Chapter 5
The Policy Dimension: the Legal
Environment of the New NHS
John Tingle
As the previous chapters have indicated, the legal and health policy contexts of
nursing have changed significantly since the first edition of this book was pub-
lished in 1995. This chapter summarises and illustrates the ways in which these
policy changes have impacted upon the legal environment of nursing care. The
summary given here is a broad ranging one, although most emphasis is given to
illustrating these processes through a discussion of the changing management of
healthlitigation.Attheendofthechaptersomegeneraltrendsinpolicychangeare
identified and pulled together.
The Woolf Civil Litigation Reforms and the Clinical Negligence Pre-Action
Protocol, discussed in more detail later in this chapter, were early products of a
national recognition that the ever present high levels of clinical negligence litiga-
tion could no longer be tolerated and had to be reduced and health care quality
improved. Trusts, health bodies and the Government are now taking the issue of
health litigation and avoiding patient injury much more seriously. Avoiding
health litigation has become a national priority and quite rightly so. At the same
time nurses are expanding their professional role and are doing more. This is all
taking place within an increasingly litigious working environment. Hence a
knowledge of the legal aspects of the health care environment has become very
important as nurses try to understand their professional and legal account-
abilities.
ThewellpublicisedcaseofDrShipmanandtheBristolheartsurgeryrevelations
and subsequent inquiry have given the Government and the health care profes-
sions a forceful push in the direction of health care quality improvement,
accountabilityandcaremanagement.And,aswesaw intheopeningchapter,the
Human Rights Act 1998 is a relevant addition and a further springboard for
change. Human rights has now become an essential part of the language and
environmentofnursing.andtheimportanceoftheActtonursingpracticewillbe
discussed in a number of the following chapters).
Clinical risk and litigation management strategies have also been developed
nationally, along with a number of other health quality initiatives, which have
introducedawholenewsetof`buzzphrases'suchasclinicalgovernance,controls
assurance, clinical risk management, patient empowerment, reflective practice,
evidenced based healthcare and life long learning.