How many avoidable deaths?

Columnist Katie Musgrave considers how many people are dying in avoidable circumstances due to pressures in the health service, and whether this is a human rights violation

Last week, I met with up a friend whose dad died recently. We grew up together. Her dad was a force of nature; a charismatic Greek man who had everyone in fits of laughter almost as frequently as he lost his temper. She told me how shocked she’d been by his sudden death from an infection, before confiding how she worried it might have been avoided, if he had received better care in hospital.

She isn’t the first person to have discussed these sorts of concerns with me. I remember hearing the news of my own grandpa’s death. My dad had attended the hospital to visit his father, who was recovering from a urine infection. When he arrived for his daily visit (my grandpa had been in for a few days), my dad said to a nurse, ‘I’m here to see Mr Roberts’. She responded, unexpectedly, with the words, ‘I’m very sorry for your loss’. Such moments are never forgotten.

Having initially made a good recovery with IV antibiotics, my grandpa had died from acute pulmonary oedema after receiving IV fluids. He’d been looking bright and well just a day earlier.

At 97, my grandpa had been a keen supporter of the NHS. From a humble background, he’d been proud to serve in the RAF during the Second World War, even surviving being taken a prisoner of war after mistakenly landing in the wrong airfield. He was the main carer for my then frail 94-year-old grandma. He used to pop to the shops daily, and was deeply proud of his relatives (myself included) who worked in the health service. The NHS would look after him in his time of need, he told me. Until it didn’t.

I find myself wondering how many thousands, even millions, of families share the valid concerns expressed by my friend, and felt by my family. Was a stillbirth inevitable, or due to medical error? Could a loved one’s death have been avoided? Were we let down by the NHS?

In times of grief, how many of us have the will – or capacity – to raise patient safety concerns? With funerals to arrange, and the shock to deal with, it is invariably too painful to contemplate. And how many doctors and nurses are willing to highlight when things have gone wrong, as they so frequently do?

As the health service staggers from crisis to crisis – with all the ambulance delays, emergency department waits, and overstretched admission teams – we will undoubtedly have years more of this. 

Between hospital staff shortages, bed shortages, falling GP numbers and appointment demand, all the statistics across the UK are headed in the wrong direction. We bicker about funding, blame governments (after all, health is a devolved matter), but continue to defend the institution. What if there are fundamental weaknesses that mean we will continue to see continued overwhelming demand, poor access, and substandard care? What then?

The United Nations’ covenant on the right to life states, ‘The right to life is a right that should not be interpreted narrowly. It concerns the entitlement of individuals to be free from acts and omissions that are intended or may be expected to cause their unnatural or premature death, as well as to enjoy a life with dignity.’

When considering human rights, a state may commit violations either directly or indirectly. Violations might be intentionally performed, or may come as a result of the state failing to prevent the violation.

Of course, the NHS does not deliberately set out to harm anyone. Indeed, staff make enormous personal sacrifices to keep things going. However, more people are currently dying in avoidable circumstances than they should. Put another way, omissions are taking place that may be expected to cause premature death (and have been for some time).

Under the United Nations’ own terms, the British Government might reasonably be accused of committing human rights abuses in our country, against our population. This may be painful to contemplate, and difficult to solve, but it is absolutely essential to discuss.

Dr Katie Musgrave is a GP in Devon and quality improvement fellow for the South West