The Coalition Government reverses key reforms to our Coroners system

If you are unfortunate to loose a friend or relative in circumstances where the cause of death is violent, uncertain or accidental you may find yourself meeting a coroner, coroner’s officer or attending an inquest for the first time. 

How friends and families are treated and what answers they receive to their questions at the inquest will depend entirely on the way an individual coroner runs his court.  Each coroner covers a particular area and he or she is responsible for investigating all deaths occurring in that area that are referred to him.  There is no consistency between different coroners’ approach to their investigations and how the inquest itself is conducted.

If a family is unhappy with the outcome of a Coroner’s investigation, after an informal approach to the coroner himself the only recourse is to Judicial Review.  This process is highly complicated, expensive and permission has to be granted for a review which may be refused.

While some coroners are also doctors many coroners have no medical knowledge or experience beyond what they have learned on the job.  Yet they are not compelled to obtain medical advice or evidence even in the most complex medical deaths (although many do).

Because there is no central organization governing the role of coroners and their courts there is no opportunity to spot problems in a particular area.  Time and again we have seen scandals involving particular doctors or hospitals (Shipman, Gosport War Memorial Hospital and Stafford Hospital come immediately to mind) but with no central system of overview it is difficult to spot trends

Last year AvMA and many other organizations involved in helping bereaved families welcomed a new law that was intended to put these problems right.  The Coroners and Justice Act 2009 included three important reforms:-

1. The appointment of a Chief Coroner
2. The introduction of medical advisors for every coroner
3. An appeals process that was straightforward and accessible to ordinary people

The Chief coroner was to have supervised a system of reporting, enabling trends to be spotted, ensuring uniformity of training and dissemination of information.  He would also oversee a new appeals process and each coroner would have the benefit of sitting with a medical advisor.

After years of consultation and a brief period of celebration that the major concerns about the coronial system may be about to be addressed we heard  recently that the government intends to abolish the role of chief coroner, delay indefinitely the appointment of medical advisors and that there will not be an appeals process.  The news was broken to us and fellow representatives from other NGOs including INQUEST and The Royal British Legion   at a meeting called by the Justice Minister Jonathan Djanogly..

And now legislation is before parliament to do just that in the form of the Public Bodies Bill that reaches the committee stage in the House of Lords on Tuesday 23 November.

AvMA together with INQUEST and The Royal British Legion are calling for the government to urgently to reconsider its decision to abolish this key role that would ensure fairness and justice for bereaved families.  Baroness Finlay of Llandaff has put down an amendment to the Bill removing reference to the abolition of the roles of Chief Coroner and Medical advisor which we strongly support

Proposals to abolish legal aid will deny access to justice for many injured people

Yesterday, the Lord Chancellor and Secretary of State for Justice Kenneth Clarke made two announcements that would, if implemented, seriously affect access to justice for people injured in the course of medical treatment.  Firstly he announced the proposal to end legal aid for clinical negligence, education and welfare claims this will have an impact on all people with disabilities including those injured by medical accidents. 

The second proposal is to end the system where claimants can recover nearly all their costs from defendants if their case is successful.  If the reform goes ahead, only about half of the costs will be recovered leading to claimants suffering large deductions from their damages, damages that are designed to compensate them for their injury and pay for accommodation and care they need as a result of that injury.

This second proposal comes from the recommendation of the Review of Civil Litigation Costs by Sir Rupert Jackson published by the Labour government in December last year.  However it is clear that Sir Rupert did not envisage abolition of legal aid to go hand in hand with his recommended reforms as in his report he says:-

'I do not make any recommendation in this chapter for the expansion or restoration of legal aid.  I do however, stress the vital necessity of making no further cutbacks in Legal Aid availability of eligibility... the maintenance of legal aid at no less than the present levels makes sound sense and is in the public interest '

While this second proposal will only affect claimants whose solicitors act for them under a no win no fee arrangement, the number of people whose legal fees are covered in this way will increase considerably if legal aid is abolished.  These reforms will have the greatest impact on children and the most seriously injured.

Peter Walsh our CEO has made the following statement:-

"AvMA are urging members of the public to respond to the consultation on plans to cut legal aid completely for clinical negligence cases.  If implemented, the proposals could add millions of pounds to the NHS bill for settling negligence claims, as well as making access to justice impossible for many would-be claimants.  This is because people will be forced to enter into no-win no-fee agreements with lawyers, which are much more expensive to settle than legal aid cases.  For some people even this will not be an option, because other planned changes in Lord Jackson’s report will mean that no-win no-fee agreements are outside the reach of many people. 

This is not joined-up government.  Whatever the Ministry of Justice would save by scrapping legal aid will cost the NHS many times more.  At the same time, the overall effect of changes will hit the poorest hardest, denying them access to justice even if they have been seriously harmed by negligence in the NHS”.

An Age Old Problem - Confidential enquiry into care of the elderly

Today the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) published An Age Old Problem.

The report examines all deaths of patients over 80 occurring within 30 days of surgery.  The report which covers deaths in both NHS and private hospitals covers a three month period from April to June 2008.  In that period there were 1752 deaths.

The report highlights the lack of consideration of the patients’ pre-operative condition which in turn leads to poor outcomes after surgery.  It lists nutrition, deafness, poor sight and dementia amongst the possible pre-operative problems in elderly patients and recommends that before surgery they are assessed by specialists in medicine for the care of older people.  Other key factors in the high death rate in this age group are delays of more than 24 hours in carrying out emergency surgery and poor post operative observation.

Time and again AvMA sees problems arising with care of the elderly in our hospitals.  We see failure to allow for their special needs and a general attitude that elderly people’s health problems are just part of the aging process but that little can be done.  Whereas, as the report concludes, recognition of the problems and properly addressing them before surgery can lead to significantly better outcomes for this group of patients.

We have also seen terrible examples of poor basic care of the elderly.  We have assisted relatives of patients at the Gosport War Memorial Hospital where an inquest last year found that in some cases there was inappropriate use of sedation that may have contributed to the person’s death.  And now at the Stafford Inquiry we hear accounts of (not exclusively elderly) patients lying in soiled beds, so thirsty one patient was seen to drink from a flower vase,.

The evidence cited in the NCEPOD report and currently being heard at the Stafford Inquiry is nothing short of a disgrace, elderly people are being let down by healthcare providers in every possible way.  By the accounts of the nursing care at Stafford the patients were being denied even the most basic care in relation to nutrition and hygiene and by this report there is a failure to provide the specialist help these patients need for their complex health needs.

AvMA's opening statement to the Inquiry

Today AvMA's CEO Peter Walsh presented our opening statement to the enquiry.  In it he described AvMA's work campaigning for safer health care and provided details of our involvement with patients and their relatives at Stafford Hospital.  He also outlined AvMA's hope for the inquiry, in particular that the eventual conclusions and recommendation of the inquiry would be robustly implemented and lead to significant improvements in patient safety and care.

A full transcript of AvMA's submission and of each day's proceedings at the inquiry can be found on the Inquiry's website . The written submissions of the various care participants have also been uploaded to the site

Stafford Hospital the opening day of the inquiry

Yesterday AvMA's CEO Peter Walsh was present at the opening day of the Mid Staffordshire NHS Foundation Trust Inquiry, together with our legal team from Kingsley Napley, led by partner Ross Brain.

Robert Francis QC, Chairman of the Inquiry said in his opening remarks  "We are all here because of the terrible standard of service inflicted on so many of the patients who went to Stafford Hospital for treatment and their families. Last year in my first inquiry I sat and listened to many stories of appalling care.  As I did so, the questions that went constantly through my mind were: why did none of the many organisations charged with the supervision and regulation of our hospitals detect that something so serious was going on, and why was nothing done about it?  That question was one which many patients and their families and, it is fair to say, health care professionals as well wanted to be answered."

link to the inquiry website

Launching the AvMA blog

On Monday 8 November the public enquiry into the Mid Staffordshire Hospital Foundation Trust will formally open.  As core participants AvMA will have the opportunity to give evidence on key areas that are of particular concern to us.  These will include, patient safety, correct use of statistics, openness and the role of the coroner.

We will  post updating information and reports from the enquiry as the news breaks.  But we do not intend that this blog will be solely devoted to the enquiry, we will also post on other issues in our on going campaign for patient safety and justice