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The article examines the issues surrounding White Paper's uncovering of the proposal to reforming the health professionals' Trust, Assurance and Safety regulation in Great Britain. The White Paper expressed that to reform, the importance of perceptions must be rightly emphasized as public needs to perceive that the regulatory system is operating in the interests of patients. It also stresses that the General Medical Council's (GMC) four functions must be integrated in the regulatory framework.

The article discusses the issuance of various reports and consultation papers with regard to health care and medico-legal issues in Great Britain. The papers include proposals for the establishment of a Council of Health Regulators and the Kennedy Report on the Bristol Inquiry which deal with several pediatric care problems and proposed solutions.

Introduction There is an increasing expectation for the NHS to deliver a constantly up-to-date health service that is both safe and patient-oriented. This paper outlines the findings of a new risk assessment tool implemented across the organization targeted specifically to medical devices. Method The process employs a new medical devices risk assessment tool (MeDRa) to collect quantitative data relating to the contributory factors and control measures associated with medical devices used in the clinical setting. The tool utilises the responses from healthcare professionals as the 'real experts' in assessing risk to compute risk ratings for each device. Consequently the risk assessments are validated through the professional judgement of the clinical staff. Results As the data is inputted, the software tool computes the individual risk profiles for device categories in the particular clinical setting. A macro perspective of medical device risk is produced through statistical analysis and mathematical modelling using cross-tabulations. Risk perceptions are influenced by the differences in professional roles of nursing and medical staff. The outcome of the analysis is a report on medical device risks across the organization and an associated action plan, which identifies ways of mitigating those risks. Conclusions This approach efficiently produced risk assessments for each clinical area across the whole Trust in a matter of weeks. The MeDRa tool collated evidence to satisfy many of the criteria necessary for the external assurance framework. The subsequent statistical analysis and mathematical modelling highlighted a number of issues across the Trust that required interventions. [ABSTRACT FROM AUTHOR]

The 'Modern Matron' is one of the prominent nursing roles to emerge from the NHS Plan. The underpinning principle is to have a professional leader who is accountable for co-ordinating safe, high-quality care to improve patients' NHS experience. This paper discusses findings from a study of the implementation of the Modern Matron role in an acute NHS Trust in the East of England. The theoretical framework of 'limiting harm' was used to assess the extent to which the Modern Matron could contribute towards safe effective care and the reduction of harm. The study found that error-prone situations were clearly identified and that the Matrons were perceived to have a positive impact on a range of clinical issues. The evidence from this small study suggests that the Modern Matron role has the potential to make a positive contribution to patient safety. [ABSTRACT FROM AUTHOR]

The criminal law looks set to play a larger role in regulating healthcare. Until recently, health professionals only faced the prospect of criminal liability if it could be proved that their gross negligence resulted in the death of a patient. In such a case, the professional could face a charge of gross negligence manslaughter (GNM). Prosecutions for ‘medical manslaughter’ have generated concern among doctors worried about what is perceived as a rise in the number of doctors facing criminal prosecution and the impact prosecutions are having on healthcare practice. May more frequent resort to the criminal process damage rather than promote better health care? In seeking to try to answer this question, the first problem is that reliable data in this area about how many prosecutions are brought and how they fare are limited due to the way cases are recorded. What evidence does exist is often based on media reports or samples that are not representative. This paper will argue that, while the real risk of being prosecuted for medical manslaughter remains low, such fears should not be dismissed because, as Donald Berwick has argued, ‘fear is toxic’ – for health professionals and their patients. [ABSTRACT FROM AUTHOR]

The article presents news briefs concerning legal issues related to medical care in Great Britain. A White Paper will be released in early 2002 on options for reforming the processing of clinical negligence claims and reducing costs associated with such claims. The Council for the Regulation of Healthcare Professionals has been created to supervise the work of several regulatory bodies. Drug labeling proposals have been announced by the Committee on Safety of Medicines.

The case of Ryan St George v Home Office [2008] EWCA Civ 1068 raised unusual issues on breach of duty, causation and contributory negligence. The 29 year old claimant had a history of alcohol and drug abuse, withdrawal seizures, and previous custodial sentences. Five days after his admission to Prison he sustained a substance withdrawal seizure injury, falling from the top bunk and striking his head on a concrete floor. He developed status epilepticus and subsequent irreversible brain damage. The medical case on causation was whether the head injury resulting from the fall triggered status epilepticus or whether the status epilepticus was a consequence of the withdrawal seizure alone. Mackay J held that the head injury triggered the status epilepticus and that the Home Office had acted in breach of duty following the claimant's admission to prison when he was allocated a top bunk in a dormitory wing. A novel issue on contributory negligence arose because Mackay J reduced the claimant's damages by 15% because his injuries were caused partly by his substance abuse, therefore his "fault" within the meaning of section 1(1) of the Law Reform (Contributory Negligence) Act 1945 ("the 1945 Act"). There had been no previous direct authority on this point. The judge's findings were the subject of an appeal to the Court of Appeal where in the leading judgment Dyson LJ dismissed the appeal against the findings on breach of duty and causation and allowed the crossappeal against the finding of contributory negligence. [ABSTRACT FROM AUTHOR]

Consultants have considerable freedom and power to improve the quality and safety of clinical care within their services. Whatever happens to healthcare in the future, patients acutely unwell with critical illnesses will be taken to hospital. The priority work of acute hospitals will always be to treat these patients with high-quality effective clinical care to swiftly and safely restore their health so that they can resume living outside hospital. For a small proportion of patients the work is to anticipate and provide for a calm end of life. Integral to this work is also the training of the next generation of healthcare professionals. Over the last five years I have been working to improve quality and safety at the point of care in acute general medicine. I discuss some of the successes and hope to open the reader's eyes to the potential for improvement in acute care processes, if clinicians and managers work together to optimize working at the point of care. [ABSTRACT FROM AUTHOR]

The Health and Social Care Bill proposes clinically led commissioning. The new Clinical Commissioning Groups will become statutory bodies and replace the old primary care trusts. This primary legislation will transfer accountability for health care spending to clinicians who will have a duty to meet the health needs of a population as well as balance a budget. This change gives rise to a number of ethical issues which are explored in this article. [ABSTRACT FROM AUTHOR]

The article explores some of the potential risk areas that exist at the interface between hospital care and general practice care in Great Britain. The work done in general practice and work done in hospitals during the early decades of the National Health Service is described. Commentators said that adverse clinical events result from poor communication. Suggestions that might reduce adverse outcomes are provided.

The article presents an interview with Liam Donaldson, chief medical officer of the British Department of Health, about patient safety. The interview begins with an assessment of the report "An Organisation With a Memory" which stimulated a lot of awareness about patient safety. Donaldson then discusses the approach to cover ups or failure to comply with the being open policy. In addition, Donaldson talks about the role of the National Health Service Litigation Authority.

The article presents several cases related to medical malpractice in Great Britain. The total settlement in the case Davies versus University Hospital of Wales NHS Trust is £279,697 which includes the pain, suffering and loss of annuity. The allegations in the case J Gg versus Salford Royal Hospitals NHS Trust includes the failure at the time of the left orchidectomy to perform a biopsy of the right testicle with reasonable care.

The article focuses on litigation in the healthcare field in Great Britain. It presents the reasons the British National Health Service (NHS) Legal Aid seeks to avoid litigation unless it is essential to establish or protect precedent in the interest of the NHS. It explains the reason the costs of litigation on the individual case are increasing. It compares the case Chester v. Afshar with Donoghue v. Stevenson.

The article focuses on the London Protocol, the revised and updated version of the original Protocol for the Investigation and Analysis of Clinical Incidents. It is aimed at ensuring a comprehensive and thoughtful investigation and analysis of an incident. The first edition was targeted at the acute medical sector while the London Protocol can be applied to all areas of healthcare, including the acute sector, mental health, ambulances and primary care.

The section presents an update on healthcare and law issues in Great Britain. It details how the law should approach the boundary between a reasonable hypothesis and evidence of causation in the case of birth asphyxia as a cause of stroke. Paul Casey has filed a lawsuit against East Lancashire Health Authority in England for negligent delay in identifying a tumour that led to additional disability.

The article comments on a number of inquiries set up by the government of Great Britain to look into a variety of national disasters where there has been serious public disquiet. Some of the inquiries have concerned the Health Service and the provision of health care in Great Britain. One inquiry investigated the killing of a musician, Jonathan Zito, in 1992.

The article considers the amount of information that should be given to patients for informed consent to be valid. It is imperative in good medical practice that a patient must give a valid consent to medical treatment and be given the prerogative to refuse treatment. Physicians must give sufficient information about the treatment before treating that person. The evolution of the doctrine of informed consent in the U.S. and Great Britain, and the amount of information that should be given to patients are explored.

The author discusses some of the current risk management dilemmas related to ensuring informed consent. The aim is to encourage positive debate about the best means of handling patient's consent decisions through review of the territory, and the issues, before moving on to consider the responses to the challenges raised and their possible solutions. [ABSTRACT FROM AUTHOR]

The article describes a practical method of rapidly developing a corporate risk register by adopting an organizational learning approach. Risk register is defined. Risks associated with the health care business is discussed. Factors that influence risk rating are cited. The notion of the British National Health Service as a learning organization is considered.

An introduction is presented in which the editor-in-chief discusses articles within the issue which focus on topics related to managing risk in older hospital patients such as the Safety Thermometer, the "Falls Safe" project, and legislation with regards to mental capacity.

The article explains the challenge of making health care safer in Great Britain. The patient safety community is beginning to understand how difficult the safety problem is in cultural, technical, clinical and psychological terms. The nature of harm, its causes, consequences and likely methods of prevention are discussed. In addition, the article offers a number of recommendations for addressing the safety problem.

The article provides information on the report "Development of Research Management and Governance in Primary and Community Care" in Great Britain. The report encourages Primary Care Trusts (PCTs) to support the implementation of the Research Governance Framework for Health and Social Care and enables them to manage research properly. According to this report, the implementing research governance within PCTs requires the establishment of systems for being notified of any research activity.

The article deals with various issues related to medical care in Great Britain. The British Medical Association, Resuscitation Council and the Royal College of Nursing issued joint guidelines which raised the question of whether it is necessary to discuss cardiopulmonary resuscitation with every patient. A specialist registrar in emergency medicine at Whipps Cross Hospital stresses the need for a constructive approach to quality issues in the education of clinical staff.

The article discusses an application with the court for an order that the care and accommodation issues involving a cerebral palsy patient should be stayed until such time as the Claimant had submitted to an assessment under Section 47 of the National Health Services and Community Care Act in Great Britain. In order to avoid a stay the Claimant's representatives agreed to an order for assessment, but limited to one person visiting for a period of around 2.5 hours.