4 During this period, the Trust has received 16 new claims, 4 clinical negligence and 12 personal injury claims.

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1 APPENDIX 2 Welsh Ambulance Services NHS Trust Interim Six Monthly Report 1 st April to 30 th September 2008 INTRODUCTION 1 This report forms the six monthly report on claims management to the Trust Board. Its intention is to provide a statement of current ongoing claims, both personal injury and clinical negligence brought against the Welsh Ambulance Services NHS Trust ( the Trust ). It also reports on actions taken in relation to claims management to ensure that the Board is appraised of the Trust s current claims profile and claims handling record. It specifically excludes road traffic collision claims, except for those which include a claim for personal injury. BACKGROUND 2 The Welsh Risk Pool ( the WRP ) entered into a Service Level Agreement with the Trust commencing on 23 June 2008 for the provision of claims management support and services. Pursuant to this agreement, the WRP Manager works within the Trust for two days per week to actively manage claims and offer advice and guidance on the direction of and strategic developments within the area of claims management. CURRENT CLAIMS PROFILE 3 Given that the current Manager has been managing the Trust s claims profile since 23 June 2008, it is proposed to use the data benchmark for the purposes of this analysis as being that date, when a database review was undertaken. Reliance cannot be placed on recorded data prior to that data. 4 During this period, the Trust has received 16 new claims, 4 clinical negligence and 12 personal injury claims. CLINICAL NEGLIGENCE CLAIMS Number of : 5 All on-going clinical negligence claims, of which there are currently 14, are case managed by Welsh Health Legal Services. 1

2 Region as at 30 th September 2008 as stated as 23 rd June 2008 New Received or Identified Closed North Central & West South East Total Aggregate Quantum and Probabilities: 6 The quantum reserves set out the estimated probability of settlement together with the estimated anticipated expenditure on a worse case scenario basis and estimated date of settlement. Settled: 7 The Trust has settled two clinical negligence claims over excess ( 25,000) during the period covered by this report. Case 1: Damages - 775,000 Legal Costs to be assessed Case 2: Damages - 30,614 Claimant s Legal Costs 19,500 Proposed Remedial Action: 8 Both cases have been the subject of remedial action and the Annex B documents have been prepared for the purposes of a Welsh Risk Pool reimbursement which set out in detail the actions taken. All Annex B information will in future be presented to the Patient Safety Panel for monitoring purposes. Trends: 9 Following a review of the subject matter of the clinical negligence claims received, it is difficult to identify any viable trends in subject matter due to the small profile. However, repetitious themes include: Delays in responding to calls and attendance to patients; and Failure to diagnose or identify severity of condition. 10 received will be monitored for trend analysis purposes. 11 All settled claims involving patient safety issues will be reviewed by the Trust s Patient Safety Panel to ensure that all lessons are learned, and 2

3 planned action is implemented to support the Trust s commitment to using adverse events to improve standards in patient safety and services. PERSONAL INJURY CLAIMS Number of : 12 The current claims profile indicates that the Trust has 88 active personal injury claims. Region as at 30 th September 2008 as stated as 23 rd June 2008 New Received Closed North Central & West South East Total The management of personal injury claims is split: 71 claims are managed by Morgan Cole Solicitors 17 claims are managed the Trust s Manager who is a practising Solicitor. 14 This reflects that Pre-Action Protocol Investigations are now undertaken within the Trust. The automatic instruction of solicitors on receipt of a letter of claim has ceased. All claims are now evaluated upon receipt and initial investigations including the gathering of information, documentation and interviewing of relevant staff are undertaken in-house. Once the information has been collated, the Manager will determine an appropriate course of action. High value and complex claims will form the subject matter of instructions to external solicitors, small value claims and those where liability is conceded will continue to be managed in-house. Aggregate Quantums and Probabilities: 15 The Trust s Manager now holds a central database which details the estimated probability of settlement together with the estimated anticipated expenditure on a worse case scenario basis and estimated date of settlement. Settled: 16 The majority of claims settled are small value personal injury claims and the Manager has commenced the collection of data on 3

4 claims currently reaching settlement with a view to providing accurate figures of the value of claims settled in future. The accuracy of the information on Datix at present cannot be guaranteed due to historic data inputting difficulties. 17 Two over excess personal injury claims have been settled: Case 1 : Damages 3,500 Legal costs 41, This claim was defended at trial as the Claimant was seeking damages in excess of 280,000. Leave to withdraw the payment from court was given but the Trust remained liable for a significant proportion of its own costs, although a proportion were recovered. Case 2 : Damages 330,000 Claimants Legal Costs to be assessed 19 This claim was a work related stress claim. Proposed Remedial Action: 20 Both cases have been the subject of remedial action and the Annex B documents have been prepared for the purposes of a Welsh Risk Pool reimbursement which set out in detail the actions taken. Whilst these cases are not directly patient safety related matters, the Patient Safety Panel has previously agreed to examine all Annex B documentation prior to submission to the Welsh Risk Pool to avoid the potential of two separate systems being established to monitor effectively lessons learned from claims which have led to completion of Annex B 21 Further Action Plans are now prepared on concluded claims. This is a specific requirement of the Welsh Risk Pool Management Standard and also one of the conditions of WHC(97)17 for the continued operation of the Trust s delegated authority to settle negligence claims below 1 million Trends: 22 A trend analysis was prepared by Morgan Cole Solicitors indicating the subject matter of claims managed by the firm: 4

5 25% 6% 1% 30% 6% 1% 21% 8% 1% Assault Deafness Equipment Lifting Needlestick Other RTA Slip/Trip Stress 23 Of the claims being managed in house, one relates to a needle stick injury, one to a slip & trip and the remainder are personal injury claims emanating from road traffic collisions. 24 The obvious common themes are that a significant proportion of personal injury claims arise out of road traffic collisions, and employee safety issues, including manual handling and tripping and slipping. Thus, and any developing trends relating to staff personal injury claims, will continue to be monitored. CONCLUSIONS 25 With regard to its claims management function, the Trust has recently undergone a period of difficulties, moving from a position of stability to a time of uncertainty. This has led to an increased dependence upon the advice and input of external solicitors, together with a corresponding increase in the associated legal costs and lack of consistency and accuracy in relation to claims data collected. 26 Whilst the hurdles are significant to achieving the objectives of good claims management and compliance with national standards, they are not insurmountable. 27 Since June 2008, the position has stabilised and initial work has been undertaken to cleanse data whilst reviewing how and when external solicitors are instructed, but particularly with a view to using their expertise more cost effectively and appropriately. 5

6 28 A continuation of this work together with a review of the Management Standard action plan, the current Management Policy and a determination of how the objectives of the new claims management standard can be implemented within the Trust should achieve the desired objectives of timely and cost effective management of claims with adherence to national standards. 6