ABSTRACT
England has a long history of inspecting and reporting standards of care under state medicine, which is affirmed by this vibrant collection of essays.2 One of the country’s most recent administrative incarnations has been the national Care Quality Commission (CQC). According to the CQC, there were 1.25 million National Health Service (NHS) ‘incidents’ reported in the year of 2010-11, which had continued a ‘year-on-year’ increase.3 In turn, a leading British newspaper, the Guardian, reported that negligence claims were ‘soaring and payouts to patients or their families [had] hit unprecedented levels’ – even the chairman of the world’s oldest medical defence organisation, the British Medical Defence Union (MDU), has commented that the 20 per cent rise in legal action between 2009 and 2010 was ‘unmatched in the company’s 126-year history’.4 Such alarmist observations are omnipresent throughout the social history of modern medical practice.5 A thin red line of medical defence lawyers keeping a tide of litigating patients at bay has been a pervasive image in modern British medicine. Historians, though, have been slow to counter the disingenuous, but persistent, claim of historically unprecedented levels of litigation and complaining in the NHS. For example, the MDU was itself inaugurated in the 1880s due to a perception of increasing charges of negligence and libel,6 but – then, as now – the court records reflect discouragement, not encouragement, for aggrieved patients. It has long been recognised that, relatively speaking, very few cases of medical negligence reach the courts. Moreover, the need for accountability in litigation tends to mask the relationships between systemic faults and the (blameworthy) ‘active’ neglect of individual medical practitioners.7 As Jean McHale reminds us in her chapter in this volume, public inquiries, policy responses to high-profile negligence and litigation statistics have often obscured the latent faults of healthcare environments. This chapter will therefore question the ‘active’ neglect by pre-NHS poor law doctors, in order to reveal some historic contrasts and commonalities in dealing with negligence under British state healthcare.
