Advising Healthcare Providers

My work involves advising healthcare providers, both NHS and Independent Sector, with interested person status at inquests. A significant part of my role involves supporting witnesses by demystifying the process, helping a witness to understand what is going to happen. Compounded harm is a well-known concept when it comes to patients and their families, in the aftermath of something having gone badly wrong, but it applies to interactions with staff too. Unsupported staff can go on to practice defensive medicine or worse leave their careers. I also help healthcare providers focus on complying with their disclosure obligations and ensure their witnesses provide clear statements, that explain the care provided to the deceased person and address any known concerns from their family. As a dual qualified Barrister and Solicitor, I then very often go on to provide legal representation at the inquest hearing. 

I think (and hope) that my involvement not only assists the Coroner but also helps families to get answers to the questions they may have about how and why their loved one died.  This highlights the disparity that in most cases the bereaved family do not have the benefit of lawyers to help them navigate a complex legal process in the midst of their grief. It is not lost on me how difficult it must be to turn up at court to find that other individuals or organisations involved have a lawyer with them. I appreciate it can seem unfair and at odds with the fact that an inquest is a neutral, non-adversarial process. I always take time to go and explain who I am and check whether there are any documents that the family are concerned they may be missing.

Unquestionably the inquest process is most difficult for the bereaved family, and I hope that nothing I say below detracts from that overriding acknowledgment.  However, it can also be a demanding process for healthcare staff called to give evidence with the inquest process taking  people away from their clinical work at the time when backlogs of people are needing treatment is extremely high. Being a witness for the first time is a great leveller: a Consultant will likely be just as scared as a nurse or paramedic, especially when shortcomings have been identified. Some will have heard about challenging experiences from colleagues. Inevitably the inquest will not hear from all those involved in caring for the deceased, so those who are called often feel singled out and worried about professional and personal repercussions.

It can be difficult to obtain appropriate evidence for every inquest; delays due to inquest backlogs mean memories fade and sometimes staff will have moved on and others have to speak to their actions. This will naturally impact the quality of evidence the Coroner receives.

Although it is not the Coroner’s role to find fault or attribute blame, the inquest will look in forensic detail at the decision-making and care in respect of the deceased. However the context in which that care was provided is not necessarily acknowledged or understood. Many of the healthcare workers I support are facing incredible pressures in their day-to-day jobs. The vast majority of the clinicians I represent are diligent professionals who are motivated to give the best care that they can, but this is not always achievable. Overcrowding, understaffing, and a lack of suitable spaces to provide care can all contribute. 

An inquest may well conclude that a failure in care, or even neglect, has caused or contributed to a patient’s death. It is right that this is recognised but it is a heavy burden for those responsible to bear. A small number of individuals have confided that the experience of giving evidence has prompted them to consider a career change where the pressure, and the stakes, are not as high. 

All that said, sometimes the inquest can be an unexpectedly cathartic experience for everyone involved. In my experience, this is more likely to happen when the Coroner clearly places the family at the heart of the inquest whilst managing expectations regarding the limits of the process and treating professional witnesses with understanding and respect.