could work perfectly well or perfectly poorly dependent on the leadership and other qualities of the individuals that comprise the institution. After all an institution/system/whatever comprises individuals who possess independent minds, and consciences, morals and integrity that sit somewhere on a spectrum of psychopath to saint. What doesn't seem acceptable to me is any institution whether private, pseudo-private (state-funded contractors) or fully state-funded, working poorly/lazily/inefficiently.
Seems a key question is what drives people - patients and the institutions that serve them - to behave in the ways described in this thread? Jon Alexander's '4 thought' Killing the Consumer' offers one explanation.

[Sloper]

The NHS works on the premiss that if it's cheaper to settle out of court even if we are in the right then fuck backing the Clinician.

Sorry simply not true.

THE NHSLA spends untold millions defending cases that are always

[webbo]

Can someone explain in one reasonable length paragraph why 10 years ago I could see a GP within a couple of days (and I knew who they were) and now I get an appointment with 'my GP' (the new one allocated to me after the other one and the one before left) two weeks after calling? I'm not blaming anyone (especially Gp's) - it just seems like something that worked in fashion is now ferked...

Hmmm the cynic would say the change to the GP contract and structures introduced by Labour, or is it more complex than that? GCW, answers please.

Webbo, time the NHC stopped dealing with every complaint as if they have a currency just because they're made, cf whistleblowing.

If what you are saying is the NHS should stop believing every compliant has validity. I would love someone to implement this.
I have a current situation with a client with an extensive forensic history including robbery with violence,kidnapping, wounding and so on. Who complained because he turned up for an appointment at the wrong time and date due the appointment letter having a date and time that didn't match. He didn't bother to ring to say the letter did not make sense, before that was delt with. He then complained because he had not been allocated a female nurse because he can not trust men.
All this rather gets in the way of providing care for other patients and people wonder why there are waiting lists.

I posted this a couple of weeks ago. We are now being threatened with legal action for not responding to this "service users" needs and it seems in order avoid a court case the trust it's bending over backwards to avoid this.
Rather than actually challenging anything.

[petejh]

Well, someone did fuck up the appointment letter did they not, causing this patient <consumer of medical product> to waste/rearrange a few hours of his existence.

But seriously, a court case for what? What could he claim for?