Success and succession at AvMA: 40 years of minding the gap in patient safety and justice

This editorial marks an important occasion for Action against Medical Accidents (AvMA), the path-breaking charity for patient safety and justice. The timing is noteworthy in two respects. First, it is their 40th anniversary as a charity. They may have been the first patient organization focused on patient safety and they have played a significant role in the birth and raising of the patient safety movement, both in the UK and worldwide. Second, Peter Walsh, who has served as Chief Executive for 20 of those years, is stepping down. The Journal has been published in association with AvMA for its entire existence, so these are seismic events for us. We should begin with personal thanks to Peter for his partnership with me over the five years that I’ve led the Journal. I first met Peter in London in November, 2010 during the relaunch of the NHS policy of Being Open about medical errors. The policy, originally adopted in 2005, promotes “greater openness with patients and families when things go wrong,” stating that “sorry is not an admission of liability and it is the right thing to do.” I had assembled a group of international experts for a day-long meeting on open disclosure of adverse events. Innovative policies and practices being implemented in Australia, New Zealand, Canada, and the US were shared with NHS leaders and other key stakeholders. During the discussions, I witnessed Peter’s passionate insistence on justice for injured patients. In subsequent meetings, he campaigned earnestly for an additional legal “duty of candour” to disclose in the UK. He was justifiably proud when the efforts of AvMA helped to pass this legislation in 2014. When I took over as Editor-in-Chief of the Journal in 2018, Peter had been in place since the inception of its predecessor Clinical Risk. He was a gracious host, helping to bring about a warm handoff as we transitioned to a new name and a more international focus. Since then, he has helped the Journal deliver medico-legal content, while keeping the important perspective of patients. Congratulations are also in order for AvMA, which can notch up several achievements. It is evident that AvMA helped create the market for malpractice claims in the UK, providing structures and support to both injured patients and plaintiff’s attorneys. This has contributed to an increase in malpractice claims. Although not all would view this as an unmitigated good, it has increased the number of injured people able to receive needed compensation. In addition, it promoted the uptake of clinical risk management in the NHS. AvMA has long provided a unique resource to the community in the form of a helpline for patients who have been injured by health care. Services include free support and advice to callers, as well as the handling of more complex casework and inquests. In a complex healthcare system, this service has been a lifeline for patients and families who don’t know how to raise concerns, or who are seeking explanations for what happened in their care. It helps them navigate the confusing processes for claiming compensation. AvMA has also produced invaluable selfhelp guides, available online. In addition, AvMA has campaigned for changes in legislation and legal procedures to improve patients’ access to justice. Notable successes included the statutory duty of candour, noted above, which was implemented by the NHS in 2014. The combined force of these efforts has been to increase awareness of the problem originally referred to as medical accidents, and the development of the field of patient safety. Recent collaborations have focused on influencing policy change, ensuring that patients and families are at the heart of any investigations into unsafe care, and that physical and emotional support are available for all when things go wrong. Groups like AvMA have value in improving patient safety and the quality of care. In discussion with Helen Huges, Chief Executive of Patient Safety Learning, we reflected on the purpose and value of patient safety charities and not-for-profit organizations. These organizations can channel and amplify the patient voice. The patient perspective is needed to influence politicians, policy makers, and organization and systems leaders to drive safety improvements, and influence awareness raising campaigns. Patient focused organizations can highlight specific services where there is avoidable harm that is not being addressed. In recent years, this has included injuries from pelvic mesh implants, pain from outpatient hysteroscopies, and maternity service failures.6–8 In the UK, many public inquiries that have highlighted appalling levels of avoidable harm have been directly commissioned due to tenacious and committed patients and families. These individuals demanded answers as to why harm occurred, and changes to prevent future harm so that others would not Editorial