NHS faces huge clinical negligence legal fees bill - are there solutions?

According to the BBC today, the NHS in England could face legal fees totalling £4.3bn to settle its outstanding clinical negligence claims.

The figure was discovered by the BBC through a Freedom of Information request and included all current unsettled claims, along with projected estimates of future claims.

Atrainability is currently helping several entirely different healthcare organisations deal with this problem.

Human Factors Ergonomics is at the heart of everyone. Some problems are at the organisational level; some are individual issues.

The organisations we work with represent a complete cross-section of healthcare.

One is a small public hospital that we have helped to identify the deep problems which can be fixed. The front line teams have stated that there is no effective senior-level leadership.

Senior leaders are not present when they should be. This absence of senior leadership is frequently a factor in failing organisations.

Along with this, they do not deal with staff complaints and evidence is there of 'encouraging' staff to change complaint statements. Clear guidelines are not there.

Staff have nothing to refer to settle differences of opinion about care pathways.

Bullying and inappropriate behaviour are rife. There is a suspicion that this abusive behaviour is implicated in a reluctance to escalate concerns about a rapidly deteriorating patient which may have resulted in a death, and consequent legal costs of course.

There are doubts about clinical competence. Unsocial hours working is not equitably shared out. There are conflicts of interest between public care and lucrative private work.

There is considerably more.

In this case, we suggest that the managers get on and manage. Stop ducking the difficult conversations with other managers, clinicians and staff. Patient safety must come first.

They also do not understand the human condition. They are ignoring work conditions that provoke increased unnecessary stress. They do not learn from failure and certainly not from success.

They have wonderful dedicated front line staff who are worn out. Some of that stress comes out in unprofessional behaviour. It needs managing.

Another organisation we are helping is not within the NHS. It has used Lean methodology as a core concept.

Lean is excellent for car production lines. Some of the concepts are laudable. Stop the line. Continuous improvement. Just in time. But with that comes 'efficiencies' in manpower. They do not have enough frontline staff.

Six Sigma is a better model. It is about doing the right thing, not the outwardly most efficient.

A defect is anything which doesn't meet customer expectations. I think that covers patient safety. They have state of the art equipment and again, dedicated front line staff whose concern is for their patients.

Here we believe a lack of standardised procedures and guidelines are again a problem. Plus lack of recognition of overwork and stress again.

Another of our current clients is rather strange and a delight.

We have an NHS Trust that has decided to be proactive. Their head of Quality Improvement (QI) has realised that building human factors ergonomics principles into their QI programme and spreading it across the entire Trust staff could have a very beneficial effect.

I say they are strange because most of our clients come to us having harmed or killed someone through 'negligence'. This one has spotted that using Six Sigma and other concepts can maybe intercept the threat vector.

The avowed intent is to empower staff to think and share their ideas; to encourage staff to take a proactive stance.

Of course, the management must be listening – actively, but this is a delight to work with.

When you look at the recent GMC publication 'Caring for doctors, caring for patients' this fits the bill superbly. Except it is not confined simply to doctors but everyone.

To ensure wellbeing and motivation at work, and to minimise workplace stress, people have three core needs, and all three must be met.

A Autonomy/control – the need to have control over our work lives, and to act consistently with our work and life values.

B Belonging – the need to be connected to, cared for, and caring of others around us in the workplace and to feel valued, respected and supported.

C Competence – the need to experience effectiveness and deliver valued outcomes, such as high-quality care.

As simple as ABC and of course it applies to everyone.

It isn't rocket science - JFDI.

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