Policy Ref No: SABP/RISK/0034

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1 Policy Ref No: SABP/RISK/0034 NAME OF POLICY: Claims Handling Policy Clinical Negligence, Liabilities to Third Parties and Property Expenses Scheme Claims REASON FOR THE POLICY: WHAT THE POLICY WILL ACHIEVE: Provide a framework for the management of claims arising under the NHSLA Risk Pooling Schemes Compliance with claims management requirements. WHO NEEDS TO KNOW All directorates, clinical and managerial staff ABOUT IT: DATE APPROVED: 19 May 2015 VERSION NUMBER: 5.0 APPROVING COMMITTEE: DATE OF IMPLEMENTATION: DATE OF FORMAL REVIEW AUTHOR/REVIEWER: DIRECTORATE RESPONSIBLE: DISTRIBUTION: Executive Board 19 May May 2018 Legal Service and Reporting Manager Quality All directorates, clinical and managerial staff Page 1 of 23

2 1.0 PURPOSE This policy and procedure provides the framework for the effective management of clinical negligence, liability and property claims. 2.0 POLICY STATEMENT Surrey and Borders Partnership NHS Foundation Trust is committed to an effective and timely investigation of and response to, any claims which include allegations of clinical negligence, liability or personal injury. The policy and procedures apply to the management of the following types of claims: Clinical Negligence - covered by the NHS Litigation Authority (NHSLA) Clinical Negligence Scheme for Trusts (CNST) Employer Liability (EL) - covered by the NHSLA Risk Pooling Scheme for Trusts (RPST) Liability to Third Parties Scheme (LTPS) Public Liability (PL) (as above) Claims in respect of loss or damage to Trust property - covered by the NHSLA RPST Property Expenses Scheme (PES). Adherence to the policy and procedures should ensure: a) That Trust staff are clear about the process for managing claims, including their responsibilities in relation to this. b) That the Trust complies with the requirements for membership of the NHSLA risk pooling schemes and also with the Civil Procedure Rules requirement of the Pre-action Protocol for the Resolution of Clinical Disputes and the Pre-action Protocol for Personal Injury, so avoiding the cost penalties associated with non-compliance. Page 2 of 23

3 Version Control Version Date Author Status Comment February 2015 Amanda Shaw Legal Services & Reporting Manager Changes made to reflect recent changes to NHSLA processes. Summary of Changes since Version 4.0 Page /Paragraph/ Appendix Number (select the appropriate action) Throughout the policy & procedure Amendment Extensive changes made to policy and procedure. Page 3 of 23

4 PROCEDURE REF NO: SABP/RISK/0034 NAME OF PROCEDURE Claims Handling Procedure Clinical Negligence, Liabilities to Third Parties and Property Expenses Scheme Claims REASON FOR PROCEDURE WHAT THE PROCEDURE WILL ACHIEVE: WHO NEEDS TO KNOW ABOUT IT? To provide a framework for the management of claims arising under the NHSLA Risk Pooling Schemes Compliance with claims management requirements. All directorates, clinical and managerial staff DATE APPROVED 19 May 2015 VERSION NUMBER 5.0 APPROVING COMMITTEE Executive Board DATE OF IMPLEMENTATION 19 May 2015 DATE OF FORMAL REVIEW 19 May 2018 AUTHOR/REVIEWER DIRECTORATE RESPONSIBLE DISTRIBUTION Legal Service and Reporting Manager Quality All directorates, clinical and managerial staff Page 4 of 23

5 Contents 1.0 PURPOSE... 2 Version Control... 3 Summary of Changes since Version INTRODUCTION Definition of terms Roles & Responsibilities Action on receipt of a claim Procedures for handling claims Trust employees Learning lessons from Claims Financial management Claims handling reports Request from clinicians for legal advice Monitoring Table - Claims Appendix 1-TIMESCALES Appendix Appendix 3 -LETTERS OF CLAIM Appendix 4 -Reporting Guidelines Appendix 5 - Equality Analysis Page 5 of 23

6 1.0 INTRODUCTION This policy recognises national NHS guidance, the Pre-Action Protocol for the Resolution of the Clinical Disputes, the Pre-Action Protocol for the Resolution of Personal Injury claims and current standards required by the NHSLA. The Trust is committed to sensitively and appropriately dealing with requests for compensation following an adverse incident. The principles adopted are based upon the Trust s Vision and Values and the following: Encouraging openness Encouraging parties to resolve disputes Reducing delays and costs Reducing the need for litigation Ensuring key staff are appropriately trained, have some knowledge of healthcare law, the complaints procedure and principles of risk management. Ensuring that our services comply with commonly accepted standards and are routinely monitored through audit and risk management. Setting up adverse reporting systems, thus enabling evidence to be collated quickly to make it easier to advise people who use services with an accurate explanation of what went wrong. Using the results of adverse incidents and complaints positively. Ensuring that people who use services receive clear and comprehensive information in an accessible form about how to raise their concerns or complaints. Advising people who use services of a serious adverse outcome and provide on request an oral or written explanation of what happened; changes in procedure which will of benefit; and information on further steps that can be taken including an offer of future treatment, an apology and/or compensation. People who use services and their advisers should: Report any concerns to the Trust as soon as is reasonably possible. Consider the full range of options available including a request for an explanation, a meeting, a complaint, alternative dispute resolution, mediation and negotiation not only litigation. Inform the Trust when the person who uses services is satisfied that the matter has been concluded. Page 6 of 23

7 2.0 Definition of terms Claimant - Any person who uses services or their representative, member of the public, or employee who instructs solicitors to act on their behalf to pursue a claim against the Trust, or who enters legal proceedings against the Trust or who pursues compensation. Claim - Where the context allows, any action against the Trust initiated by a claimant or any claim lodged by the Trust under the terms of the Property Expenses Scheme. Clinical Negligence Scheme for Trusts (CNST) The scheme, operated by the NHSLA, of which the Trust is a member, and which assumes liabilities for the appointment of solicitors and the settlement of all claims, in full, which are made against the Trust. Liabilities to Third Parties Scheme (LTPS) The scheme operated by the NHSLA, of which the Trust is a member, which assumes liability for the appointment of solicitors and (subject to member excess) the settlement of all claims which are made against the Trust. Property Expenses Scheme (PES) The scheme operated by the NHSLA, of which the Trust is a member, which assumes liability for the management and settlement of all claims made by the Trust in respect of premises and property. 3.0 Roles & Responsibilities The Director of Quality is responsible for ensuring that the arrangements for the management of claims are appropriate and complementary to the Trust s risk management programme and for reporting annually to the Trust Board. The Director of Finance is responsible for ensuring that there are sufficient provisions for managing the payment of membership fees and claims in accordance with Trust Standing Financial Instructions (SFIs) and ensure that there is sufficient oversight of the claims processes through the internal audit committee. The Director of Risk & Safety is responsible for ensuring: That the management of claims is in line with the requirements set out by the NHS Litigation Authority and that appropriate representation is sought from Trust Solicitors when required; Page 7 of 23

8 That the Trust Executive Board is informed of ongoing legal proceedings. The Legal Service and Reporting Manager is responsible for managing the claims made under the NHSLA risk pooling schemes and will ensure that the appropriate procedures are followed: Where a formal complaint is pursued under the NHS complaints procedure and where there is a demand for compensation. When there is a request for disclosure for records under the relevant Pre-Action Protocol indicating that the claimant is contemplating legal action against the Trust. When a letter of claim is received. Where legal proceedings have been entered against the Trust. The Legal Services and Reporting Manager will report claims to the NHSLA and undertake all associated administration and liaison with the NHSLA, Panel Solicitors, Trust officers, Claimants Solicitors and others as necessary. Managers are responsible for investigating claims and obtaining the required documentation requested by the Legal Services and Reporting Manager in order to comply with any disclosure requirements. All staff are responsible for co-operating with the Trust in the investigation and management of a claim and will be supported should their involvement be required at a later stage. 4.0 Action on receipt of a claim All potential claims under any of the NHSLA schemes should be forwarded immediately to: Legal Services and Reporting Manager Trust Headquarters 18 Mole Business Park Randalls Road Leatherhead Surrey KT22 7AD The Legal Services and Reporting Manager will, as appropriate, submit the claim to the NHSLA in accordance with the rules of the relevant scheme (CNST, PES, LTPS). The NHSLA may appoint a Panel Firm of Solicitors to act on behalf of the Trust in the legal management of the claim. Page 8 of 23

9 Any request for disclosure of medical records in relation to a claim should be forwarded to the Medical Records department.they will inform the Legal Services and Reporting Manager who will acknowledge the request. The Medical Records department will subsequently arrange for the required disclosure. 5.0 Procedures for handling claims Legal Services and Reporting Manager will provide the following services on behalf of the Trust: On receipt of a request for disclosure of records which indicates that a clinical negligence claim is being contemplated, will in conjunction with Medical Records Department, obtain all medical records pertaining to the treatment in question, obtaining more information from the person who uses services or their solicitor if necessary. Contact appropriate clinicians. Disclose copy records in accordance with Trust policy. Receive, acknowledge and assess all new NHSLA claims that arise against the Trust. Set up and maintain a claim file. Notify the Employment Services Bureau of any new employers liability claim Notify the Finance department of all RPST claims and amount to be established in the provisions Establish an objective account of the original incident, giving appropriate weight to the recollection of the staff originally involved (this may already be available from Datix incident report forms). Identify and arrange for the preservation of all records and other items (eg equipment) related to the incident. Establish and as necessary maintain contact with all relevant staff and former staff. Provide support for staff involved in the litigation process. Undertake the initial preliminary analysis of clinical negligence claims on facts, liability, causation and quantum, where possible Report claims to the NHSLA under the appropriate scheme. Liaise with NHSLA claims handlers during the course of the claim. Systematically review case files to ensure that claims are progressed and brought to a conclusion as swiftly as possible. Prepare reports for the Trust to include: 1. The number and value of claims and details of individual claims 2. The progress and likely outcome of these claims, including the expected settlement date 3. The final outcome of the claims 4. Any proposed remedial action arising out of a particular claim Page 9 of 23

10 Notify all relevant staff when the claim is concluded NB The NHSLA is responsible for the overall determination of how a claim is handled within the relevant Scheme, and negotiation and authorisation of out-of-court settlements, but will take the views of the Trust into account. There may be occasions when the Trust may wish to make an ex-gratia payment without an admission of liability. In these circumstances the claim is not within any NHSLA Scheme and the Trust would not be able to recover any costs from the NHSLA and would need to be satisfied that the CNST reporting guidelines had not been breached. Advice is available from the Legal Services and Reporting Manager. 6.0 Trust employees The full co-operation of all Trust staff is essential to ensure that the opportunity to defend any claim is maximised (or in the case of property and contents claims, fully documented and substantiated). Witness statements (and where appropriate, opinions) shall be sought and carefully considered. The Legal Services and Reporting Manager will provide general advice on statement writing and request statements from staff. In some cases, solicitors will be involved in drafting statements. In respect of clinical negligence claims, the clinician with responsibility for the overall care of the claimant will be consulted prior to release of medical records to the claimant and/or their nominated solicitor. The clinician responsible for the on-going care of the patient shall be kept advised of the progress of the claim, including details of the claims resolution. Trust staff involved in a claim are encouraged to contact the Legal Services and Reporting Manager for information, advice or support on any claim related matter. 7.0 Learning lessons from Claims It is a vital part of the Organisation s response to a claim that lessons are learned and shared with staff. To this end, once a claim has been closed, a report will be produced, outlining a brief synopsis of the claim, details of the process with NHSLA/Solicitor, and details of the resolution that has been reached. Lessons to be learned from the claim will be noted. The report will be shared with the Director for the relevant Service or delegated deputy, and team/ward area that the claim relates to. Should the lessons learned identify that a change in practice/policy/procedure is required; changes will be made as appropriate. Page 10 of 23

11 8.0 Financial management Responsibility for the accounting and management of clinical negligence claims rests with the NHSLA (although the Trust retains legal responsibility for such claims). In respect of other legal claims such as personal injury and property losses, the Trust must make financial provision for the policy excess, associated damages and legal costs. In order to ensure the completeness and accuracy of Trust accounts, the Legal Services and Reporting Manager will liaise with the Finance Department of any claim lodged against the Trust and all claims made by the Trust in respect of Trust property, upon receipt (or submission). The current policy excesses are as follows: Scheme Excess applicable CNST No excess Property Expenses Scheme Buildings - 20,000 Plant, machinery, contents 20,000 Liabilities to Third Parties Scheme Public liability - 3,000 Employer liability - 10,000 Product liability - 3,000 Professional indemnity - 3, Claims handling reports The Audit Committee will receive quarterly reports on: The number and aggregate value of claims and details of individual claims The progress and likely outcome of these claims, including the expected settlement date The final outcome of the claims Any proposed remedial action arising out of a particular claim The Quality Committee will receive an annual report on the effectiveness of the claims management processes Request from clinicians for legal advice Should clinicians feel they may require legal advice, they are advised to contact the Legal Services and Reporting Manager. Full information on the situation requiring clarification should be provided, including the clinician s contact details. Page 11 of 23

12 The Legal Services and Reporting Manager may provide this advice, or may contact the Trust solicitors for further clarification and this will then be shared with the clinician. On occasions, the Trust solicitor may communicate directly with the clinician following instruction from the Legal Services and Reporting Manager Monitoring Table - Claims What will be Monitored How/ Method Frequency Lead Reporting to (What Committee) Gap analysis/action That duties outlined within policy are still relevant. Report Annual Director for Service or nominated deputy Quality Management Board or other delegated Trust Committee If duties of nominated people change, policy to be amended to reflect Claims management process to include action taken and communication with stakeholders Review Annual Director for Service or nominated deputy Quality Management Board or other delegated Trust Committee Non-compliance will be reported to the relevant Director for Service or nominated deputy for them to take appropriate action 3 Solicitors Risk Management Reports on claims Lessons learned report Annual Director for Service or nominated deputy Quality Management Board or other delegated Trust Committee Non-compliance will be reported to the relevant Director for Service or nominated deputy for them to take appropriate action Compliance with the policy. Report Annual Director for Service or nominated deputy Quality Management Board or other delegated Trust Committee Non-compliance will be reported to the relevant Director for Service or nominated deputy for them to take appropriate action Page 12 of 23

13 Appendix 1-TIMESCALES There are timescales relating to the period within which a claim should be brought the limitation period. For personal injury and clinical negligence claims the Claimant should issue their Claim Form through the Court within a period of 3 years of the date of incident which allegedly caused them harm or within 3 years of their date of knowledge if this can be proven to be later. The two main exceptions to this are: children (their 3 year period does not commence until they reach the age of 18), or people under a disability ie: of unsound mind who are incapable of managing their own affairs (such people may bring an action at any time whilst the disability exists). There are a number of timescale targets which apply to the claims management process. The Trust will aim to meet these targets where applicable: A. Provision of copy medical records under the Data Protection Act 1998 (DPA), the Access to Health Records Act 1990 (applies to deceased people who use services only) and the Pre-action Protocol for the Resolution of Clinical Disputes within 40 days of receiving a properly authorised request or within 21 days for deceased people who use services if the record has been added to within the 40 days preceding the receipt of the request. B. Reporting a potential clinical negligence claim to the NHSLA within 2 months of receiving an indication of a claim. Legal Services and Reporting Manager will need to obtain records, clinician s comments and produce a preliminary analysis prior to reporting. C. Reporting a potential employer/public liability claim to the NHSLA Under the new Claims Portal, Employers Liability (EL) and Public Liability (PL) claims are to be managed by a web-based portal process. All EL and PL claims valued up to up to 25,000 will be notified direct to the NHSLA via the Portal. D. Acknowledging the claimant s solicitor s letter of claim 21 days E. Responding to the claimant s solicitor s letter of claim with a letter of response (with either an admission or denial of liability) 3 months after receipt of letter of claim. F. Acknowledging the service of formal proceedings (ie: the Claim Form, Particulars of Claim, Schedule of Damages) 14 days from receipt. G. Serving a Defence 28 days from receipt of proceedings. An extension may be applied for if, for example, the proceedings were incomplete or the claimant s solicitor has not complied with the Pre-action Protocol due to a limitation issue. Page 13 of 23

14 Appendix 2 PROCEDURES FOR DEALING WITH CLAIMS UNDER DIFFERENT SCHEMES A Procedure for management of Existing Liabilities Scheme (ELS) cases ELS cases are those involving any clinical incident that occurred prior to 1 April 1995, where settlement was or will be made after 1 April All the existing cases were transferred for direct management to the NHSLA in August Any new ELS cases (See flowchart, Appendix 4) received after that date will be fully investigated upon receipt and reported to the NHSLA as follows: Claims with a value of more than 1m or which are novel, repercussive or contentious will be registered with the NHSLA immediately following receipt of a letter of claim. All other claims will be registered with the NHSLA when prior approval is required for a step, as detailed in NHSLA C2/99 ELS Protocol and Standard Report Format, dated 1 April B Procedure for management of Clinical Negligence Scheme for Trusts (CNST) cases, including requests for disclosure of records, serious clinical incidents and complaints CNST claims are those involving any clinical incident that occurred after 1 April These claims will be managed by Claims Managers in accordance with Reporting Claims to the NHSLA, version 1.01 April 2014 and the Pre-Action Protocol published under the new Civil Procedure Rules in 1999 (see flowchart, Appendix 5). N.B. NHSLA authorisation is required before admissions may be made and monetary compensation may be offered. In the absence of such authorisation, the NHSLA will not reimburse Trusts either for the compensation awarded or for any of the costs generated. Any such payments made by a Trust will fall outside the scheme and could possibly result in criticism from auditors. In addition, the CNST reporting guidelines require Trusts to report the following events as claims. The definition of a claim being allegation of clinical negligence and/or a demand for compensation made following an adverse clinical incident resulting in personal injury, or any clinical incident which carries significant litigation risk for the Trust : Those revealing a possible breach of duty leading to a potential large value claim (i.e. damages of over 250,000). These cases to be reported to the Legal Services and Reporting Manager who will prepare the preliminary analysis. Claims arising from a complaint investigation where the response, on the facts, indicates that an admission of liability has been implied. These cases to be Page 14 of 23

15 reported to the Legal Services and Reporting Manager who will prepare the preliminary analysis. Requests for disclosure of records with no indication of a claim, where the preliminary analysis indicates the possibility of a claim with a significant litigation risk, regardless of value. C Procedure for Management of Employee and Public Liability claims Legal Services and Reporting Manager will receive, assess and notify claims as follows: Incidents prior to Claim reported to commercial insurer who will investigate claim in conjunction with the Trust. Incidents after Employee and public liability claims reported to the NHSLA Liabilities to Third Parties Scheme (LTPS). D Procedure for Management of NHSLA Property Expenses Scheme (PES) Claims Legal Services and Reporting Manager will receive, assess and notify property claims covered by the NHSLA s Property Expenses Scheme (PES) in conjunction with the relevant service managers, as detailed in the NHSLA PES manual. The following claims will be reported to the Scheme: All cases where the potential will exceed the excess (see section 7, Financial Management) Cases within 20% of the excess, regardless of whether the Trust wishes the NHSLA to handle the claim on a sub-excess basis. Cases where the potential develops to the extent that the excess will be breached. Legal Services and Reporting Manager will work with the NHSLA claims handler in investigating the claim and providing appropriate information and evidence as required. Page 15 of 23

16 Appendix 3 -LETTERS OF CLAIM A formal letter of claim should include: A. The main allegations of negligence B. The injuries sustained C. The present condition and prognosis D. Any financial loss with an indication of the heads of damage Page 16 of 23

17 Appendix 4 -Reporting Guidelines Reporting Guidelines have been issued by NHSLA to assist with reporting of claims. It is recommended to work from the electronic version of the Reporting Guidelines as the Guidelines will change over time. Information contained includes: When should a claim be reported to the NHS LA What documents should be sent to the NHS LA when reporting a claim NB NHSLA will be unable to consider requests for indemnity unless the relevant Claim Report form has been completed. Claim Report forms to be completed: Clinical Claim Report Form (if CNST claim) LTPS Claim Report Form (If LTPS claim) Inquest Funding Request Form. (NB-This form needs to be sent to NHSLA in addition to the relevant scheme s Claim Report Form and Useful Documents Guide.) PES claim report form (If PES claim) Page 17 of 23

18 Appendix 5 - Equality Analysis The equality analysis guidance notes and template are provided to support you in meeting the requirements of the Public Sector Equality Duty which came into force on 5 April You should use this template to record evidence that equality analysis has been carried out before policy decisions take place. The form is a written record that demonstrates that you have shown due regard to the need to eliminate unlawful discrimination, advance equality of opportunity and foster good relations with respect to the characteristics protected by equality law. 1. About the policy/project/change Title of the policy / project / change: What are the intended outcomes / changes expected as a result of this policy / project / change: Are there links with other existing policies/projects: (if yes provide details) Claims Handling Policy Intended to support staff through the process of claims handling. No 2. Decide if the policy / project / change is equality relevant Does the policy/project involve, or have consequences for people using services, carers, employees or other people? If yes, please state the groups of people who are likely to be affected. If yes, then the policy/project is equality relevant. If no, you can skip to section 6. However the majority of Trust policies and projects are equality relevant because they affect people in some way. Yes 3. Gathering evidence to inform the equality analysis What evidence have you gathered to help inform this analysis? This can include evidence from national research, surveys & reports, interviews and focus groups, policy monitoring and evaluations from pilot projects, etc. If there are gaps in the evidence available under any of the characteristics, please explain why this is the case and state what actions will be taken to close the gaps as part of the action plan. Please ensure you check Annex C of the guidance notes for sources of evidence. Page 18 of 23

19 The Protected Characteristics & Evidence Using the relevant available evidence - what is known, understood or assumed about each of the equality groups / protected characteristics identified below that could be relevant to this policy / project / change. Record the sources of the evidence used for all the protected characteristics Age (consider & record evidence for people from all age ranges e.g. this might include safeguarding, capacity & consent) The group looked at whether there was any specific mention of a different process or procedure for people of varying ages and concluded there was not. Caring responsibilities (consider and record relevant evidence e.g. part time working, shift patterns, general caring responsibilities) The group looked at whether there was any specific mention of a different process or procedure for people with caring responsibilities and concluded there was not. Disability (consider and record relevant evidence e.g. attitudinal, physical and social barriers etc.) The group looked at whether there was any specific mention of a different process or procedure for people with disabilities and concluded there was not. Gender reassignment (Transgender) (consider and record relevant evidence e.g. issues of privacy of data, historical records, promoting dignity & reducing harassment) The group looked at whether there was any specific mention of a different process or procedure for people with gender reassignment and concluded there was not. Marriage and civil partnership (applies to employment only) (consider and record relevant evidence e.g. part time working, shift patterns, general caring responsibilities etc.) The group acknowledged the information in the Human Rights Act and the Equality Act. Pregnancy and maternity (consider and record relevant evidence e.g. working arrangements, part time working, infant caring responsibilities etc.) Employment Rights Act Race / ethnicity (consider and record relevant evidence e.g. different ethnic groups, nationalities, language barriers, cultural differences etc.) Equality and Human Right Acts; information from staff network Religion or belief (consider and record relevant evidence e.g. people of different religions, beliefs or no belief) Equality and Human Right Acts; information from staff network Sex / gender (consider and record relevant evidence for men and women - also consider links to other characteristics e.g. caring) Equality and Human Right Acts; information from staff network; Employment Rights Page 19 of 23

20 Act; Sexual orientation (consider and record relevant evidence for heterosexual people as well as lesbian, gay and bi-sexual people) Equality and Human Right Acts; information from staff network 4. Engagement and Involvement Record the names of the people and/or groups involved in gathering evidence and/or testing the evidence against the policy / project / change. Who and how were they involved? Who name of individual / group(s) represented Amanda Shaw, Ben Chambers, Tracey Pettit How have these people been involved e.g. meeting Meeting 5. Analysis of the potential impact of the policy / project / change Based on the evidence you have gathered; describe any actual or likely impacts that may arise as a result of the decision and whether these are likely to be positive or negative. Where actual or likely impacts are identified, you should also state what actions will be taken to promote the likelihood of positive impacts as well as minimise or mitigate against possible or likely negative impacts, i.e. what can the Trust reasonably do to actively manage the consequences of its decision / action Eliminate discrimination, harassment and victimisation: Does the policy / project / change, help eliminate discrimination, harassment and victimisation in any way? If yes, provide details. If no, provide reasons Age No evidence to believe that this group will be adversely affected by the use of this policy. Relevant to all ages. Caring responsibilities No evidence to believe that this group will be adversely affected by the use of this policy. Relevant to all people equally. Disability No evidence to believe that this group will be adversely affected by the use of this policy. Relevant to all people equally. Gender reassignment No evidence to believe that this group will be adversely affected by the use of this policy. Relevant to all people equally and does not discriminate. Marriage & civil partnerships No evidence to believe that this group will be adversely affected by the use of this policy. Relevant to all people equally. Page 20 of 23

21 Pregnancy & maternity Race / ethnicity Religion or belief Sex / gender Sexual Orientation No evidence to believe that this group will be adversely affected by the use of this policy. Relevant to all people equally. No evidence to believe that this group will be adversely affected by the use of this policy. Relevant to all people equally. No evidence to believe that this group will be adversely affected by the use of this policy. Relevant to all people equally. No evidence to believe that this group will be adversely affected by the use of this policy. Relevant to all people equally. No evidence to believe that this group will be adversely affected by the use of this policy. Relevant to all people equally. Advance equality of opportunity: Does the policy / project / change, help develop equality of opportunity in any way? This could include removing or minimising disadvantages suffered by people due to their protected characteristics, taking steps to meet the needs of people from protected groups where these are different from the needs of other people, or encouraging people from protected groups to participate in activities where their participation is disproportionately low. If yes, provide details. If no, provide reasons Age Caring responsibilities Disability Gender reassignment Pregnancy & maternity Race / ethnicity Religion or belief Sex / gender Sexual Orientation No-impact neutral No-impact neutral No-impact neutral No-impact neutral No-impact neutral No-impact neutral No-impact neutral No-impact neutral No-impact neutral Promote good relations between different groups: Does the policy / project / change, help foster good or improved relations between different groups in any way? If yes, provide details. If no, provide reasons. Page 21 of 23

22 Age Caring responsibilities Disability Gender reassignment Pregnancy & maternity Race / ethnicity Religion or belief Sex / gender Sexual Orientation The policy allows for a fair process in relation to Claims Handling. The policy allows for a fair process in relation to Claims Handling. The policy allows for a fair process in relation to Claims Handling. The policy allows for a fair process in relation to Claims Handling. The policy allows for a fair process in relation to Claims Handling. The policy allows for a fair process in relation to Claims Handling. The policy allows for a fair process in relation to Claims Handling. The policy allows for a fair process in relation to Claims Handling. The policy allows for a fair process in relation to Claims Handling. What do you consider the overall impact: Considering the combined impact of the analysis and the actions required to promote the likelihood of positive impacts and minimise or mitigate against potential negative outcomes does the analysis support the implementation of the policy / project / change? Yes because it ensures a fair process for Claims Handling. 6. Action Planning Actions to be taken as a result of this analysis (add additional rows as required): 1. None Name of person who will take this action Date action due to be completed 7. Authorisation Name & job title of person completing this analysis: Amanda Shaw Page 22 of 23

23 Date of completion: 20/01/2015 Name & job title of person responsible for monitoring and reporting on the implementation of the actions arising from this analysis: Name & job title of authorised person: (If there are doubts about the completeness or sufficiency of this equality analysis, seek advice from the Equality and Human Rights Team or the Legal Services & Reporting Manager in the Clinical Risk & Safety Team) Amanda Shaw Date of authorisation: 05/02/2015 Billy Hatifani, Director of Risk & Safety/Deputy DoN/Emergency Planning Lead Page 23 of 23

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