The NHS Information Centre has published data showing that there has been a 13.4% increase in complaints made against PCTs and NHS Trusts. In the year 2009/10 there were more than 100,000 complaints.

It has to be said of course that it is not necessarily due to falling standards. It may be equally due to the fact that patients are finding their voice, and are less willing to accept the consequences of an adverse outcome, without explanation. There is also increased activity in the NHS generally, so potentially more incidents to complain about.

The Complaints Procedure has to be effective however, and whilst it can be said that generally there has been improvement over the past few years in Trusts etc. actually dealing with complaints, I equally come across clients who have consulted a solicitor due to their dissatisfaction with the whole complaints process. Sometimes this can be due to simply not receiving a timely response, or the Trust not adequately addressing the patient’s concerns.

Hospital doctors who quit their jobs are routinely being bullied into signing “Gagging Orders” which prevents them from publicising their concerns about systemic errors and mistakes which harm patients.

In a joint investigation by the Bureau of Investigative Journalism and Channel 4 News, it was discovered that more than 170 doctors in England and Wales had agreed to “Gagging Orders” at the conclusion of their employment costing the NHS more than £3 million.

The investigation also found that 19 NHS staff decided to take their cases to the Employment Tribunal after “whistle-blowing” about the poor standards in hospitals but their claims were eventually settled before going to hearing.

Whistle-blowers have legal protection from dismissal or victimisation under the Public Interest Disclosure Act 1999. The Act protects whistle-blowers from any retribution by their employer even if they have entered into a contractual Gagging Order.

Patient Safety should always be paramount in the NHS and Trusts should foster an open dialogue with their doctors where staff feel safe to point out bad practice and errors at an early stage.

When they fail to do this problems can occur. The recent scandal at the Bristol Royal Infirmary where 29 babies and children died after heart surgery, fare higher than one would expect from a specialist unit of that type, proved the importance of openness.

North Cumbria University Hospitals NHS Trust has been in the news this week, but unfortunately for the wrong reasons.

1600 tests and examinations have been under review for breast cancer screening, after concerns about the accuracy of the results. 8 women previously told they were not suffering from breast cancer have now been advised that they will need treatment.

Such incidents are thankfully rare, but regretably the consequences of these isolated incidents can be extremely distressing for the individuals and their families concerned. An anxious wait will no doubt follow.

The Narayana Hrudayalaya in Bangalore is the largest hospitals specialising in cardiac surgery in the world. It carries out over £6,000 operations per year, half on children. Great Ormond Street Hospital in London, a world leading centre for children’s heart operations managed to undertake less than 10% of that number last year.

The hospital works on the premise that bigger is better. By carrying out huge volumes of operations the cost of each procedure can be substantially reduced. A complex heart operation at the hospital can be carried out for as little as £1,140 although the hospital is attempting to reduce this to less than £600. The same apportion in the US or the UK may lose up to 20 to 30 times as much

The simple but revolutionary idea means that instead of building small hospitals with only a hundred or so beds, surgery is in fact carried out in super hospitals with over ten times as many beds. Despite carrying out the huge numbers of operations death rates at the Bangalore Hospital are comparable or better than those in the UK or the US.

The hospital, which is a private venture will shortly be opening a similar super hospital in the Cayman Islands where it hopes to attract patients from Florida and other Southern States who do not have access to full healthcare.

On the Prime Ministers recent trip to India Vince Cable, the Business Secretary who was travelling with the Prime Minister called the Cardiac Hospital as well as its two sister hospitals, one specialising in orthopaedics and the other in Cancer treatment “quite inspirational”.

Could this signal a new direction for the NHS?

New Delhi Metallo-ß-Lactamase-1, or more simply known as NDM-1 has been found to be present in a small number of patients in the UK. This new “superbug” has caused strong concern amongst healthcare professionals, not least because it appears to be resistant to even the strongest anti-biotics.

In addition this bacteria can exist with other bacteria such as e-coli, and then go on to cause urinary tract infections and blood poisoning.

The Health Protection Agency is monitoring information closely, but has stressed the need for hospitals and visitors to be vigilant, and adhere to cleaning and disinfectant procedures

It has been published in the news this week by the Royal College of Physicians and Vascular Society, that patients suffering from transient ischaemic attacks are not getting the care they should. Sometimes referrred to as “mini-strokes”, these episodes can often be a sign of something more severe around the corner.

The College has stated that patients suffering a TIA should have surgery to prevent a larger stroke further down the line, but following research, just a third of 3,000 patients had this procedure in the optimum time specified.

We have all probably seen the recent television campaign about heeding the early signs of a stroke, but it is of course of paramount importance that hospitals and stroke centres around the country have adequate facilities to treat patients and implement these preventative measures, once the signs are noticed.

A tragic case has been reported in the news recently, involving a surgeon incorrectly removing an infant’s bladder, in the mistaken belief that this was a hernia. The GMC found the surgeon in question, guilty of misconduct. The girl, aged just 18 months, will now require a catheter for the rest of her life.

Regrettably, cases can arise like this, where there has been a failure to adequately identify the parts of the anatomy before proceeding to operation. I am frequently faced with reports from surgeons, when investigating clinical negligence cases, who state that it is absolutely crucial to identify and protect the surrounding organs when surgery is taking place. This is perhaps most notable in laparoscopic cholecystectomy cases. In such incidents, it is usually the case that the bile duct has been damaged when trying to remove the gall bladder, resulting in open, reconstructive surgery being required thereafter. Unfortunately this surgical error, as with the above example, can have life changing consequences for the patient concerned.

The concerns of patients at Mid Staffordshire NHS Trust have been widely reported on today in the press, with publication of an inquiry implying that the Trust became more obsessed with targets than patient care.

I commented a while ago on concerns raised by the Patient’s Association on varying standards of care involving the elderly, at differing NHS Trusts, and have also been involved in cases against the Medway NHS Trust in Kent, which was the subject of intense scrutiny following a report criticising the standards of hygiene there. It is saddening to read such reports again. These incidents at Stafford follow a private inquiry in respect of concerns that arose approximately 12 months ago. The government have so far resisted calls for a public inquiry.

Amongst the comments made in the report are instances of receptionists at Accident & Emergency acting as stand-in “triage”, instances of patients being left alone, inadequate supervision, and difficulties obtaining food and drink.

What is striking about these points is that they are basic care needs; in other words, supervising a patient, escorting them if they need to use the toilet and ensuring they are given adequate nutrition. These do not require the use of expensive equipment, or impose a higher standard of skill than what should be expected from a healthcare provider. Indeed, no doubt the vast majority of patients at hospitals up and down the country will be rightly satisfied at the high level of care they receive. From a personal perspective, it is frustrating to see these types of cases. Whilst each case has to be looked at in isolation, these types of incidents seem all the more preventable.

The National Patient Safety Association has encouraged NHS Trusts to apologise to patients once errors have been made, which they say may reduce the number of complaints and indeed litigation.

Clearly, if someone has been injured due to negligent care, it is only right that they are compensated for their injuries. However, the vast majority of clients I speak to all have one thing in common: they are motivated to bring a claim, not through a desire for compensation, but because they want answers as to what went wrong, and a recognition of this from the healthcare provider. More recently, in cases I have been dealing with, the Trusts do seem willing to offer an apology where liability has been admitted. This can frequently be of some comfort for a patient; it’s as if their concerns have been vindicated, the Trust has recognised that errors were made, and it has been taken on board that lessons can be learned.

The Crown Prosecution Service has summonsed a Hospital Trust to Magistrates Court after the death of Mayra Cabrera.

Mayra, a 30 year old Theatre Nurse originally from the Philippines died on 11 May 2004 shortly after giving birth to her son Zac at the Great Western Hospistal in Swindon.

The Coroner, Mr David Masters deemed Mayra’s death to be unlawful. The Coroner also made a number of recommendations including improving the appraisals system for Midwifes as well as better drug labelling.

It was found that Mayra died of a heart attack when a drug, Bupivacaine which should have been administered through epidural but was in fact injected into her arm.

The Trust claims that they have made a significant number of improvements since the incident in the maternity department.

It is unusual for the Crown Prosecution Service to take such serious measures against a Primary Care Trust but the Health and Safety Executive who are assisting in the prosecution now seem to be more willing to bring criminal prosecutions as I have previously blogged.