NHS complaints procedures

BMJ 1994; 309 doi: https://doi.org/10.1136/bmj.309.6947.129c (Published 09 July 1994) Cite this as: BMJ 1994;309:129

Consider financial compensation

  1. Graham Neale
  1. Consultant physician Addenbrooke's NHS Trust, Cambridge CB2 2QQ.

    EDITOR,—The report of the review committee on NHS complaints procedures, with its emphasis on accessibility, impartiality, simplicity, speed of resolution, and cost effectiveness, has been generally well received.1 Unfortunately, however, it does not address the problem of serious adverse clinical events which may result in a claim for financial compensation. The committee states that its terms of reference excluded considerations of civil litigation. Yet I estimate that this year the hospital complaints procedure will cost the nation less than £5 million; medicolegal claims will cost well over £100 million. The minister of health proposes to tackle the problem of litigation by establishing a central fund to cover the cost of the largest claims to minimise the amount of money diverted from patients’ care. It is far from clear, however, that this will prove to be effective in improving the quality of care and reducing the number of claims.

    The present medicolegal system is slow, cumbersome, expensive, and often unfair. Most cases take more than two years to resolve; those going to court may take five years or more. With such delays the criteria for an adequate procedure as stated by the review committee (“the earlier [the action], the fuller the response may be and the sooner any action to improve the quality of service can be taken”) cannot be met.

    The minister for health should be persuaded to grasp this nettle. It is not sufficient to accept the statement “Where complainants suffer compensatable harm as a result of NHS treatment, the NHS should not try to avoid its responsibilities towards them or to withhold information.”1 Are those seeking compensation to be encouraged to complain and then to use the resulting report to support their case through the courts? Or will the minister consider setting up a fairer system of compensation independent of the court action?

    Four years ago Smith addressed the problem of adverse clinical events in hospital practice and indicated the need for a national survey.3 His suggestions were ignored. The chief medical officer, Kenneth Calman, has urged the profession to take the initiative in shaping health care.4 We should move away from the adversarial means of resolving claims for compensation and seek to improve a system that may pay £1 million to the parents of a brain damaged infant if lawyers are satisfied that a clinician can be held to have been negligent yet nothing to the parents of an infant who has a God given defect of equal magnitude.


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