What Can the NHS Learn About Risk From Airlines?

What Can the NHS Learn About Risk From Airlines?

In early February 2015 television news and social media showed the shocking moment TransAsia Airways Flight GE235 swerved to miss Taipei skyscrapers, before striking a bridge and crashing into a river. Follwoing the search for survivors and those fatally injured, attention turned to recovering the black box flight recorder. Early data appeared to show the likely cause of the crash was a combination of technical failure whereby one of the plane’s two engines had stalled, and human error, where the remaining engine had been inexplicably shut down manually.


Despite this incident and other recent air disasters, BBC News online reported the most recent data from safety analysts Ascend suggested last year was the safest year eve for airline travel, with one fatal accident per 2.38 million flights, compared to every 1.91 million flights the year before.


The aviation industry, through forensic analysis and flight recorder data registers the mistakes that pilots and crew make and implements systems to prevent them happening again. As a result, commercial aviation is now said to be the safest mode of transport.


In response to this recent disaster the Taiwanese Civil Aeronautics Administration announced that it was to subject all 49 TransAsia Airways ATR pilots to additional proficiency tests and cancelled more than 100 TransAsia flights to do so. Ten pilots were reported to have failed the engine-out oral test and were suspended pending a resit. This swift action potentially saved further devastating loss of life and is an example of the importance the airline industry places on safety.


Most hospital procedures come with a degree of unavoidable risk of complication however patients don’t expect to suffer death or serious injury in hospital to be caused by avoidable human error.


Yet we see there are many such deaths and injuries. We see fractures missed on x-rays, medication prescribed in error and cases of cancer being brushed off as nothing serious. It should be said that we have some of the greatest healthcare in the world and when it works immeasurable good comes from it. However, the NHS is delivered by human beings. Under pressure, they can and do make mistakes. They will sometimes, when distracted, in a hurry or lacking resources, open the wrong package, flick the wrong switch or administer the wrong dose. When they do, patients suffer.


We should not accept mistakes in the same way that we should accept the idea of necessary and unavoidable risk. We’re told clinical negligence claims are costing the NHS millions of pounds and are only increasing every year. Last month the Financial Times reported the NHS Litigation Authority, which provides indemnity cover for legal claims against the health service, has set aside £26.1bn to cover outstanding liabilities. This we are told is equivalent to almost a quarter of the £113bn annual health budget with £1.6bn being paid out last year.


In its report, the newspaper interviewed Michael Wade, a former Lloyd’s of London insurance executive instructed by the government to investigate public sector insurance schemes. He was quoted as saying “I’m not saying there shouldn’t be a duty of care, because of course there should be, but at what point do we say, ‘No, I’m sorry, the statutory law says you can’t sue’?” The implication here is that some patients’ claims are brought undeservedly.


Patients shouldn’t be made to feel guilty for seeking redress for their injuries. The only fair way to reverse this trend must be to design these errors out of the system through a process of acknowledgement, learning and change.


Health Secretary, Jeremy Hunt’s recent announcement of an annual review of 2,000 cases of patients who later died in NHS hospitals in England must be welcomed. Whether this goes far enough remains to be seen with some groups suggesting that all unexpected hospital deaths should be reviewed in order to consider whether the death was preventable. Mr Hunt’s announcement is however a step in the right direction.


Going back to the aviation industry; the importance of learning from mistakes cannot be overstated. However in a letter to The Times, Dr John Firth, consultant physician, made a fair point on the distinction between aviation and healthcare. Dr Firth wrote “Whenever I’d been on a plane, the number of passengers was limited to the number of seats, and the plane didn’t take off until the pilot thought it was ready to do so”.


There’s no doubt the NHS is under strain and its users present with ever more complex needs. However this must strengthen the argument that we must learn from medical mistakes. The airline passenger market would refuse to accept any disclaimer that in buying a ticket the airline accepts no liability for personal injury or even death from an accident in order to reduce costs and keep fares low. NHS patients should not have to accept this either. The only fair way to reduce the medical negligence bill must be to improve patient safety by preventing mistakes from occurring in the first place.


By Ian Craig for Axiclaim

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