A sevenfold increase in NHS urological litigation in 20 years? Are we practising in a litigation culture?

In my conversations with many urologists, indeed doctors, it is a commonly held perception that there relentless rise in medical negligence litigation leading to ‘crisis costs’ [1]. The analysis by Lane et al. [2] of 20 years claims urological practice the NHS therefore timely. It identified 2585 against urologists over years, sevenfold increase from approximately 50 per year 1996/1997 350 2016/2017. Damages increased £0.2m £7m. Does this provide evidence for crisis NHS? Are patients becoming ever more litiginous? Or are other explanations litigation? Two considerations paint less alarming picture. Firstly, prevalence conditions and treatments rising, on [3]. Over rates radical prostatectomy ureterorenoscopy have almost quadrupled, those nephrectomy not far off having doubled. We doing should come as no surprise also increase. Secondly, UK consultant urologist numbers substantially 520 2002, 800 2010 and, September 2019, 1158 [4] (according BAUS). Applying data total number study rough estimate, annual risk was 0.2 cases 2002 (100 spread urologists), (150 amongst urologists) 0.28 2019 (325 urologists). For individual chances being sued risen – but only 1.5-fold. This relatively small urologist, spanning two generations (if generation equates roughly years) may be so dramatic, especially when seen context activity. shorter apprenticeship younger has perhaps translated into greater risk. An based first post would interesting. Other factors account than dramatic litigation. Guidelines (National Institute Health Care Excellence, BAUS, European Association Urology) now ingrained practice. Adherence can shield [5]. Consultant-led, often delivered, care offset trend yet further. What does tell us scale or trends private practice, which indemnified insurance carriers. Furthermore, while provides glimpse litigation, glimpse. Resolution do allow sophisticated causes beyond ‘intra-operative’ ‘postoperative’, example, we left limited direction modify our behaviour order avoid (watch space journal). simply tells problem, what specific actions inactions lead practical remedies likely be. conclude ‘Intraoperative related represent proportion overall surgery … arguably these could some most avoidable through training mandatory pre-operative checks’. I’m sure I agree. Error prevention intensity ‘heat’ effective focusing ‘slower’ phases preceding following surgery. With mind, notable 10 2009 were 88 successful consent claims. judgement Supreme Court Montgomery vs Lanarkshire Board 2015, widely believed will continue consent-related These warning shot. My own experience an expert witness rise. Consent low hanging fruit prevention. Avoiding alternatives, risks outcomes easy. require attain technical surgical skills. impacted upon might (e.g. high anaesthetic patient). about use words giving information. adequate achievable, if simple rules followed [6]. Adequate takes time, too defending allegation inadequate consent, at General Medical Council. There doubt facing House Commons Committee Public Accounts [7] predicted spending clinical consume 4% Hospital Trusts’ income 2020, money otherwise spent patient care. However, pan-specialty. Fifty percent value managed 2018–2019 relate high-cost obstetric representing just 10% lifetime brain injury birth) [8]. Urological nowhere near costly because faced need make rapid decisions required obstetricians frenetic environment labour ward. room complacency all bear burden costs, whether financial tax payers, reputational profession, personal second victims errors bit reduce guidelines, attention detail simply, Joe Smith, who founded Department Urology Oxford President Defence Union, used say, honest nice patients. As difficult sue doctor you like, think genuinely interested looking after comes across honest, caring professional. approach impact positively good patients, health service, specialty ourselves. None declared.