A “never event” is one that should never happen in a hospital; events that “are utterly unacceptable and pose a huge risk to patient safety” according to the Chief Executive of the Patients Association, Katherine Murphy.
Some examples of “never events” include leaving instruments inside a patient during surgery, wrong implants being fitted, or surgery being performed to the wrong part of the body. All seemingly very easy to avoid, but events that occur with sometimes devastating consequences.
Figures released by NHS England show that Colchester Hospital University NHS Foundation Trust reported the highest number of “never events” in the 2014-2015 period, with 9 procedures going unacceptably wrong. The other hospitals named include:
- King’s College Hospital NHS Foundation Trust – 8
- Mid Essex Hospital Services NHS Trust – 7
- University Hospitals Bristol NHS Foundation Trust – 7
- Guy’s and St Thomas’ NHS Foundation Trust – 6
- Queen Elizabeth Hospital, King’s Lynn NHS Trust – 6
- Oxford University Hospitals NHS Trust – 6
- Wrightington, Wigan and Leigh NHS Trust – 6
Whilst on the face of it these hospitals could be criticised for what can only be described as poor levels of treatment and care, a spokesman for Colchester Hospital University NHS Foundation Trust suggested that the high number of incidents accounts for the “open and … ‘no blame’ policy” that exists within the Trust. The Trust is of the view that today’s announcement “shows an organisation encouraging transparency and learning … to prevent recurrence and to safeguard the welfare of patients”.
This may on first glance appear to be a PR spin, to mitigate what could be seen as a devastating impact on the Trusts reputation. However, it cannot be overlooked that 75% of those NHS Trusts named above are ‘Foundation’ Trusts, responsible for some of England’s most highly regarded and leading hospitals. A Trust is awarded ‘Foundation’ status as a mark of excellence, having demonstrated consistently high levels of care and governance and rewarded with greater levels of autonomy over the running and care offered.
Could the reality be that these Trusts are simply more open and honest about errors that take place in their organisation; addressing them directly to improve standards? In other words, should we be more concerned about those Trusts with low numbers of declared “never events”, who may brush incidents under the carpet to avoid the burden of confronting the aftermath; ultimately allowing dangerous practices to continue?
Unfortunately we as patients can only base our view on the information presented to us, as can NHS England, but the issue adds another string to the bow that is criticism of transparency within the NHS. On the flip side, if these hospitals are supposed to be the “best” that the NHS has to offer, should those with high numbers of “never events” be permitted to retain their quality mark of Foundation status?
If you or anyone you know has been affected by a “never event” or other form of clinical negligence, contact Clarke Willmott’s specialist Clinical Negligence Team on 0800 316 8892 or email James.Edmondson@clarkewillmott.com.