Title: Adverse medical incidents and outcomes in the NHS: understanding prevalence, patients’ perspectives and factors that influence subsequent actions
Funder: Department of Health and Social Care

Abstract: Background Patients and families taking formal action when things go wrong remain relatively rare. The costs of litigation are high, both in terms of psychological consequences for litigants and financial impact on the NHS. There is little empirical evidence as to the proportion of the English general population experiencing healthcare-related harm and the subsequent actions taken. A better understanding of personal, organisational and societal factors underlying decision-making after such an occurrence will ensure that the scope and nature of future interventions or national policy developments best meet the needs of people receiving NHS care. Aim: To determine the prevalence of adverse incidents experienced amongst the general population and factors that affect decision-making in relation to future action. Objectives: To establish a population-based estimate of the proportion of people experiencing healthcare-related adverse incidents amongst the general population. To identify the range of actions taken after an adverse incident and the proportion of people who pursue each one. To determine the association between type and severity of harm, demographic and socioeconomic factors, service and wider contextual factors amongst those that make a claim and those that do not. To understand the decision-making journey following an incident and how factors across the system may interact to influence courses of action. Method A two year multi-method study is proposed. First, a survey of 20,000 people will be conducted to identify people experiencing harm. Second, a diverse sample of 40 survey participants will be invited for an in-depth interview. Participants will have either chosen to litigate or to not taken formal action. This sample will be supplemented by a further 20 people who have experienced an adverse incident recruited through community groups or social media to ensure representation across BAME and socioeconomic groups. The interviews will provide deep understanding of individuals experiences of and responses to healthcare-related harm focusing on the decision-making journey surrounding the decision to pursue a formal complaint or legal remedy or not. PPI input in the development and implementation stages will be crucial to ensure the study is conducted with sensitivity and provides support for both participants and researchers. The survey will be delivered and analysed in the first 14 months of the study and the qualitative interviews between months 8 and 21 months. Dissemination and Impact The study findings will be disseminated through traditional channels such as publications and conference presentations but also to wider audiences via social media posts and video presentations. PPI colleagues will be essential in identifying and connecting to healthcare, and patient and carer audiences. The evidence provided by the study will inform future policy and programme development directed at providing better support to patients and their families who experience adverse outcomes. As well as improving patient and family experience in the short-term and avoiding further physical and psychological harm or financial hardship, this may eventually lead to a reduction in the number of people seeking legal redress. These changes would result in large potential savings for the NHS.

Lay abstract: When failures in NHS care result in physical or psychological harm, the impact on health and wellbeing can be long-term. Despite this, few people choose to make a complaint or pursue legal action to obtain financial compensation. Although many people taking legal action say they do so because of the lack of early support and good communication, this does not imply that those that don t, are satisfied with the way they have been treated. In fact, relatively little is known about why the majority of people don t complain or make a legal claim and what might be the longer-term consequences for them. To ensure that the NHS is doing all it can to address the needs of those who experience healthcare-related harm and to avoid litigation where other routes of support and resolution are available, we need to better understand the experiences and actions of all people using the NHS, including those who do not complain formally or litigate. We will conduct a survey amongst the general public (20,000 adults) to identify the proportion of people who have experienced harm, where it happened, how it affected health and employment and consequent actions taken. As the results of two previous similar surveys are available, we will be able to examine trends in these issues over the last 20 years. From the survey we will identify around 40 people who have both chosen to take legal action and those that have not for in-depth interviews. We will also recruit a further 20 people from community groups or via social media to ensure that our sample reflects the range of people who live in England. The interviews will focus on factors that affected decision-making after the event such as the impact on daily life, knowledge of how to make a complaint or seek legal help, or the responses of NHS staff to the situation and any support by staff. We will aim to understand how these determine actions. This work will ensure that future NHS interventions address aspects of patients and families experiences that are most important to them and are thus more likely to promote the best long-term outcomes in the circumstances.

Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: GENERIC HEALTH RELEVANCE