Survey Suggests NHS Micromanagement is to Blame for Surgical Mistakes

Bournemouth University has carried out an online questionnaire of 600 surgeons to uncover the reasons behind surgical mistakes. The survey, which has been published in the Annals of the Royal College of Surgeons and attracted replies from 549 general surgeons, revealed that, during the two-week period covered by the study, 40 per cent of surgeons were involved in an ‘untoward event’ that nearly resulted in harm to the patient. Regrettably, just over 19 per cent of surgeons were involved in incidents during the two-week period that did cause harm to come to patients. The results of the survey are likely to generate deep concern among patients and those involved in the NHS; furthermore, they could at least partially explain the rising number of personal injury claims affecting certain medical procedures.

In typical circumstances, patients who undergo planned surgery on the NHS are aware that certain risks exist. Indeed, no operation – not even the most minor elective surgical procedure – is completely devoid of risk. The consultation period that exists before surgery is carried out is intended to be used by patients as a means of addressing concerns about the operation, but it also provides surgeons with a vital opportunity to learn more about their patients; unfortunately, the survey revealed that many surgeons are routinely asked to ‘slip in’ extra patients on their operating lists and, consequently, this undermines the consultation period. In fact, many surgeons complained that they are not always in full clinical control because hospital management constantly demand that operating lists are cleared quickly to meet targets. The net effect of such behaviour is to place patient safety at risk.

The survey’s principal author, Professor Colin Pritchard from the School of Health and Social Care at Bournemouth University, argues that hospital management could be exposing many patients to unnecessary risks. Professor Pritchard said: “If anything goes wrong they’re [the surgeons] responsible but not in charge. The key is the influence – and often the malign influence – of managers who are concerned with meeting targets”. Personal injury claims involving acts of clinical negligence remain relatively high in the UK, at least in comparison to other EU countries. The degree to which NHS micromanagement exerts undue pressure on surgeons to cause instances in which patients are harmed is not entirely clear, but surgeons feel it is a key issue that needs addressing. Other factors that have been cited as contributing towards botched operations include poor staffing, insufficient equipment and thinly spread clinical teams.

A spokesperson for the Patients Association claimed: “This study gives yet more weight to the idea that whilst the NHS may have been meeting its targets over the past few years, that doesn’t mean those targets are always a benefit for patients”. Health Secretary Andrew Lansley added that the survey highlighted the failings of the previous administration. Mr Lansley said: “Patient safety must come first, that means allowing clinicians to focus on the outcome of a patient’s treatment, rather than the diktats of managers. That’s why we will abolish Labour’s top-down process targets and replace them with outcome measures, which drive improvements in the quality of patient care”. Whatever steps are taken to improve the management of surgical teams in the UK, it is clear that more must be done to put the patient’s needs ahead of hospital targets.

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