The NHS’s Accident and Emergency departments have, for decades, served a vital role at the front line of healthcare in the UK.
We rightly trust that if we have a medical emergency, they provide the best chance of dealing with our problem and either discharging us home or admitting us for surgery or further treatment. A&E are, however, struggling to meet the duty of care they have to patients, and this is leading to an increasing number of errors being made. NHS Resolution’s latest annual report shows that the number of clinical negligence claims received was highest for emergency medicine (at 13% of all cases), exceeding orthopaedic surgery (12%), and obstetrics (10%). The value of claims is, however, considerably higher for obstetrics (50% of the total amount claimed £4,931.8m), whereas A&E only relates to 9% of the total. Nevertheless, the fact that A&E has now overtaken orthopaedics as the highest number of claims suggests a real cause for concern.
What are the factors behind the rise in emergency medicine claims?
According to NHS England, the total number of emergency attendances in June 2019 was 2,108,001, representing an increase of 0.7% on the same month last year. They also report there were 528,808 A&E admissions in the same month (3.0% higher than the same month last year), and emergency admission growth over the previous 3 months has been at 4.0% and over the last 12 months, 5.4%. These represent significant increases in admissions relative to attendance, and as such, there has been a corresponding decline in performance. In June 2019, the volume of patients admitted, transferred or discharged within 4 hours reached 1.6m (4.4% decrease on the figure for June 2018).
Due to the rise in those attending and being admitted to A&E, there is a corresponding increase in the pressure on already limited resources and staff. For some A&E patients, this has led to treatment delays, misdiagnosis, and in limited cases, poor treatment. According to Rachel Power, chief executive of the Patients Association, the increase in A&E claims “reflects the crisis conditions that patients are now suffering in A&E all year round — not just in winter. These arise directly from the long-term underfunding of the NHS and failures in workforce planning.”
Lives damaged by poor quality A&E care
There are, unfortunately, all too many real-life examples which illustrate the problem which patients have encountered in NHS emergency departments.
Misdiagnosis of meningitis
In March 2018, Tim Mason, who had contracted a meningococcal W infection (MenW), was wrongly diagnosed at Tunbridge Wells A&E department with gastroenteritis. After being discharged home, he was rushed back to hospital only hours later and died following a heart attack due to sepsis. Following an investigation, it was discovered that hospital staff had made mistakes during Mr Mason’s sepsis screening and had altered medical records. The hospital has now implemented changes to avoid such circumstances in the future, including mandating a ‘senior review’ by a supervising clinician before a patient with abnormal observations is allowed to go home.
Clinical error led to dying patient being turned away from A&E
Firefighter, Paul Smith, who had suffered a heart attack, was sent on arrival at Warrington Hospital A&E to Liverpool’s Broadgreen hospital despite being in a critical condition. Paramedics had spent considerable time performing CPR on Mr Smith prior to arrival at Warrington, and then had to continue this on the journey to Liverpool for 25 minutes. However, he was pronounced dead shortly after arrival. Following an investigation, it was concluded that the consultant should have admitted Mr Smith immediately on arrival at Warrington Hospital rather than making an initial assessment in the ambulance. Dr Raphael Perry, medical director and deputy chief executive at the Liverpool Heart & Chest Hospital (LHCH), explained, "The ambulance crew record suggests that there was no attempt at Warrington A&E to assess the situation, but they were simply told to go to LHCH." It has been acknowledged that while Mr Smith’s condition meant he stood a low chance of survival even if he had been admitted to Warrington Hospital, by making the decision to send him to LHCH, his chances were much further diminished, to the point of being “negligible”.
It could be reasoned that the NHS’s A&E departments have, in many ways, become a victim of their own success. Despite the introduction of the 111 non-emergency service in 2013, A&E departments are dealing with considerable volumes of patients with limited funds, resources, and staff. However, this cannot be used as a basis for allowing medical errors to occur. Often by raising complaints and making claims for medical malpractice compensation, the NHS is forced to make strategic changes which lead to improved outcomes for all patients. While some may feel reluctant to bring a claim against an already overstretched public health system, it is precisely this action which may prevent others from being the victim of serious medical mistakes.
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