NHS Publishes Detailed 'Never Event' Data
18th December 2013
As ‘never events’ in the NHS pose a serious risk of harm to patients, and should not occur if proper procedures have been put in place and followed, Clearwater Solicitors are concerned that 148 of these ‘never events’ were recorded between April 1st and September 30th 2012.
These were seen in a total of 102 NHS Trusts and eight independent hospitals, and included 37 different cases of wrong-site surgery and 70 cases of foreign items being left in patients post-operation.
Some of the never events that occurred included an incident in which a woman’s fallopian tube was taken out instead of her appendix, drugs given incorrectly or given to overdose, five cases of nasogastric tubes leading into the lungs, and doctors performing surgery on the wrong patients, including prostatectomies, colonoscopies and a cardiac procedure.
Patients died as a direct result of never events – a woman died as a result of post-partum haemorrhage following a caesarean section, while another patient died because their oxygen levels were not properly monitored.
Are Never Events Always Medical Negligence?
As medical negligence must involve real personal injuries, not all patients who have been involved in never events can claim medical negligence compensation. For instance, in some wrong-site surgery cases, doctors will notice that they are making a mistake at the beginning of the operation, just after the initial incision, and will instantly correct their mistake, so the injuries sustained by the patient would not be significant enough for them to claim compensation.
Furthermore, not all medical negligence claims are never events – in fact, very few are. For instance, misdiagnosis of illnesses, or most instances in which drugs are incorrectly administered, are not considered never events, but can still have a drastic impact on the health and safety of patients.
NHS England says the rate of never events is currently just around one incident in every 20,000 procedures, or less than 0.005%. Every year, there are just a few hundred never events, despite the fact that there are 4.6 million hospital admissions in England annually, as well as 500,000 non-caesarean births and countless other interventions, such as cardiology and internal radiology.
Newcastle-upon-Tyne Hospitals NHS Trust had the highest number of never events, experiencing a total of four, with eight NHS Trusts going through three never events in the six-month period.
Why Is The NHS Providing Never-Event Information?
The transparency about never events is welcome to personal injury solicitors, as it is thought that such openness will encourage healthcare organisations to improve standards and create a culture of honestly and clarity. Professor Don Berwick, who recently held the landmark Berwick Review into patient safety, hailed the NHS’ publication of this data, calling it an important step in achieving the goals he outlined in the review.
NHS England National Director of Patient Safety Dr Mike Durkin said that publishing data about never events is nothing to do with “naming and shaming”, but is instead about ensuring the public can hear about mistakes and that the NHS can openly discuss and learn from them. This will help the NHS reduce the number of errors that occur in the treatment of patients and minimise incidents of avoidable harm.