NHS ‘Never Events’ Report 2022

The NHS have recently shared their annual ‘Never Events’ report which details incidents occurring between 01 April 2021 and 31 March 2022.

The NHS describes ‘Never Events’ as ‘serious, largely preventable patient safety incidents that should not occur if healthcare providers have implemented existing national guidance or safety recommendations.’

In other words these are patient safety events that are wholly avoidable and should never happen.

The purpose of the report is to enable the NHS to recognise and learn from these events with the intention of improving patient safety.

Types of ‘Never Event’

The report details a total of 407 ‘Never Events’ in this period. These are categorised as:

  • 171 incidences of wrong site surgery
  • 98 incidences of a retained foreign object
  • 47 incidences of a wrong implant / prosthesis
  • 31 incidences of a misplaced naso or oro gastric tube
  • 21 incidences of medication administered by the wrong route
  • 13 incidences of a patient being connected to an air flowmeter when requiring oxygen
  • 11 incidences of insulin overdose
  • 7 incidences of transfusion or transplantation of ABO incompatible blood components or organs
  • 3 falls from poorly restricted windows
  • 2 incidences of mis selection of midazolam during conscious sedation
  • 2 overdoses of methotrexate for non-cancer treatment
  • 1 incident of mis selection of a strong potassium solution

In addition, the report identifies a further 29 serious incidents which did not meet the definition of a ‘Never Event.’

Comparison to Previous Reports

By way of comparison previous reports outlined the following:

  • 2020/2021: 364 ‘Never Events’
  • 2019/2020: 472 ‘Never Events’
  • 2018/2019: 496 ‘Never Events’

The numbers have therefore increased since 2020/2021 but this could be due to other factors, such as the national lockdowns throughout 2020.

Over the 4 years summarised above the numbers are relatively consistent and may indicate that further action is necessary to ensure learning from these events.

‘Never Events’ at Yorkshire Trusts

The report also details the Trust where each of these ‘Never Event’s occurred. The Manchester University NHS Foundation Trust reported the most with 11 events over the course of the year.

At Morrish Solicitors we act for clients who have suffered clinical negligence throughout England and Wales. We have offices in Leeds and Bradford (where we hold a legal aid franchise) and we are therefore instructed in relation to claims concerning a number of Trusts in the Yorkshire region.

The largest number of ‘Never Events’ in the region were at the Leeds Teaching Hospitals NHS Trust with a total of 7 over the course of the year. The Hull University Teaching Hospitals NHS Trust had 5 and the Bradford Teaching Hospitals NHS Foundation Trust, the Harrogate and District NHS Foundation Trust, the Mid Yorkshire Hospitals NHS Trust and the Sheffield Teaching Hospitals NHS Foundation Trust each had 3. The remaining Trusts in the area, detailed within the report each had 1 or 2 ‘Never Events.’

Conclusion

NHS clinicians work hard performing many successful procedures and providing vital treatment. The report shows that on occasion avoidable mistakes are made and unfortunately this can have life changing consequences patients.

A number of recent newspaper reports have highlighted increasing difficulties across the NHS including record wait times in Emergency Departments, delays in referrals and operations as well as staffing shortages. There is concern that the number of ‘Never Events’ could increase due to overworked doctors and nurses having to provide treatment under extreme pressure and within unreasonable time constraints.

Never Event Claims

Morrish Solicitors experienced team of medical negligence solicitors specialise in never event claims. If you or a loved one has suffered an injury as a consequence of a completely avoidable medical mistake then you may be entitled to make a never event negligence claim.

Our medical negligence experts are here to support you, we could help you get the justice and compensation you deserve.

Contact us today on 033 3344 9600 or simply email [email protected] with your request.

To stay up to date with the latest law-related news, case studies and updates to our services please sign up to our newsletter.