The findings from the independent investigation into the NHS in England

In September 2024, the Rt Hon. Professor the Lord Darzi of Denham published the findings of his independent investigation into the NHS, commissioned by the Secretary of State for Health and Social Care. The report is striking, although not surprising, in concluding that the health service is in a ‘critical condition’. 

Clinical negligence

This is reflected in the picture for clinical negligence, with the report noting it is ‘striking that complaints have nearly doubled in a little over a decade’ with clinical negligence claims at a record high. Staggeringly, the report explains that aside from pensions and nuclear decommissions, NHS clinical negligence claims are the largest liability on the government’s balance sheet. 

This sharp increase in clinical negligence claims is an indication of the harm being experienced by patients receiving poor care. The duty of candour introduced by the NHS a decade ago, to help establish an open culture, could have contributed to this increase as more people have been made aware of the harms suffered. But in my experience, people becoming more aware of making claims is not the whole picture. In most cases, my clients appreciate the fantastic service the NHS does deliver in general, but where things have gone wrong, they tell me they are pursuing a claim because they don’t want the same harm they have experienced to happen to anyone else.

For me, it is clear that the best way to reverse this trend of rising claims and the associated costs is by calling out poor practice, so people can learn from these mistakes and improve patient care.

The quality of care

What does the report tell us about the quality of care being received by patients? The report concluded that the picture on the quality of care is mixed. For the most part, once people are in the system they receive high-quality care, but there are areas of concern. This includes maternity care, which has been the subject of multiple inquiries in recent years. The document goes on to identify that there are ‘huge inequalities that exist in maternity care’, pointing out that neonatal mortality of the most deprived portion of society is more than double that of the least deprived. This is a picture that many clinical negligence solicitors will recognise well. 

The report highlights some of the contributing factors for this poor care. Importantly, as the age of women becoming pregnant rises and more mothers have conditions such as diabetes, more strain is placed on the NHS, as they need careful monitoring throughout their pregnancies. While the report notes high rates of staff sickness and absence, which is likely to have an impact on the quality of care, other factors, such as skills, culture and clinical models, need to be considered.

It doesn’t stop at maternity care, however. As others will note, there has been a clear lack of progress in many areas, with previous review recommendations not being universally adopted across all NHS trusts. Unfortunately, this is not a surprise to me, as it has been the case since I started my career in law nearly 20 years ago. I’m still seeing the same errors and poor care despite the recommendations made in reviews over the years, because the recommendations don’t seem to have been implemented consistently.

There are a lot of hardworking people in the NHS, who deliver high-quality care for their patients, but it’s right to challenge poor practice and, in doing so, make the system better. The submission by Dr Bill Kirkup points to issues I have seen time and time again. That is high levels of pressure and stress leading to burnout and absenteeism, safety incident responses being dominated by fear and training in silos. These issues are leading to more patients experiencing unnecessary harm and who often turn to firms like Coodes to support them in demanding better.

Planned care has also seen large increases in waiting times for elective procedures. This can mean long waits for treatment, which can have significant impacts on patients, a worse prognosis and longer recovery times.

As noted in the report, this sense of poor care should not be normalised. And for my clients who have already been let down by the care they received, we’ve been experiencing huge delays in obtaining client’s medical notes and records.

Conclusion

Whilst this review into the current state of the NHS is much needed, it’s frustrating to see the same issues keep arising. And despite several of these types of reports and recommendations, the same issues continue to come-up in cases time and time again. 

As concluded in the report, there is much work to be done if quality of care is to become the organising principle of the NHS once more. I believe that the key to this is collaboration in the interest of patients and staff. I look forward to seeing how these insights are used to develop the 10-year health plan next year and the action that is taken.