If you're admitted to hospital, you expect to leave in better health than when you went in. You certainly don't expect to be harmed during your stay by the medical professionals responsible for your care.
That, however, is the experience of hundreds of NHS patients each year. Figures released by the Department of Health show that 1,110 people have been the victim of serious or life-threatening medical accidents since 2012. These include the wrong legs, eyes or knees being operated on, incorrect doses of chemotherapy being given to cancer sufferers, and foreign objects such as scalpels being left inside people's bodies after surgery.
Other cases highlighted in 2015 involved a woman having her fallopian tubes accidently removed, and a feeding tube inserted into a patient's lung - a potentially fatal error.
While such events are referred to as "never events", on the grounds that they should never happen and are thankfully rare, their prevalence within the NHS is still too high. Earlier in the summer an investigation by the Care Quality Commission into Brighton and Sussex University Hospitals NHS Trust identified four incidents of surgeons operating on a wrong body part in a single year, and issues over cleanliness and hygiene.
There has been a significant amount of attention paid to widespread and systemic failures in specific hospitals and trusts, such as at Stafford hospital, where as many as 1,200 patients died as the result of poor care and negligence over the course of four years. Just as serious, however, is what Health Secretary Jeremy Hunt describes as the "silent fatalism" within the NHS - a growing belief that unacceptable medical practices will be tolerated or even covered up, with the public becoming more conditioned to the prospect of being mistreated while in hospital.
Spurred on by a determination to never see a repeat of the Mid Staffs scandal, the Government has sought to grapple with the issue of patient safety. A tougher inspection regime has been introduced, which led to 27 hospitals being placed under special measures and put on improvement plans. The law was changed to bring in a duty of candour aimed at tackling the pervasive blame culture within the NHS. There have been attempts to usher in greater transparency, with trusts now required to publish yearly data about the number of deaths and accidents in their hospitals. A special taskforce was also commissioned to investigate the scale of "never events" and advise on a new set of national standards to prevent mistakes.
A key challenge, however, is the question of how medical professionals providing sensitive or invasive treatment should be regulated. While doctors are required to be registered through the General Medical Council, there are tens of thousands of other healthcare professionals who are not subject to any form of statutory oversight - with high standards across different medical professions being enforced purely due to the efforts of voluntary organisations. The unregulated workforce within the NHS includes those with responsibility for procedures that have the potential to cause significant harm if things go wrong, such as fitting pacemakers, performing lung function tests, and diagnosing hearing loss.
This is a fundamental issue when it comes to ensuring patient safety. Statutory regulators are empowered by law to monitor the actions of the workforce, have structures in place to identify or allow the reporting of incidents, and can discipline or even strike off professionals if appropriate.
Despite an accreditation scheme run by the Professional Standards Authority, voluntary registers have no such power. Although they are run by diligent professionals determined to uphold high standards, they are hamstrung by having limited resources to identify negligence or mistakes, and no legal authority to sanction incompetent practitioners.
What does this mean in practical terms? If a doctor causes harm to a patient, their negligence would be identified and the doctor investigated. They could be suspended or even struck off. But if an unregulated professional were to harm a patient, the issue might go undetected. Even if the person responsible was a member of a voluntary body, they could simply resign from the register and resume their career elsewhere with little or no consequence for their actions.
These scenarios are not hypothetical. For that reason, many voluntary registers, aware of the limited powers granted to them through the Professional Standards Authority, are campaigning for statutory regulation for thousands of healthcare professionals. This is a move endorsed by the Health and Care Professions Council and the Health Select Committee, as well as organisations such as the Registration Council for Clinical Physiologists, which represents professionals working in fields such as cardiology, neurophysiology and respiratory physiology.
Too much of the debate around the NHS has been focused on the impact of funding cuts or the degree to which private providers should be able to deliver services to patients. However, more needs to be done to reassure patients that they will be safe in hospital. The Government should look at the extent to which it is prepared to allow so many healthcare professions to operate with such limited oversight. There should be a process in place whereby a voluntary register can be granted statutory authority if a clear and compelling case can be made that this is required to protect patient safety.
This approach will not eliminate all clinical negligence, but it would make the biggest contribution in ensuring that medical errors are kept to a minimum and end the situation where voluntary registers are handcuffed in their attempts to protect patient safety without the backing of the law.