Nurses should call doctors by their first names to prevent patient deaths, says Jeremy Hunt

Nurses must be allowed to address senior doctors by their first names in order to prevent fatal medical errors, Jeremy Hunt has said.

The Health Secretary said medicine’s strict hierarchy was stopping junior staff speaking up when they notice disasters unfolding and that doing away with formality in operating theatres and other settings was crucial to saving more lives.

He told an international conference on patient safety that health was one of the last professions yet to fully adopt the use of first names.

In many hospitals, staff adhere to convention by using the formal titles "doctor" and, in the case of surgeons, "mister".

Mr Hunt also accused some doctors of squandering the chance to improve because they are often “terrified” of admitting mistakes for fear of being struck off.

It is estimated that up to 9,000 hospital death a year are caused by NHS failings.

Mr Hunt gave the example of Elaine Bromiley, the wife of a British Airways pilot who died when a nurse realised she needed a life-saving tracheostomy but stayed silent due to fear of the surgeons.

“In the operating theatre, if you’ve got a hierarchy, it means you’ve only got one pair of eyes spotting the mistake, whereas if you remove the hierarchy you can have eight or nine pairs of eyes spotting those potentially lethal mistakes,” he said.

“In the UK we are still very hierarchical in medicine.

“It’s one of the only professions where we talk about mister this and doctor that rather than first-name terms that are normally used.”

The intervention follows the revelation this week that NHS drug errors alone may be contributing to up to 22,000 deaths a year.

The study, led by the University of York, found doctors, nurses and pharmacists between them make 237 million drug errors annually, and that one in six hospital patients falls victim to the blunders.

The Government said the problem was “far bigger” than previously recognised.

"People are terrified that if they're open about what happens, they will be removed from the register, they might get fired by their hospital, it'll be bad for the reputation of their unit, the reputation of their trust,” said Mr Hunt.

"A thousand worries prevent the one thing that really should be happening, which is proper learning from that mistake, and then a proper attempt to make sure it can never be repeated."

Planned improvements include the introduction of electronic prescribing systems across more NHS hospitals this year which promise to reduce errors by 50%.

Proposals have also been made to soften the current criminal sanctions faced by pharmacists when they accidently mis-prescribe drugs.

However, some medical leaders have said low staffing levels are at the heart of preventable deaths.

"Short staffing and severe financial pressures create an environment where it's easier to make mistakes," said Janet Davies, chief executive of the Royal College of Nursing.

“The high use of agency nurses brings an unintended risk too, fewer mistakes are made when patients are cared for by staff who work permanently at that hospital and know its patients, equipment and procedures."

Peter Walsh, Chief Executive Action against Medical Accidents, said: "Anything that helps better team working among health professionals is to be welcomed, but frankly we we expect more than just encouraging the use of first names.

"The 'safer surgery checklist' has been shown to be effective at preventing mistakes through involving whole teams, but it is inconsistently applied and not properly regulated.

"Probably the biggest factor affecting teams currently is the pressure they are under. It's not much help being on first name terms if you are short staffed and exhausted."

The case of Elaine Bromiley

Elaine Bromiley was admitted to hospital in Milton Keynes for what should have been a routine sinus operation in 2005.

During the course of the procedure her airways became obstructed, which surgeons immediately worked to unblock.

A surgical nurse realised Mrs Bromiley would require a tracheostomy (an opening created in the front of the neck to allow the insertion of a breathing tube), and prepared the necessary equipment.

However, the intervention was never ordered and the nurse did not speak up out of deference to the surgeons.

Mrs Bomiley subsequently died.

Her husband, Martin Bromiley, a British Airways pilot, now lectures NHS hospitals on how to break down hierarchies in order to avoid this kind of error.

He encourages clinicians to adopt the “no blame” learning culture adopted by the aviation industry since the 1970s, which has been associated with a significant improvement in safety.

Mr Bromiley tells staff how in his work as an airline captain he always insists the crew refer to him by his first name so they will feel more comfortable voicing concerns during flights.