This is part of our series of Patient Safety Spotlight interviews, where we talk to people working for patient safety about their role and what motivates them.
Paul talks to us about how AvMA helps people who have suffered direct or indirect medical harm and to help them to seek justice, why upcoming changes to the legal system could restrict access to clinical negligence claims and the importance of compassionate engagement in improving harmed patients’ experiences of the healthcare system.
About the Author
Paul is CEO of Action against Medical Accidents (AvMA) and has been in post for just six months. Paul has held senior leadership positions in a variety of sectors with a common theme across all of them of trying to level the playing field by supporting people with limited resources trying to get answers from big institutions.
Questions & Answers
Hello Paul. Please can you tell us who you are and what you do?
I’m Paul Whiteing, the Chief Executive of Action Against Medical Accidents (AvMA), the patient safety charity that supports people who have been harmed by healthcare to achieve justice. I joined AvMA in January 2023, taking over from my predecessor Peter Walsh who had been at the organisation for 20 years.
How did you first become interested in patient safety?
For the past two decades, I’ve been involved in compliance, quality improvement and change management in various industries. Although I’ve not been working in healthcare or patient safety, there are lots of parallels and many of the skills and principles transfer really well.
One of the things I have focused on throughout my career is trying to level the playing field for the ‘little guy’. That was one of the things I was committed to while working for the Financial Ombudsman Service, so when I saw the role at AvMA, it fitted really well with that focus. When an individual comes up against a problem with an institution, the institution can look after itself as it has plenty of resources, such as a legal team. But the individual is on their own, and we need to try and redress that imbalance by supporting them.
Some of the stories people share with us are shocking—this week, I’ve encountered two different people whose medical experiences have stopped me in my tracks. The impact of harm on their lives and on their loved ones is huge. The level of support people need also varies considerably—you might just need signposting to the right place, or you may need more handholding. The complaints and justice system is incredibly complex—if you have an issue to raise, where do you begin? There are so many avenues and it’s hard to know which one is right for you; should you go to the hospital, a regulator, the ombudsman or a lawyer?
When you have been harmed by healthcare, you are likely to be in a vulnerable position and probably aren’t at your best, so navigating the system can be challenging. We aim to give a voice to people when they are in this position and importantly, we try to help people find their own voice.
Which part of your role do you find the most fulfilling?
I’m really enjoying running a small organisation because I have the opportunity to be involved in all areas of our work, including policy, campaigning, governance, communications and working with our stakeholders in health and social care.
Being part of a small organisation also means there aren’t many layers between me as chief executive and the frontline work, which for AvMA is the helpline and our casework team. The thing I find most rewarding is working with our beneficiaries, and this week I spent some time shadowing one of my colleagues who was taking helpline calls. It was so helpful to hear the kind of issues people were raising and see how our advisers tailor the advice they give to each personal situation. It was great to have that proximity to the people we are here to serve and actually listen to what they need.
What patient safety challenges do you see at the moment?
When I started this role in January, the challenging context that the health system is operating in was very clear. The NHS was facing winter pressures, the backlogs and impact of Covid-19, high staff shortages and disputes over pay and conditions for healthcare staff. I’ve been into hospitals over the past few months and met with patient safety teams and the pressure they are under is phenomenal. Against this backdrop, we need to understand that the need to focus on crisis management limits the capacity that healthcare staff have to consider proactively dealing with patient safety.
With the current level of stress on the health system, mistakes and errors will happen, and we have to acknowledge that. In the short term, I suspect patient safety will get worse rather than better. However, I’m optimistic that in the long term, we will make improvements—I’ve met a huge number of individuals and organisations who are committed to improving patient safety and adopting the science to make it happen, such as human factors.
Our role at AvMA is to advocate for patients’ rights to justice, so we’re involved in discussions amongst the legal community. Another issue we are very aware of is the likely restriction of access to clinical negligence claims because of upcoming changes to the law. Where people need a legal route to justice, restricting their ability to access that will lead to further secondary harm.
Last year the Government consulted on a proposal for a system of fixed recoverable costs for low value claims of up to £25,000. ‘Fixed recoverable costs’ limits the amount of legal costs the winning party can claim back from the losing party. On top of this, the Government has recently put forward a further proposal that cases between £25,000 - £100,000 will also be subject to fixed recoverable costs. This is a much more radical change that seems to be inconsistent with the consultation the Government undertook last year, so the approach feels very muddled and confused. The ultimate outcome if these changes go forward is that many claimants with clinical negligence claims up to £100,000 will find their ability to bring a claim is severely restricted. Where people can bring a claim, their damages will be reduced by the capping of recoverable costs, and we will see many lawyers turning cases down as they won’t be commercially viable. Even when claimants are successful, they will find their damages are reduced as they will have to cover some of the costs, even though they won their case.
I think the combination of these two issues—the increased strain on the healthcare system and restricted access to legal services—will lead to a perfect storm.
What do you think the next few years hold for patient safety?
There are reasons to be optimistic about the positive forces of change that we’re seeing—some of the emerging thinking about human factors is key, recognising that patient safety relies on a combination of many different factors that need to be considered together.
The element of the Patient Safety Incident Response Framework (PSIRF) around compassionate engagement looks encouraging. If that can be implemented and embedded into the culture of NHS trusts, there’s a real opportunity to improve the way we listen to and respond to patients, particularly when things go wrong. Things that we’ve talked about for years, such as early intervention and meaningful apologies, could make a real impact in restoring trust for patients when things go wrong. There was one man I spoke to on the helpline this week who was looking for a lawyer, but for him it wasn’t about the money. He wanted accountability, understanding and an apology for the poor treatment his wife received. I think if we could do these things better, many people would walk away with more understanding and they would be less likely to need to litigate.
There are cultural barriers to compassionate engagement that we need to try and break down, and that will require efforts that go beyond just adopting a policy. There are NHS trusts out there already working at this and we need to learn from the best.
If you could change one thing in the healthcare system right now to improve patient safety, what would it be?
So many of the issues that come to AvMA have escalated and become compounded by breakdowns in communication, healthcare staff not giving clear and timely explanations and the lack of a meaningful apology. If these things could be embedded in how the healthcare system deals with harmed patients, we would see a reduction in many of the issues we see. If I was in a trust, I would be focusing on training staff in communication and listening to patients. We need to acknowledge that patients do know what they're talking about and the idea that ‘doctor knows best’ still permeates healthcare culture in the UK. It’s time to move on from that and respect the views and knowledge of patients.
Are there things that you do outside of your role that have made you think differently about patient safety?
I’m naturally curious and read a lot of fiction and nonfiction. I’m always looking for parallels between industries and areas of expertise, so I’ve joined an organisation for chief executives of charities. It has been very helpful to hear about how others deal with challenges. An organisation might have a completely different focus, but I can learn from the ways they have dealt with issues that we are also facing.
Tell us one thing about yourself that might surprise us!
I love ties and have a collection of over 100. Lockdown changed the way we dress at work, but whenever I have the opportunity I still love to wear a suit and tie!
- Success and succession at AvMA: 40 years of minding the gap in patient safety and justice (Helen Hughes and Albert Wu, 2 December 2022)
- Patient Safety Spotlight on Bill Kilvington, Trustee for Action Against Medical Accidents (AvMA) and Patient Safety Lead at the College of Operating Department Practitioners
- NHS Litigation Reform: Inquiry response from AvMA (October 2021)