REPORT OF THE EXPERT GROUP ON FINANCIAL AND OTHER SUPPORT
ANNEX I THE AIMS AND WORK OF AVMA (ACTION FOR VICTIMS OF MEDICAL ACCIDENTS)
ORIGINS OF AVMA
AVMA is a registered charity established in 1982.
The impetus for the founding of the charity was a TV play, Minor Complications, shown on the BBC in 1980. The play was based on a true story of a woman who suffered a medical accident. During a laparoscopic sterilisation her bowel was punctured. The doctors initially would not acknowledge that there had been an accident and she nearly died.
The play then dealt with her attempts to find out what had happened and to secure compensation. She came up against a wall of silence on the part of the medical profession and sheer incompetence on the part of the legal profession.
Following the screening of the play there was such a large response from members of the public who had also suffered medical accidents that the playwright, Peter Ransley, realised that he had stumbled on a serious social problem. He was surprised to find that there was no help for victims from the NHS and no independent organisation to help them. He therefore decided to set up AVMA.
Aims
From the outset the aim of the organisation was twofold. On the one hand to work to try and ensure that avoidable accidents did not happen (the political campaigning side), and on the other to help those who had suffered to secure redress (the personal help).
AVMA's work
AVMA provides personal help for victims which is divided into legal and non-legal work and is carried out by the casework department. Because they deal with medical accidents the caseworkers must have a medical background. Over the years the department has included nurses, midwives and doctors. They also need to have legal training. Some of the caseworkers have had law degrees and have even had a dual qualification but most have received their legal training once they joined AVMA.
Because of severely limited resources and the number of patients dealt with, most of the advice has been given by correspondence. The caseworkers analyse and help the patient to understand what has gone wrong. They then advise what action can be taken. Where they identify the possibility of legal action they refer clients to one of AVMA's panel solicitors.
Legal work
Although AVMA's main work is not about compensation it is the work that has been done in the legal arena that has been the key to the improvement of the situation for victims and indeed for the raising of the profile and advances made in patient safety in the health service. AVMA identified that clinical negligence was a discrete area of the law, which required specialist lawyers to handle it. This was addressed in two ways: - firstly by providing a resource service for all lawyers dealing with clinical negligence as well as running courses and conferences to improve their skills particularly their skills in understanding medical issues; secondly by building up a panel of solicitors in whom AVMA had confidence to refer their clients. The key to this was the fact that the caseworkers monitor the conduct of the cases by the panel solicitors who are required to report on progress every six months.
Resources
AVMA's problem has always been resources. To date, AVMA has dealt directly with 40,000 patients and indirectly with more than double that number through the solicitors who belong to their resource service. With adequate funding AVMA would have been able to do much more including action on the campaigning front. AVMA started with a small grant from the Greater London Council. Subsequently it was supported by the King's Fund for a short period and for a period of five years by a grant from the Department of Health in England (DoH). We have recently received a new grant from the DOH to provide second tier advice to the pilot of the Independent Advocacy and Advice Service that will be dealing with the complaints side of the abolished Community Health Councils. They have also recently received a grant from the Community Fund to establish a fully functioning help line.
They have received some donations from clients and the public but AVMA's cause is not an obviously popular one (like children, animals or cancer for example) and it has not been possible to raise much in this way. This has meant that they have had to raise funds themselves.
This has been done by charging lawyers for the services they provide for them and by running conferences and courses for lawyers. When AVMA held its first conference in 1989 it was something novel and attracted some 120 delegates. Since then clinical negligence has become a popular subject for conferences but AVMA's annual conference remains pre-eminent with the 2002 conference being attended by 430 delegates.
Staffing
When the organisation was set up they had funding for one worker, the Chief Officer. As further funds were secured they engaged and trained specialists to deal with further aspects of the work in the different departments.
The organisation is in the process of restructuring but to give an idea of the resources required the essential staff dealing with the casework and legal work is as follows: -
Casework Manager
5 caseworkers
Lawyers' Service Manager
Legal Worker
Medical Support Worker
Risk Assessment Manager
Campaigning
It is the work that AVMA do with patients that informs their campaigning role. This has enabled them to advise healthcare workers and government of the requirements of victims and what is needed to improve both the lot of victims and patient safety. They have had success not only in raising the profile of medical accidents but in educating healthcarers and creating the conditions for government initiatives such as the National Patient Safety Agency, an inspectorate in the form of the Commission for Health Audit and Inspection and other initiatives such as the revalidation of doctors.