> ### CIVIL PROCEDURE PRE-ACTION PROTOCOLS

> ### CLINICAL NEGLIGENCE PROTOCOL

> ### THE AIMS AND OBJECTIVES

> ### THE AIMS OF THE PROTOCOL

> 2.1 | The general aims of the protocol are - to maintain/restore the patient/healthcare provider relationship; to resolve as many disputes as possible without litigation.
> 2.2 | The specific objectives are:-

> ### OPENNESS

> | to encourage early communication of the perceived problem between patients and healthcare providers; to encourage patients to voice any concerns or dissatisfaction with their treatment as soon as practicable; to encourage healthcare providers to develop systems of early reporting and investigation for serious adverse treatment outcomes and to provide full and prompt explanations to dissatisfied patients; to ensure that sufficient information is disclosed by both parties to enable each to understand the other’s perspective and case, and to encourage early resolution;

> ### TIMELINESS

> | to provide an early opportunity for healthcare providers to identify cases where an investigation is required and to carry out that investigation promptly; to encourage primary and private healthcare providers to involve their defence organisations or insurers at an early stage; to ensure that all relevant medical records are provided to patients or their appointed representatives on request, to a realistic timetable by any healthcare provider; to ensure that relevant records which are not in healthcare providers’ possession are made available to them by patients and their advisers at an appropriate stage; where a resolution is not achievable to lay the ground to enable litigation to proceed on a reasonable timetable, at a reasonable and proportionate cost and to limit the matters in contention; to discourage the prolonged pursuit of unmeritorious claims and the prolonged defence of meritorious claims.

> ### AWARENESS OF OPTIONS

> | to ensure that patients and healthcare providers are made aware of the available options to pursue and resolve disputes and what each might involve.
> 2.3 | This protocol does not attempt to be prescriptive about a number of related clinical governance issues which will have a bearing on healthcare providers’ ability to meet the standards within the protocol. Good clinical governance requires the following to be considered – Clinical risk management: the protocol does not provide any detailed guidance to healthcare providers on clinical risk management or the adoption of risk management systems and procedures. This must be a matter for the NHS Executive, the National Health Service Litigation Authority, individual trusts and providers, including GPs, dentists and the private sector. However, effective co-ordinated, focused clinical risk management strategies and procedures can help in managing risk and in the early identification and investigation of adverse outcomes. Adverse outcome reporting: the protocol does not provide any detailed guidance on which adverse outcomes should trigger an investigation. However, healthcare providers should have in place procedures for such investigations, including recording of statements of key witnesses. These procedures should also cover when and how to inform patients that an adverse outcome has occurred. The professional's duty to report: the protocol does not recommend changes to the codes of conduct of professionals in healthcare, or attempt to impose a specific duty on those professionals to report known adverse outcomes or untoward incidents. Lord Woolf in his final report suggested that the professional bodies might consider this. The General Medical Council is preparing guidance to doctors about their duty to report adverse incidents and to co-operate with inquiries.

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