British government hospitals to pay for harming patients

A big step forward for Britain but it is a pity the taxpayer will be paying. What about the negligent managers, doctors and staff?

All hospitals should be fined if patients contract superbug infections or are harmed by medical errors while in their care, the Government's Chief Medical Officer said yesterday. Setting out a radical plan to tackle the NHS's record on patient safety, Sir Liam Donaldson said that the taxpayer should not foot the bill for treating patients who had suffered bad or unsafe care.

Instead, NHS hospitals and clinics involved in botched surgery, prescribing errors or superbug infections such as MRSA or Clostridium difficile should be penalised for the extra treatment required. The proposals - which are to be put before Lord Darzi of Denham, Health Minister, in his ongoing NHS review - are designed to reduce the rate of error and death. More than 733,000 "patient safety incidents" occurred last year, causing the deaths of more than 3,000 patients.

Sir Ian Carruthers, who stepped down as chief executive of the NHS last year, agreed that urgent action was needed to end a culture of sweeping safety issues under the carpet. He added that only a "miniscule" amount of energy in the NHS was currently focused on the issue. Safety errors currently cost the NHS an estimated 3.4 billion in extra treatment and compensation. The recommendations follow a damning report by MPs which branded the National Patient Safety Agency (NPSA), the watchdog charged with monitoring and improving the safety of care, as "dysfunctional". Sir Liam said that there were now signs of progress in the monitoring of incidents - with more logged by the NPSA that in other countries - but avoidable and often "incredulous" mistakes were still being made in a range of areas, from radiotherapy to patient falls.

"Why should the health service, funded by the taxpayer, pay for the care of a patient that's had bad or unsafe care?," Sir Liam said. "In any other walk of life if you receive very bad service then you don't pay for it, you get a refund, and I don't think it should be any different in the health service. "If someone develops MRSA and has to stay in hospital longer to be treated, why should it be funded?"

Under the plans, hospitals responsible for harming patients will have a portion of their budget withheld to cover the cost of treatment to remedy the mistake. Hospitals would likely face set tariffs for different types of blunder or infection. Sir Liam said that while withholding money was a controversial strategy, it was the a very powerful "lever for change". "You can't have enough incentives to improve patient care and primary care trusts hold most of the budget for the NHS. They fund hospital care and as such are a great lever for change."

Of the 733,070 safety incidents in the year to this June, more than half a million occurred in hospitals. The errors resulted in 3,006 deaths, caused "severe harm" to 6,144 patients, and "moderate harm" in 42,047 cases. MRSA, or methicillin-resistant Staphylococcus aureus, infected a further 6,381 patients last year while the more virulent C. Difficile caused 55,000 infections.

Sir Liam's comments came as the Government published its Operating Framework for the NHS, which makes tackling hospital infections and hitting waiting targets key priorities for the coming year. The framework suggests penalising hospitals for failing to meet two high-profile targets in 2008 - halving MRSA rates by April and ensuring patients are treated within 18 weeks. However the NHS is expected to miss the three-year MRSA target by a long way.

Sir Ian Carruthers, who is now head of NHS South West, said that urgent action was a must and financial penalties were a welcome driver for change. "Our culture is to pretend things don't happen or to recognise they do but try to deal with them outside any processes. If we continue to do that, we won't make the impact in making the changes we require. "Even with best practice and best evidence, somebody argues against it."

In the United States, some states require hospitals by law to report so-called "never events" - a list of medical errors that are considered so preventable and so serious that they should never happen. One hospital in Rhode Island, was recently fined $50,000 for performing "wrong site" surgery on a patient for the third time this year. Sir Liam said similar fines should be brought in to the NHS to act as a "hard-nosed financial incentive" for hospitals to provide better care.

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