At this stage, given the final list of “never events” has not been determined, a full impact analysis of the proposals has not been provided. We are able to discuss the likely impacts of the proposals, however.
The costs of these proposals will take a variety of forms. One impact should be to incentivise the NHS to further prevent these “never events”. This process of prevention could be argued to incur costs to the NHS, although these are not possible to quantify because the cost of prevention for each event will vary due to the very different nature of the interventions required for each event and also because different providers will have different systems and methods of prevention already in place. Therefore, the actions they need to take will vary.
It could also be argued that prevention of these events should happen already given the existence of relevant alerts and clinical guidance, which should already have been implemented. All providers are subject to the same requirements to provide safe care and that they must comply with all relevant patient safety standards and alerts (regardless of the status of “never events”). One of the criteria for the definition of a never event is that clear guidance and/or principles exist, which, if followed by providers, will prevent the event from happening. All providers must implement such guidance and, given that the obligation to do so sits outside the policy on “never events”, any associated costs could be considered as separate to this policy proposal.
Similarly, while there will be an increase in the reporting of “never events” due to expanding the list, this should not increase the costs associated with reporting these events because they are all serious incidents, and as such should already be reported to commissioners and the National Patient Safety Agency (NPSA).
The impact of cost recovery will be borne by providers, but will be cost neutral to the NHS as a whole as the recovered money will be returned to the commissioner for reinvestment in NHS services. Estimating the impact of cost recovery is difficult given the varying costs associated with dealing with each event and the varying costs of the care episode in which a particular event could occur. It is also possible that the number of events will reduce immediately anyway simply due to the impact of categorising these events as “never events” and the increased scrutiny this would bring.
However, to give providers an idea of the potential impact, we have conducted a very rough analysis of the potential number of “never events” that might occur if the proposed list of events below were made “never events”. Our analysis suggests there would be between 300 and 400 “never events” per year at present (using information from the NPSA and other published sources). This suggests there would be between one or two events per NHS provider (assuming 240 NHS providers – 169 NHS Acute and specialist trusts, 57 mental health trusts, 11 ambulance trusts and 3 learning disability/other trusts). This compares to data from the NPSA’s annual report on “never events” for 2009/10 indicating there were 111 events in 2009/10. This is obviously a crude estimation, however, as Trusts vary widely in the number of patients they care for and therefore the risk that a serious errors will occur. Equally, some trusts will be better at preventing safety incidents than others.
The benefits of these proposals to the NHS include the savings associated with not having to treat patients for the consequences of any “never events” that are prevented, plus the savings associated with reducing the legal action that could result from errors. As an illustration, in 2009/10, over £2.1m was paid in relation to clinical negligence claims where wrong site surgery formed part of the claim, according to the NHS Litigation Authority (note that part of this sum will be for losses relating to other aspects of the claims). There will also be a resulting ‘reputational’ benefit for the NHS as it is seen to apply even more stringent safety standards and further demonstrate its lack of tolerance for serious safety incidents.
Most importantly, however, and fundamental to the concept of “never events” is the impact on patients of ensuring these events never happen. This has the key benefit for individuals and their families and friends of not having to endure the potentially devastating and long-term impacts of a very serious safety incident. Depending on the incident, occurrence of a “never event” could lead to death, serious long-term disability, a significantly prolonged period in hospital, further intrusive and unpleasant treatments and interventions, significant emotional and mental trauma, and wider consequences for quality of life, ability to work, family life and long-term well being. For all these reasons, reducing the incidence of these events will be of huge benefit to patients and their families and should be the overriding consideration when reviewing these proposals.