Posted by Simon Elliman, Partner
The Darnley vs Croydon Health Services NHS Trust case: too onerous a duty?
The Supreme Court has recently handed down its judgment in the case of Darnley v Croydon Health Services NHS Trust. The case had raised the question of whether reception staff owed a duty of care to patients; the Supreme Court has now confirmed that non-medically trained staff do owe such a duty of care. But where does this leave A&E departments, and what does it tell us about the state of our NHS?
The case in question revolved around the experiences of Mr Darnley, who sustained a head injury on 17 May 2010 and consequently attended the Accident & Emergency department (A&E). He told the receptionist that he was feeling unwell and that he thought he needed urgent attention, but he was advised that he would need to wait for up to four to five hours before he could be seen by a medical practitioner. The reality was that Mr Darnley would have been seen by a triage nurse within 30 minutes, due to the nature of his injury, but unfortunately Mr Darnley decided to leave after 19 minutes because he felt too unwell to remain in the waiting room.
After leaving the hospital, Mr Darnley became distressed and an ambulance was called. On arrival at A&E, he was diagnosed with a large extra-dural haematoma with a marked midline shift (where the brain shifts out of position due to extensive pressure). He subsequently underwent an operation to remove the pressure of his brain, however Mr Darnley suffered a severe left hemiplegia (paralysis on one side of the body) resulting in permanent brain damage and leaving him disabled.
At trial, the judge accepted that Mr Darnley would have remained in the waiting room if he had been aware he would be seen within 30 minutes. Had he waited, it is likely that his subsequent collapse would have occurred at the hospital and the surgery could have been performed earlier. Under these circumstances Mr Darnley would have made a full recovery.
It was also found that the information provided to Mr Darnley by the receptionist influenced his decision to leave the hospital. Despite these findings, the trial court concluded that the case was outside the scope of any duty owed by the Hospital and dismissed the claim. A majority in the Court of Appeal upheld this decision after expressing concern that the claim represented an extension of the duty of care.
Allowing the appeal, the Supreme Court decided that the Hospital, and therefore the receptionist, was under a duty to take reasonable care not to provide misleading information to Mr Darnley which may, foreseeably, have caused him physical injury. This falls within the existing duty to take reasonable care not to cause physical injury to a patient. No distinction was drawn between the responsibilities of medical and non-medical staff; both have a responsibility to provide accurate information as to the availability of medical assistance.
What does this mean for non-medically-trained A&E staff?
At first glance, you might be concerned that this is an onerous duty to place on overworked A&E staff. However, the Supreme Court has confirmed that this case does not mean that staff will be expected to provide “minute-perfect or hour-perfect” information. Rather it means that, when providing information to patients, all hospital staff must be reasonably careful that the information they are providing is accurate.
There is, undoubtedly, considerable pressure on our country’s NHS, and particularly on our A&E departments. This played no small part in the decision of the Court of Appeal. Lord Justice Sales commented that it would not be fair, just or reasonable to impose “a duty of fine-grained perfection” regarding the information provided to patients in A&E waiting rooms, as it would be unrealistic given the conditions staff are working under. It seems that the pressures alluded to in Darnley may be impacting on the standard of care that patients are receiving.
What does this case tell us about the NHS?
The NHS Resolution Annual Report and Accounts 2017/18 identified that A&E claims made up the majority of the claims it dealt with last year, with a 7% increase in A&E claims between 2016/17 and 2017/18. On the face of it, these figures paint a concerning picture of the state of the emergency services provided by the NHS.
It is important to note that these claims could relate to incidents that have happened over a number of years. These figures may not be indicative of an increase in incidents at all but representative of some other factor.
However, it could be that the level of claims reflects an NHS that is straining from the rise in the number of people attending A&E. This increase could be for any number of reasons. It might be that the lack of available GP appointments is leading people to seek help from hospitals or that there is poor-signposting to alternative services. Regardless of the reason, the rising demand is being exacerbated by longstanding staffing issues and the low number of available hospital beds. These factors have led to an increase in waiting times, with the 4 hour waiting-time standard not having been met since July 2015. Any delay in treatment in emergency situations can have a devastating impact. This could ultimately be the reason that we are seeing the number of claims relating to A&E treatment creep up.
Arguably, the decision in the Darnley case merely reinforces the necessary standard for patients to feel confident in the care they will receive when they attend A&E. Anyone visiting hospital for assistance in an emergency should feel sure that all staff will take care to provide information that is as accurate as possible. In this case the hospital failed to meet this standard with tragic consequences, but if the Supreme Court judgment helps avoid similar situations in the future it can only be a good thing.
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