Doctors and a bereaved parent have argued that the Thirlwall inquiry recommendations will increase blame and suspicion in the NHS, and have pointed to New Zealand's no-fault compensation system as a safer alternative.
Concerns over Thirlwall recommendations
Dr Pamela S Melding, a retired hospital consultant and clinical director, said the recommendations will lead to more blame and suspicion in the NHS. She noted that trusts often prioritise preserving their reputations, internal inquiries go nowhere, and defensive clinical staff deflect blame, with non-disclosure of errors to patients.
Melding said the Thirlwall recommendations of more surveillance will make the situation worse, and argued that an alternative exists.
New Zealand's no-fault system
Melding, who spent most of her professional career in New Zealand, explained that the country's publicly funded NHS is the same model as the UK's, but with a major difference. In the 1970s, New Zealanders lost their right to sue for damages for medical accidents through the public court system with the Accident Compensation Act.
This removed the grievance culture and ambulance-chasers, and the system provided remedial care for any injury. In the 1980s, after a scandal regarding medical investigations, the Cartwright inquiry led to the creation of the independent Health and Disability Commissioner (HDC) and principles of patient safety, interests and consent.
All complaints about any health facility, organisation or practitioner go first to the HDC for investigation. If deemed necessary, cases go to professional disciplinary bodies or the Medical Council of New Zealand. HDC reports are publicly available.
In 2005, the government passed its "no fault, no blame" legislation, bringing in a duty to report "any risk of harm to the public from authorities responsible for patient safety". This freed clinicians to engage with compensation cases openly.
Calls for candour and partnership
Mark Hanson of Hitchin, Hertfordshire, said the Thirlwall reforms appear to be based on surveillance, suspicion and blame, including cameras in cots and encouragement to report colleagues, retreating from the "no blame" culture.
Hanson asked: "Destroy candour and you destroy one of the most powerful tools of patient safety. A frightened workforce will hide mistakes, keep quiet about doubts and practise defensively. Patients will pay."
A reader who lost her baby in a neonatal intensive care unit in March this year said she believes the death was preventable and one key mistake was made, but she does not blame the consultant who made the error. She said the trust's management has "bent over backwards to try to hide their tracks" rather than discussing it openly and learning from it.
Paul Whiteing, CEO of Action Against Medical Accidents, said the NHS needs staff who can speak up without fear, but also patients who are listened to, informed, supported and involved. He said: "Some of the most important safety signals come not from systems, but from the people experiencing care. If there is one lesson from the Lucy Letby case, it is that patients and families must be recognised as partners in identifying risk, seeking answers and driving improvement."
