I used to enjoy the blog of Anna Raccoon, and I wish her all the best with her ongoing illness (she has cancer), but I believe the fight she is currently waging on behalf of the NHS is wrong. She recently had an article in The Times:
A woman dying of cancer has started a campaign to curb the compensation culture in the NHS despite suffering two cases of medical negligence herself.
NHS Resolution (formerly known as the NHS Litigation Authority) estimates that £56bn could be needed to deal with all cases arising from failures and mistakes made up to March 2016.
She is currently running a campaign on Twitter to prevent people from suing the NHS and “free up” that £56bn to cover ongoing expenses:
56 Billion in NHS litigation fund.
Give it to lawyers for people who have suffered past errors.
Or fund staff to alleviate understaffing.
— Anna Raccoon (@LettucePrey101) April 20, 2017
Her arguments seem to be that the NHS will take care of anyone who they damage anyway, so no monetary compensation is necessary; that years ago nobody thought of suing the NHS and so there is no need to allow it now; and this pot of money, if freed up for general expenditure, would reduce the chances of mistakes being made in the first place.
None of these is convincing, at least to me. I assume that the NHS is self-insured, meaning it must pay compensation and other legals costs themselves rather than taking out an insurance policy. I don’t know where the £56bn figure comes from but I will further assume that is calculated using actuarial data and is of a size commensurate with the volume of litigation and size of compensation payouts expected. Little wonder they are self-insured, then: no insurance company would touch them.
I pointed out in my conversation with Anna Raccoon that requiring organisations and individuals to either take out liability insurance (or set aside funds if self-insured) is absolutely standard pretty much everywhere: what the NHS is doing is hardly unusual, but because it’s the state religion we’re talking about here, people think exceptions should be made. She made the quite reasonable comment that this £56bn could be better spent elsewhere, but I responded by saying that anyone who has to pay insurance premiums of any kind would think the same thing. I’m sure I could find better uses for my car insurance premiums, for example, but there are good reasons why the law requires me to have it before I take to the road.
There is also the issue that if freed up, this £56bn would be swallowed up in an instant, probably on increased salaries, and when the time came to pay somebody compensation the NHS would not have any spare cash. Ring-fencing it for compensation claims is probably a very sensible idea. The suggestion that nobody should be allowed to sue the NHS is also one I don’t like much. Whereas I believe the litigation culture imported from the US has gotten out of control and needs to be curbed, particularly in relation to silly multi-billion pound awards resulting from class-action suits, being able to sue a government organisation for damages caused through incompetence or negligence is a fundamental right in a civilised country. But given we’re talking about a Soviet-style public service here, a lot of people think the people forced to use it should enjoy a Soviet-style right of recourse. Где книга жалоб?
I am also skeptical of the idea that the NHS can provide all the care it needs to a victim of negligence, something Anna and her supporters insist it can do. They believe if somebody loses an arm in a botched operation, it is enough that the NHS provides all the necessary care thereafter. Even assuming they can and they will – a big assumption – what if the negligence results in a loss that doesn’t need NHS services to resolve? The example I’m thinking of is a woman losing her child giving birth. She doesn’t need any special care afterwards, except perhaps some counselling. But is she not entitled to monetary compensation? From what I can gather, some people think she should just suck it up.
When I mentioned the fact that the NHS’ idea of what constitutes “all the care necessary” after a foul-up might differ from what the patient thinks, and the responses really got to the heart of why it is so impossible to reform the British healthcare system. Basically, most people believe individual patient choice is secondary to the greater good, and they do so because in their personal experience the NHS has been satisfactory. They think that because their personal experience was fine, everybody else should reach the same conclusion. There is no contemplation of the fact that other people’s experiences may differ, let alone that they might have a different opinion on the same experience.
The problem with the NHS isn’t that it is universally shit, because it isn’t. I know enough people who have used it who tell me how wonderful their experience was, and Anna Raccoon is currently singing the praises of those treating her. The problem is that things do go wrong and people are treated appallingly with alarming regularity but there is almost no meaningful recourse and no feedback mechanism to ensure things improve. The way the NHS is set up means there is no incentive to pick up on the failings and eliminate them, and being able to sue is one of the few avenues open to a victim of negligence or incompetence.
If the NHS is finding too much of its budget going to the victims of negligence or incompetence, they should find ways of reducing the instances of negligence and incompetence rather than preventing the victims from suing and forcing them to accept “compensation” in a form of the organisation’s own choosing. If it were not the hallowed NHS we were talking about, the conversation wouldn’t even be taking place.