Further Confessions of a GP

Is the quality of NHS care really declining?

Late one evening 30 years ago, the senior partner at my surgery visited a six-year-old boy at home with a fever. He diagnosed a viral illness and advised paracetamol. By the next morning, the young lad was dead from meningitis. Mortified to hear of his mistake he visited the grieving family to apologise, but rather than being met with anger and legal proceedings, he was thanked by the tearful parents for his help and efforts the previous night – and he continued to be the family’s GP for years to come.

The diagnosis of early meningitis is as difficult to make now as it ever was and it is still missed by doctors today, as it was 30 years ago. Losing a child to the disease is as horrendous as it always has been. The difference appears to be that expectations have changed. We don’t yet have lawyers loitering around A&E waiting rooms or chasing ambulances, but there definitely appears to be an increased awareness that medical errors can lead to financial compensation and claims continue to increase year on year.

Annual NHS compensation payouts grew from £277 million in 2000/01 to almost £1 billion in 2010/11. This is partly related to the increase in the number of claims but also to the increased cost of the individual claims, which can be up to £10 million each. Ironically, this increase is in part due to improved NHS care rather than an increase in errors. The young boy with the missed meningitis 30 years ago may well have survived today. The diagnosis may have still been missed early on, but improved intensive care facilities could have resulted in him surviving, albeit with severe brain damage and physical disabilities. The biggest compensation payouts are made to help financially support severely disabled children who may now live for several decades but remain in need of long-term expensive care packages.

So in these times of desperately low NHS resources, what can we do about expensive compensation payouts? The obvious answer is to reduce the number of cock-ups. This may seem simple enough, but unfortunately mistakes and errors will always happen. The causes are multiple and I am not trying to brush over or dismiss them. I am also not trying to excuse them or suggest that the NHS and its staff shouldn’t be held accountable; I am simply stating that as long as health care is delivered by humans, errors will be made.

Every day the tabloid media offer terrifying tales of health-care blunders. It feels like a continuous drip-feeding of the idea that the NHS is broken and doomed to collapse. These stories feed fears that every operation will be botched and every medical decision made will be the wrong one. I don’t begrudge compensation payouts when genuine mistakes have been made and I’m sure the families involved would rather have the good health of their loved one than a damages payment. However, it is important to recognise that the rise in the number of claims isn’t due to standards of care in the NHS falling. We still have a long way to go, but here on the coalface, I genuinely think that overall the quality of care is improving.

As doctors, it is our job to learn from our mistakes, share them, be honest and open about them, and most importantly make sure they don’t happen again. As patients, I would advise that you ask questions, share medical decisions with your doctor and educate yourselves about your own health and illnesses. Medical mistakes have been, are and will always be made, but fortunately genuine cases of medical negligence are still rare. The cynic in me wonders if the constant drip-feeding of medical error stories is an attempt to convince the public that the NHS is failing and therefore dampen down any opposition as widescale privatisation of the health-care system is sneaked in through the back door.