NHS Never Event Information Hub
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What is a never event?
An NHS Never Event, put simply, is an event that should never have happened whilst a patient was under the care of the NHS. The NHS publishes a detailed report regarding Never Event incidents every year. They do this in order to learn from these events and ensure they do not happen again.
The NHS define a never event as:
“Never Events are serious incidents that are entirely preventable because guidance or safety recommendations providing strong systemic protective barriers are available at a national level, and should have been implemented by all healthcare providers.”
There are four overarching categories of NHS never event. These are:
- Surgical – incidents that occur during or post surgery
- Medication – the administration of the wrong medication
- Mental Health – suicide attempts made possible with unsafe NHS equipment
- General – miscellaneous events like falls or serious burns
Within each of these categories is more detailed criteria that must be met for an incident to be classed as a never event. More specific examples of never events include:
- Wrong site surgery
- Retained foreign objects post surgery
- An overdose of a substance such as insulin
- Giving medication through the wrong route
- Transfusions using the wrong blood type
- Patient entrapment in a bed by their neck or chest
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Most common never events
Between the 1st April and the 31st October 2022 there were provisionally 231 accepted reports of never events in the NHS. Of these, 103 events were linked to wrong site surgery, making this the most common type of NHS never event. The highest number of never events occurred in April 2022 and the least in September 2022.
In comparison the figures for 2021 showed there were 407 never events recorded, with 51 of these happening in October 2021. Again, the most common type of never event was wrong site surgery, with 171 incidences in the period from 1 April 2021 to 31 March 2022.
It’s important to note that in 2018, the NHS changed the framework and redefined some of the criteria around certain never events. This means that it isn’t possible to accurately compare figures from more recent years with anything prior to 2018, as it would not be a like-for-like comparison.
NHS Trusts with the most never events
As part of the provisional report, the NHS lists the various trusts across the whole of the UK and the number of never events that occurred in each trust. The figures show that Manchester University NHS Foundation Trust has the highest rate of never events, with 7 reported incidents from April 1st 2022 to October 31st 2022.
The previous year’s report also showed that Manchester University NHS Foundation Trust had the highest number of never events, with a total of 11. The size of the trust and the area served can be taken into account as those cities with a higher population may have a higher number of occurrences. Yet regardless of this, a never event should never happen and improvements must be made.
Reducing never events/action against never events
The NHS states that:
“We continue to encourage NHS staff to report Never Events and Serious Incidents to StEIS and all patient safety incidents to the NRLS, to help us identify any risks so that necessary action can be taken.”
As part of this continued action, the NHS has implemented several strategies to help tackle patient safety and reduce never events. In 2018 they undertook a project titled ‘Opening The Door To Change’. This report examined the reasons never events happen, the challenges trusts face and what can be done to limit incidences.
Following on from this, in 2019, the NHS Patient Safety Strategy was launched. This strategy focuses on eight key areas for the NHS to more thoroughly investigate in order to maximise patient safety standards. These eight areas are:
- Reducing inequalities in healthcare safety
- Improving patient safety intelligence and understanding patient safety challenges
- Improving organisational patient safety culture and practice
- Patient safety behaviours
- Effective patient safety practices
- Patient safety impacts of alternative service delivery models
- Ergonomics, design and human factors
- Clinical risk scores (validation, implementation and outcomes)
The strategy also involves work with several NHS partners who come together to delve into all of the above areas and move forwards with comprehensive ways to keep patients safe and stop never events from happening.
Compensation for NHS never events
An NHS never event is an extremely serious incident. To make a claim for an NHS never event you should contact a specialist medical negligence solicitor who has the skills and experience to help you.
Patient Claim Line has supported clients across the UK following an NHS never event, including our client who received a six figure settlement following a hospital fall. Compensation figures for never events will vary, but due to the seriousness of these events and the resulting impact, the amount patients receive is typically high.
If you or a loved one has suffered an NHS never event, Patient Claim Line has over 100 specialist solicitors in the UK ready to help you. Contact us for a free no obligation chat about your nhs never event and, if you decide to go ahead, you can do so with our no win no fee agreement.
Meet our medical negligence team
Director of Medical Negligence
Peter leads the Medical Negligence Serious Injury department, which now boasts some of our most knowledgeable, dedicated and hardworking team members.
Peter is dedicated to supporting victims of catastrophic medical negligence injuries and endeavours to provide a clear and coherent approach to claims. He recognises the effects serious injuries can have and therefore ensures his customers’ need for support is met. Peter also has a vast amount of experience working with customers who have been injured abroad and is able to act under international law to provide the best outcomes.
Partner, Head of Strategy and Legal Operations
Christian is Head of Medical Negligence at Patient Claim Line and has specialised in clinical negligence claims since qualifying in 1998; having dealt with a wide variety of claims throughout his career. He is also featured in the Legal 500 as a recommended claimant solicitor in the North West.
Christian qualified as a solicitor in 1998, specialising in clinical negligence. From 2010 onward he has had a particular interest in gynaecological and urogynaecological claims, having represented several hundred claimants in the George Rowland Litigation against the Liverpool Women’s and Aintree Hospitals. This investigated the treatment given to women in the Merseyside area over several decades, and in particular focused on the introduction and development of mesh into the UK in both the treatment of stress urinary incontinence and pelvic organ prolapse. The development of this area involved pursuing claims under a unique ADR protocol with the NHS and also looking to develop the current thinking on the valuation of compensation for complex urinary symptoms. He has successfully recovered hundreds of thousands of pounds in compensation on behalf of my clients.
Christian was also involved in setting up and chairing a Claimant Support Group for those involved in the Rowland litigation, which provided a discussion forum for the many women who were left isolated and damaged by negligent gynaecological treatment. He now co-ordinates the firm’s mesh claims and has delivered training and commented extensively on the medico-legal implications of urogynaecological / mesh complications. He is a member of APIL, Liverpool Law Society and Legal 500 recommended.
Francesca Paul is an Associate, Senior Solicitor and Team Leader within the Clinical Negligence Department. She is one of the driving Solicitors in the Group Litigation Team dealing with this niche and specialist area of work that Fletchers undertakes.
Francesca previously worked in Nottingham, dealing with Group Action work. She now works at Fletchers, bringing with her those years of experience heading up a team of 10 people. Francesca is involved in the early identification of potential new Group Litigation Work and analyses information from the collective pool of new enquiries into the business, of which there are hundreds per week looking for hot spots or recurrent issues which might suggest a potential pool of Claimants.
One of the highlights for Francesca and her team is that they have successfully recovered over a million pounds in compensation for clients who have received treatment from a single orthopaedic surgeon who was operating in the Colchester area. Her role requires a specific set of skills, patience and a forensic approach to detail whilst being able to see the wider picture.
Francesca has previously acted for a claimant in a case that reached the Supreme Court in the case of NA v Nottinghamshire County Council.
Sion is a team leader and senior solicitor with many years’ experience in dealing with a wide range of medical specialisms and different types of injuries. He is an experienced medical negligence solicitor and manages a team of lawyers within our department.
Sion joined Fletchers in 2018 as a Team Leader in the Medical Negligence Department. Throughout his 24 year legal career, he has specialised in conducting medical negligence claims on behalf of Claimants, previously working for other highly ranked leading firms in the field.
He has undertaken claims covering the full spectrum of medical specialisms, clinical settings, categories of defendant and types of negligent medical care and treatment.
These include high value and complex maximum severity cases, such as those involving limb amputations and permanent neurological injuries.
Sion is experienced at representing bereaved families at inquests and has a particular interest in fatal accident claims.
JI v Warrington and Halton Hospitals NHS Trust: £1.25m recovered for client left paraplegic after spinal anaesthesia.
RS v Central Manchester University Hospitals NHS Foundation Trust: £150,000 recovered for client in respect of a failure to recognise complications after a kidney transplant, where her father was the donor.
JN v MA: £100,000 recovered for a client who suffered 2 years persistent pain and disability after knee replacement surgery undertaken as a private patient.
CS v Pennine Acute Hospitals NHS Trust: £400,000 recovered for a child who sustained Erb’s palsy during her delivery.
WO’C (Deceased) v Central Manchester University Hospitals NHS Foundation Trust; £450,000 recovered for the family of the deceased who died as a result of a delay in diagnosing a brain tumour.
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