UK: Government-run healthcare but private litigation for malpractice?

Do No Harm: Stories of Life, Death, and Brain Surgery (Marsh) is a great book in the English tradition of experts writing for laypeople (contrast to the standard American presumption that laypeople are too stupid to understand any technical subject). I’ll write more about this book later but one of the things that struck me was that England seems to have retained its system of private litigation for malpractice despite the fact that medicine is now socialized/government-run:

‘Mrs Seagrave’s daughter was threatening to sue us last night,’ he said. ‘She said we were all hopelessly disorganized.’ ‘I’m afraid she’s right but suing us isn’t going to help, is it?’ ‘No,’ he replied. ‘It just puts one’s back up. And it’s quite upsetting.’

The case was over an operation I had carried out three years earlier. The patient had developed a catastrophic streptococcal infection afterwards, called a subdural empyema, which I had initially missed. I had never encountered a post-operative infection like this before and did not know any other neurosurgeons who had either. The operation had gone so well that I had found it impossible to believe it might all go wrong and I dismissed the early signs of the infection, signs which in retrospect were so painfully obvious. The patient had survived but because of my delay in diagnosing the infection she had been left almost completely paralysed and will remain so for the rest of her life. The thought of the conference had been preying on my mind for many weeks.

I had not dared to ask for how many millions of pounds the case would probably be settled. The final bill, I learned two years later, was for six million [about $9 million].

I wonder if UK-based readers of this blog can shed some light on this arrangement. If the government runs most of the hospitals and also the court system, why would it send medical malpractice cases through the court system to be decided by lay judges and juries? Why not legislate an administrative process for compensating victims of medical mistakes? Why have a system where Person X gets paralyzed from a neurosurgeon’s mistake and gets $X million in compensation while Person Y, starting from roughly the same circumstances and suffering the same paralysis, gets $Y million, purely due to variations from jury to jury?

(And speaking of mistakes, you definitely don’t want to read this book before heading anywhere near a hospital:

I hope I am a good surgeon but I am certainly not a great surgeon. It’s not the successes I remember, or so I like to think, but the failures. But here in the nursing home were several patients I had already forgotten. Some of them were people I had simply been unable to help, but there was at least one man who, as my juniors put it in their naive and tactless way, I had wrecked. I had ill-advisedly operated on him many years earlier for a large tumour in a spirit of youthful enthusiasm. The operation had gone on for eighteen hours and I had inadvertently torn the basilar artery at two in the morning – this is the artery that supplies the brainstem, and he never woke up again. I saw his grey curled-up body in its bed. I would never have recognized him were it not for the enamelled plaque with his name by the door.

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