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Elizabeth Dixon was a child with special health needs. She had been born prematurely at Frimley Park Hospital on 14 December 2000. Following treatment and care at Great Ormond Street Hospital and a children’s hospice she was nursed at home under a care package. As a result of a failure to clear a tracheostomy tube she asphyxiated and was pronounced dead at Frimley Park hospital on 4 December 2001. The investigation chaired by Dr Bill Kirkup looked at the events surrounding the care of Elizabeth and makes a series of recommendations in respect of the failures in the care she received from the NHS. Recommendations Hypertension (high blood pressure) in infants is a problem that is under-recognised and inconsistently managed, leading to significant complications. Its profile should be raised with clinicians; there should be a single standard set of charts showing the acceptable range at different ages and gestations; and a single protocol to reduce blood pressure safely. Blood pressure should be incorporated into a single early warning score to alert clinicians to deterioration in children in hospital. Community care for patients with complex conditions or conditions requiring complex care must be properly planned, taking into account and specifying safety, effectiveness and patient experience. The presence of mental or physical disability must not be used to justify or excuse different standards of care. Commissioning of NHS services from private providers should not take for granted the existence of the same systems of clinical governance as are mandated for NHS providers. These must be specified explicitly. Communication between clinicians, particularly when care is handed over from one team or unit to another, must be clear, include all relevant facts and use unambiguous terms. Terms such as palliative care and terminal care may be misleading and should be avoided or clarified. Training in clinical error, reactions to error and responding with honesty, investigation and learning should become part of the core curriculum for clinicians. Although it is true that curricula are already crowded with essential technical and scientific knowledge, it cannot be the case that no room can be found for training in the third leading cause of death in western health systems. Clinical error, openly disclosed, investigated and learned from, must not be subject to blame. Conversely, there should be zero tolerance of cover up, deception and fabrication in any health care setting, not least in the aftermath of error. There should be a clear mechanism to hold individuals to account for giving false information or concealing information relating to public services, and for failing to assist investigations. The Public Authority (Accountability) Bill drawn up in the aftermath of the Hillsborough Independent Panel and Inquests sets out a commendable framework to put this in legislation. It should be re-examined. The existing haphazard system of generating clinical expert witnesses is not fit for purpose. It should be reviewed, taking onto account the clear need for transparent, formalised systems and clinical governance. Professional regulatory and criminal justice systems should contain an inbuilt ‘stop’ mechanism to be activated when an investigation reveals evidence of systematic or organisational failures and which will trigger an appropriate investigation into those wider systemic failures. Scrutiny of deaths should be robust enough to pick up instances of untoward death being passed off as expected. Despite changes to systems for child and adult deaths, concern remains that without independent review such cases may continue to occur. The introduction of medical examiners should be reviewed with a view to making them properly independent. Local health service complaints systems are currently subject to change as part of wider reform of public sector complaints. Implementation of a better system of responding to complaints must be done in such a way as to ensure the integration of complaints into NHS clinical governance as a valuable source of information on safety, effectiveness and patient experience. The approaches available to patients and families who have not been treated with openness and transparency are multiple and complex, and it is easy to embark inadvertently on a path that is ill-suited to deliver the answers that are being sought. There should be clear signposting to help families and the many organisations concerned. Ministerial Statement Anne and Graeme Dixon reaction to Dr Bill Kirkup’s report Patient Safety Learning's statement on the Dixon Inquiry report

I believe all clinicians should read this latest report. There is so much to be learned and so many changes in clinical practice that can be made right away. Since 2018, I have been teaching using Oliver's tragic story to promote reflection on best practice in prescribing and in implementing the Mental Capacity Act. I could write a lot here; however, I believe this is a report all clinicians, and especially all prescribers, need to read in full. A summary of how I see this (or indeed how any individual sees it) it will not be adequate.

When considering the persistence of unsafe care, a recurring theme that emerges is a failure to involve patients in their own care. Patient safety concerns raised by patients and family members are too often not acted on and, when harm occurs, they are often left out of the investigation process. As set out in Patient Safety Learning’s A Blueprint for Action, we share the view that patient engagement is key to improving patient safety, with this forming one of our six foundations of safer care.[1] The NHS Patient Safety Strategy identifies the involvement of patients in patient safety “throughout the whole system” as a key part of achieving its future patient safety vision.[2] The strategy includes plans to create a patient safety partners framework; earlier this year, the NHS published a consultation on its draft Framework for involving patients in patient safety.[3] In this blog, we will provide a summary of our feedback to the consultation. You can find our full submission at the end of this blog. Involving patients in their own safety The NHS Framework is divided into two parts, the first of which sets out the broad approach that should be taken to involving patients in their own healthcare and safety. We particularly welcome its emphasis on: encouraging patients to ask questions; if problems occur, the importance of providing information and help to maintain patients’ safety; the role of patient incident reports and complaints as a source of learning. In our response, we fed back with our thoughts on improvements in two specific areas - complaints and patient safety incident reporting. Complaints We share the view set out in the Framework that patient complaints should be viewed as “a valuable resource for monitoring and improving patient safety”.[3] We believe it’s important the Framework is joined up with the ongoing work of the Parliamentary and Health Service Ombudsman (PHSO), who have recently completed a consultation on a new Complaints Standard Framework for the NHS.[4] We believe that this presents an opportunity to embed patient safety into these processes and we responded to the PHSO consultation highlighting this. Patient safety incident reporting The Framework highlights the importance of patients reporting patient safety incidents, noting that the future introduction of a new Patient Safety Incident Management System will create “new tools to more easily participate in the recording of patient safety incidents and to support national learning”.[3] We believe more needs to be to be done to address the cultural barriers that deter patients from reporting concerns. Patients, carers and families need to feel assured that their stories and testimonies are welcome. Alongside this, it is crucial that, when concerns are reported, they are used to inform the assessment of risk and patient safety. As noted in the Cumberlege Review, not only are incidents not being reported but the existing systems “cannot be relied upon to identify promptly significant adverse outcomes arising from a medication or device because it lacks the means to do so”.[5] Patient Safety Partners The second part of the Framework is concerned with the newly proposed role of Patient Safety Partners (PSPs) in NHS organisations. PSPs would formally participate in safety and quality committees, patient safety improvement projects and investigation oversight groups. In our consultation response, we highlighted several areas where we feel these proposals require strengthening if they are to be successful. Training and guidance for staff The Framework rightly acknowledges the importance of having appropriate training and guidance for staff to help support the new PSP roles, pointing towards the new National patient safety syllabus as a key source. We have concerns that the National patient safety syllabus, in its current form, does not have a strong enough focus on patient involvement to provide this support. We highlighted the need for a greater emphasis on the skills and knowledge required to understand why and how patients can be actively involved in patient safety in our response to the consultation on the draft syllabus earlier this year.[6] We believe the syllabus could be significantly strengthened by drawing on further research and resources available in this area, such as the World Health Organization (WHO) Patient Safety Curriculum Guide.[7] Support and peer networks for PSPs We believe there needs to be more clarity about the induction and training that would be made available to PSPs. We also make the case that PSPs need access to networks with their peers PSPs in other organisations, enabling them to share good practice for safety improvement and receive support from others. We believe that it would be beneficial to create these networks alongside the new PSP roles. We suggest it would be helpful to draw on experiences of other programmes involving patients in patient safety, such as the WHO Patients for Patient Safety programme in the UK and the Canadian Patients for Patient Safety programme.[8] [9] Patient Safety Specialists The Framework makes brief reference to the relationship between future PSPs and the newly proposed Patient Safety Specialists, which all trusts and CCGs have been asked to put in place by the end of November.[10] We believe that if Patient Safety Specialists are to work effectively in organisations then these roles will need to be filled by leaders with expertise in patient engagement. Responding to a consultation earlier this year, we commented that those filling these roles will need strong skills and experience.[11] We also believe the Framework should place a great emphasis on the role of Patient Safety Specialists in supporting the work of PSPs. Co-production In our feedback, we also argue that there should be a strong emphasis on co-production with PSPs and more broadly throughout this Framework. ‘Co-production’ is an activity, an approach and an ethos which involves members of staff, patients and the public working together, sharing power and responsibility across the entirety of a project.[12] In our view, projects and patient safety programmes should always be co-produced with patients where possible. What needs to be included in the Framework As well as commenting on the specific proposals of the Framework, we identified two additional areas which we believe should be added to it: 1. Measuring and monitoring performance Patient Safety Learning believes that, to make improvements in the involvement of patients in patient safety, we need to be able to clearly measure and monitor our progress. Publicly reporting on changes and improvements made through patient involvement and patient safety allows for sharing examples of good practice. It would also mitigate against concerns that the role of PSP could become tokenistic in some organisations, resulting in little real impact. 2. Restorative Justice Many national healthcare systems and organisations are actively listening to, and engaging with, patients for learning through restorative justice. Restorative justice in healthcare allows patients to be heard, listened to, and respected. By patients, clinicians, healthcare leaders and policy makers engaging with one another on patient safety, it can help to establish trust with the patient. This can also provide the impetus for learning and action to be taken to prevent future harm. We commend the approach adopted by New Zealand’s Ministry of Health in how it responded to harm from surgical mesh and the impact this has had on improvements in patient safety.[13] Closer to home, there are some beacons of good practice within the NHS, such as the Mersey Care NHS Foundation Trust.[14] We believe that the NHS should do more to share and promote a just and learning culture, asking organisations to develop and publish goals on their progress. Only one piece of the puzzle We welcome and recognise the positive steps being set out in the Framework to improve patient involvement in patient safety within the NHS. Our comments and suggestions for improvement are mainly centred around the need to ensure other key pieces are in place. Significant change is still needed. The Framework focuses on increasing patient involvement in governance and decision-making. This wider need for change in how we engage patients in patient safety is outlined in the recently published WHO Global Patient Safety Action Plan 2021-2030.[15] It promotes a range of actions for governments and healthcare organisations to help engage patients and their families in patient safety; we would expect to see this reflected in the work of NHS England and NHS Improvement. Strengthened as we suggest, we believe that the Framework could make a big difference to improving patient involvement with patient safety. References Patient Safety Learning. The Patient-Safe Future: A Blueprint for Action, 2019. NHS England and NHS Improvement. The NHS Patient Safety Strategy: Safer culture, safe systems, safer patients, July 2019. NHS England and NHS Improvement. Framework for involving patients in patient safety, 10 March 2020. PHSO. Making Complaints Count: Supporting complaints handling in the NHS and UK Government Departments, July 2020. The Independent Medicines and Medical Devices Safety Review. First Do No Harm, 8 July 2020. Patient Safety Learning. Patient Safety Learning’s response to the National patient safety syllabus 1.0, 28 February 2020. World Health Organization. Patient Safety Curriculum Guide, 2011. Action Against Medical Accidents. Patients for Patient Safety, Last Accessed 15 October 2020. Canadian Patient Safety Institute, Patients for Patient Safety Canada, Last Accessed 16 October 2020. NHS England and NHS Improvement. Patient Safety Specialists, Last Accessed 15 October 2020. Patient Safety Learning. Response to the Patient Safety Specialists consultation, 12 March 2020. Dr Erin Walker, What should co-production look like?, 1 April 2019; National Institute for Health Research, Guidance on co-producing a research project, March 2018. Jo Wailling, Chris Marshall & Jill Wilkinson. Hearing and responding to the stories of survivors of surgical mesh: Ngā kōrero a ngā mōrehu – he urupare (A report for the Ministry of Health). Wellington: The Diana Unwin Chair in Restorative Justice, Victoria University of Wellington, 2019. Mersey Care NHS Foundation Trust. Just and Learning Culture – What it Means for Mersey Care, Last Accessed 16 October 2020. World Health Organization. Global Patient Safety Action Plan 2021-2030: Towards Zero Patient Harm in Health Care, 28 August 2020.

Research shows that patient complaints are significantly associated with physicians' risk management activity and lawsuits. Research also demonstrates that a small subset of physicians and surgeons in various areas of practice are associated with disproportionate shares of patient complaints. Coded and aggregated patient complaint data therefore offer a metric for identifying and promoting behavior change. Analysis of the distribution of patient complaints associated with 41 paediatric cardiac surgeons is presented as a means for helping leaders show one surgeon how her/his risk status compares with peers. The paper describes a specific plan and reliable process by which medical group/centre colleagues and leaders may: address lapses in professionalism and performance; follow-up to promote professionalism, professional accountability, quality, and a safety culture; and reduce risk.

In July, the PHSO submitted a report to the Public Administration and Constitutional Affairs Select Committee exploring the state of local complaints handling across the NHS and UK Government Departments. Drawing on evidence from a wide range of individuals and organisations, Making Complaints Count identified three core weaknesses in the existing complaints system: There is no single vision for how staff are expected to handle and resolve complaints. Staff do not get consistent access to complaints handling training. Public bodies too often see complaints negatively, not as a learning tool that can be used to improve service.[1] The PHSO stated in this report its intention to consult on a new Complaint Standards Framework for the NHS, aiming to “help create a stronger culture in which complaints are genuinely learned from”.[2] Patient Safety Learning believes that having an effective complaints process in healthcare is vital to improving patient safety, and in this blog we will set out our response to the consultation on this new Framework. Complaints: an untapped patient safety resource Too often complaints processes in healthcare are viewed in a negative light and patients and their families are not recognised as being a “primary source of learning for safety”.[3] Having an effective complaints system provides an important opportunity to learn from incidents of unsafe care. Patients experiences can be used to help identify patient safety problems, ascertain the causes of these issues and put in place remedial measures to prevent them from recurring. The absence of an effective system has often been cited in patient safety scandals as contributing towards the persistence of unsafe care. Robert Francis identified this in the Public Inquiry into the Mid Staffordshire NHS Foundation Trust, noting that complaints “were not given a high enough priority in identifying issues and learning lessons”.[4] More recently, the Independent Medicines and Medical Devices Safety Review stated that the current complaints system is “both too complex and too diffuse” to promptly identify safety issues arising from a medication or device.[5] It has also been long acknowledged that the complaints system in the NHS requires significant improvements, in terms of both the processes and finding an effective way of learning from complaints to bring about improvements. In the wake of the Mid Staffordshire Inquiry, a review of NHS hospital complaints, co-chaired by Ann Clwyd MP and Tricia Hart, made a number of recommendations for change in complaints handling and procedures.[6] More recently, a report from Healthwatch England which focused on how hospitals report on and communicate their work on complaints highlighted concerns about inconsistency in reporting and a focus on counting complaints rather than learning from them.[7] The consultation process for the PHSO’s Complaint Standards Framework was composed of a survey with several questions and a section in which to add any additional comments. Below is the response provided by Patient Safety Learning in the additional comments section. Consultation response Patient Safety Learning welcomes the PHSO’s Complaint Standards Framework and its recognition of the need to reform the NHS complaints system. From a perspective of making improvements for patient safety, we welcome: The statement that organisations should “have clear processes in place to show how they capture learning from complaints, report on it, and use it to improve services”. Its acknowledgement of the importance of sharing learning and complaints widely with other organisations in healthcare. The identification of the need for clear complaints governance structures, ensuring the feedback is regularly reviewed by staff at a senior level. Its recognition that an effective complaints system is intrinsically linked with promoting a Just Culture in healthcare, one that is less focused on blame and encourages transparency and accountability when mistakes occur. Implementation We note that this Framework is focused on providing “a shared vision for NHS complaints handling” rather than looking in more detail at how this would be put into practice.[8] While we welcome many of the aspirations set out in this, its implementation will ultimately determine its effectiveness in reforming the NHS complaints system. Too often, there exists a gap between learning and implementation in healthcare. We may know what improves patient safety, but in practice such measures can often remain siloed in specific organisations, resulting in patients continuing to experience harm from problems that have already been addressed. If this Framework is to create a more effective complaints process, one which contributes to improving patient safety, we feel that there are several issues that will need to be addressed prior to its implementation: It will need to be clear how organisations report on their progress in implementing the Framework. There will need to be guidance on how organisations report on their implementation of the Framework and a level of transparency and consistency to allow for monitoring and comparison. It needs to be made clear who is responsible for ensuring that organisations will design this approach to complaints into their governance structures. There is also the question of how this change will be monitored. In the consultation survey, the PHSO pose a question related to this, asking whether they “should be given legislative powers to set and enforce national complaint standards for the organisations it investigates”. At Patient Safety Learning, we think that it is vital that this process is monitored. However, we question whether the PHSO, specifically, can do this, in terms of whether it has both the legislative remit and the resources for this undertaking. In practice, we suggest that this role would sit better within the remit of the Care Quality Commission and its existing inspections regime. We feel this issue needs further consideration. Public reporting As mentioned previously, we believe a key question that needs to be addressed before implementing the Framework is how it will be reported on by organisations, and whether reporting will be consistent to allow for monitoring and comparison. A recent report from Healthwatch earlier this year looking at hospital complaints highlighted the difficulties around this. It noted significant variations amongst different hospitals regarding how they reported on complaints (in terms of the data provided publicly) and, in some cases, whether they did actually report on these complaints.[7] It stated “because the regulations don’t require trusts to publish their annual complaint reports, we can’t know for sure how many of them are fully compliant with the regulations”.[9] Achieving the goals of the Framework may encounter similar challenges, not providing clear indications of how its suggestions should be implemented. For example, the Framework states that organisations should “report on the feedback they have received and how they have used that feedback to improve their services”.[10] We believe that this needs to be accompanied by clear guidance, for instance, stating that feedback should be publicly reported on a quarterly basis. Sharing good practice We welcome the strong emphasis that the Framework places on the need to learn from complaints, and to share this learning widely. We believe that complaints too often remain an untapped resource for making patient safety improvements; a negative view of these processes present a barrier to effectively utilising the insights they can provide. In our report, A Blueprint For Action, we note that “healthcare is systematically poor at learning from harm”.[3] This has also been recognised in the CQC’s report, Opening the door to change, stating that “there is no clear system for staff to learn from each other at a national level. Local reporting systems are often poor quality and do not support staff well”.[11] How we achieve this ambition of sharing learning from patient complaints widely between NHS organisations requires further consideration. Organisations need the means to be able to share learning from complaints widely and effectively with other organisations in the NHS, without this getting lost in “the avalanche of other information that bombards organisations daily”.[3] Patient Safety Learning welcomes the opportunity to collaborate with PHSO on this issue and to promote and share good practice on the hub. References PHSO, Making Complaints Count: Supporting complaints handling in the NHS and UK Government Departments, July 2020. Ibid. Patient Safety Learning, The Patient-Safe Future: A Blueprint For Action, 2019. Robert Francis QC, Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry, February 2013. The Independent Medicines and Medical Devices Safety Review, First Do No Harm, 8 July 2020; Patient Safety Learning, Findings of the Cumberlege Review: patient complaints, 30 July 2020. Rt Hon. Ann Clwyd MP and Professor Tricia Hart, A Review of the NHS Complaints System: Putting Patients Back in the Picture, October 2013. Healthwatch, Shifting the mindset: A closer look at hospital complains, January 2020; You can find further reading on complaints in healthcare on the hub. PHSO, Have your say in shaping the future of NHS complaints handling, Last Accessed 18 September 2020. Ibid. PHSO, Complaint Standards Framework: Summary of core expectations for NHS organisations and staff, July 2020. CQC, Opening the door to change: NHS safety culture and the need for transformation, 2018.

In our recent blog Analysing the Cumberlege Review; Who should join the dots for patient safety? we identified a number of key patient safety issues which were reflected in the Review’s findings. One theme running throughout the Review was a lack of support for patients after incidents of unsafe care, particularly around patient complaints. Why are complaints important for patient safety? Complaint processes are often viewed in a negative light, with patients and families not being recognised as playing a ‘primary source of learning for safety’.[1] Too often, processes are variable in their quality and are insensitive and adversarial, frustrating patients further and causing additional harm. Review findings The Review reflects on the complexity of the complaints system in health acting as a significant barrier to patients raising concerns, highlighting issues around: 1) Difficulties navigating the system – the Review notes that they have heard from many patients who “have expressed their frustration at the lack of a clear pathway for them to make a complaint or raise concerns about aspects of their care”.[2] They note that the length of time this can take, all while patients are living with complications from their original complaint, results in some patients describing themselves as being “broken” by this experience.[3] 2) Failure to listen – another issue cited was dissatisfaction with the complaints system itself. The Review notes that complainants feel that they are being treated unfairly during the process. It expressed concerns that this could discourage patients from making complaints again, reinforcing a “culture of denial and resistance to acknowledging mistakes”.[4] 3) Time limits – the Review raises the issue that “where there is a pattern of complaints relating to an individual doctor that spans years, these restrictions mean older complaints are not investigated by the GMC”.[5] Investigations into clinical matters by the GMC are limited to the event taking place within five years of the allegation. The Review notes that this may risk prevent exposing “a pattern of poor practice” where complaints relating to an individual doctor may span a number of years.[6] There is a significant amount of literature on complaints in healthcare. Earlier this year, Healthwatch published a report looking at complaints processes in the NHS, finding inconsistent local reporting and a focus on counting complaints rather than demonstrating learning.[7] The Paterson Inquiry in February also highlighted concerns about this, noting that “while there were differences in the way patients complained in the NHS and the independent sector and how they escalated their complaints, the response was inadequate in both sectors”.[8] What needs to be done to improve complaints processes? The Cumberlege Review suggests some specific recommendations around complaints processes, including: Patients across the NHS and private sector must have a clear, well-publicised route to raise their concerns about aspects of their experiences in the healthcare system.[9] All organisations who take complaints from the public should designate a non-executive member of the board to oversee the complaint-handling processes and outcomes, and ensure that appropriate action is taken.[10] The Parliamentary and Health Service Ombudsman (PHSO) are currently working to develop a Complaints Standards Framework to provide a “shared vision for NHS complaint handling”.[11] In their proposals for public consultation, they suggest an effective complaint handling system is one that: promotes a learning and improvement culture positively seeks feedback is thorough and fair gives a fair and accountable decision [12]. At Patient Safety Learning, we concur with these points and think it is vital that we have systems where harm is properly investigated and where learning is applied to prevent future harm. Further to the PHSO’s suggestions, we believe that it is important that learning from complaints processes is shared widely and feeds directly into the actions taken. Organisations should be able to demonstrate how complaints have been acted on, and resulted in, improvements. What are your thoughts on this issue? Are you a patient or member of staff who has had a negative or positive experience of the complaints process. Do you have examples of good practice that we can share? Let us know in the comments below. References 1. Patient Safety Learning, The Patient-Safe Future: A Blueprint For Action, 2019. https://s3-eu-west-1.amazonaws.com/ddme-psl/content/A-Blueprint-for-Action-240619.pdf?mtime=20190701143409 2. The Independent Medicines and Medical Devices Safety Review, First Do No Harm, 8 July 2020. https://www.immdsreview.org.uk/downloads/IMMDSReview_Web.pdf 3. Ibid. 4. Ibid. 5. Ibid. 6. The Independent Medicines and Medical Devices Safety Review, First Do No Harm, 8 July 2020. https://www.immdsreview.org.uk/downloads/IMMDSReview_Web.pdf 7. Healthwatch, Shifting the mindset: A closer look at hospital complaints, January 2020. https://www.healthwatch.co.uk/sites/healthwatch.co.uk/files/20191126%20-%20Shifting%20the%20mindset%20-%20NHS%20complaints%20.pdf 8. The Right Reverend Graham Jones, Report of the Independent Inquiry into the Issues raised by Paterson, 2020. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/863211/issues -raised-by-paterson-independent-inquiry-report-web-accessible.pdf 9. The Independent Medicines and Medical Devices Safety Review, First Do No Harm, 8 July 2020. https://www.immdsreview.org.uk/downloads/IMMDSReview_Web.pdf 10. Ibid. 11. PHSO, Have your say in shaping the future of NHS complaint handing, Last Accessed 17 July 2020. https://www.ombudsman.org.uk/csf 12. PHSO, Complaint Standards Framework: Summary of core expectations for NHS organisations and staff, Last Accessed 17 July 2020. https://www.ombudsman.org.uk/sites/default/files/Complaint_Standards_Framework-Summary_of_core_expectations%20.pdf

This version of the Framework is for: All NHS staff, including all clinical and non-clinical staff and senior leaders, to: provide a clear vision of how to approach feedback and complaints effectively set out how they should approach learning from complaints to improve services. Everyone who provides feedback or makes a complaint about the NHS, and the people who support, advise or advocate for them. It sets out what they can expect to see and experience when doing so. NHS staff who are being complained about. It will make sure they are supported and that the complaint is seen as a learning opportunity rather than a finger-pointing exercise. The Framework is built on the following four principles: Promoting and learning and improvement culture. Positively seeking feedback. Being thorough and fair. Giving fair and accountable decisions.

The advice covers: taking legal action for clinical negligence the NHS Litigation Authority compensation schemes what is clinical negligence? compensation time limits going to a solicitor paying for a legal claim 0rganisations that can help with legal action.

NHS resolution's five year strategy, Delivering fair resolution and learning from harm, extends their role beyond the historic narrow remit of claims management and shifts the focus of the organisation on prevention, learning and early intervention, to avoid unnecessary court action. This will improve the experience for those who are injured as well as address the level and cost of negligent harm.

This website can give further information on: claims management practitioner performance advice primary care appeals safety and learning.