Claims Management Policy

Transcription

1 Claims Management Policy GOV 08 October 2007 GOV 08 Claims Management Policy 3.doc Page 1 of 12

2 Document Management Title of document Claims Management Policy Type of document Policy GOV 08 Description Target audience A policy describing the management process for Claims against the PCT. All NtPCT staff. Author Department Directorate David Thomas Governance Corporate Services and Human Resources Approved by Governance Committee Date of approval 10 Oct 2007 Version Number 1 Next review date October 2009 Related documents Superseded documents Incident and Near Miss Policy, Complaints Policy Claims Management Policies from the predecessor PCTs Internal distribution All staff External distribution Availability All ratified policies, strategies, procedures and protocols are published on the NtPCT Intranet and Public Website. Contact details (of main contact for this document) Name: Dave Thomas Address: Bevan House, Kettering Tel: David.thomas@northants.nhs.uk GOV 08 Claims Management Policy 3.docPage 2 of 12

3 Contents 1 Introduction 4 2 Definition of Claim 4 3 Background 4 4 Principles 5 5 Delegated Authority 5 6 Organisational Responsibilities 6 7 Individual Responsibilities 6 8 Review 7 9 Claims Procedure 7 10 Claims Management Procedure 9 11 External Agencies Claims Information Policy Monitoring 11 Appendix 1 Policy Impact Assessment 12 GOV 08 Claims Management Policy 3.docPage 3 of 12

4 CLAIMS MANAGEMENT POLICY 1 INTRODUCTION 1.1 Northamptonshire Teaching Primary Care Trust (herein the NtPCT ) is committed to the safety of patients, carers, staff, contractors and visiting individuals to the NtPCT premises. Claims Management along with Incident, Near Miss and Complaints reporting and management are fundamental processes to support the management of risk within NtPCT. In the event of clinical negligence and personal injury claims, the NtPCT will ensure an effective and timely investigation and response in accordance with the NHS Litigation Authority (NHSLA) s Protocol for Delegated Authority and the Risk Management Standards for NtPCT s Reporting Guidelines 1.2 This policy describes how claims should be recorded, investigated and analysed across the NtPCT. 2 DEFINITION OF A CLAIM 2.1 A claim is an allegation of clinical negligence and/or demand for compensation made following an adverse incident resulting in personal injury or any incident that carries a significant litigation risk for the NtPCT. 3 Background 3.1 The NHSLA is a Special Health Authority that manages the NHS financial pooling schemes: - The Existing Liabilities Scheme (ELS) for all clinical negligence claims arising before The Clinical Negligence Scheme for NtPCT (CNST) for all clinical negligence claims arising since The Risk Pooling Schemes for NtPCT (RPST) for all staff personal injury claims Liabilities to Third Parties Scheme (LTPS) The Property Expenses Scheme (PES) GOV 08 Claims Management Policy 3.docPage 4 of 12

5 4 PRINCIPLES 4.1 Northamptonshire Teaching Primary Care Trust is committed to: - Timely and thorough investigation of allegation of clinical negligence or staff and third party personal injury, or property damage Prompt preliminary assessment of the merits of a claim in accordance with the CNST and RPST Reporting Guidelines and Clinical Negligence Pre-Action Protocol Full consultation and support will be given to all employed staff directly involved in claims Prompt settlement of claims where an admission of liability is indicated Repudiation of claims where there is no indication of negligence as currently defined Work in co-operation with the NHSLA and its appointed CNST and RPST panel solicitors under the Protocol For Delegated Authority Learn from claims by making changes in clinical and organisational practice and procedure and facilitating education of staff as appropriate Maintaining confidentiality of data relating to staff, patients, individuals and third parties. 5 DELEGATED AUTHORITY 5.1 The NtPCT Board have delegated authority from the NHSLA to make admissions of breach of duty and/or causation and payment of compensation on behalf of the NtPCT in clinical negligence and personal injury claims up to the financial limits set out below: - CNST 25,000 (Excluding defendant and claimant legal costs) RPST Staff Personal Injury 10,000 (Including defendant and claimant legal costs) RPST Third Party Personal Injury 3,000 (Including defendant and claimant legal costs) 5.2 Clinical negligence and personal injury claims values over the respective financial thresholds will be reported to the NHSLA under the CNST and RPST Reporting Guidelines. 5.3 The Governance Committee on behalf of the NtPCT Board will: - Review active, new and closed claims on a quarterly basis Liaise with the Audit Committee regarding outcome of claim management GOV 08 Claims Management Policy 3.docPage 5 of 12

6 Liaise with groups involved in clinical quality and safety to ensure that lessons learned from claims are shared as appropriate Review claims data to identify professional appraisal and revalidation issues 6 ORGANISATIONAL RESPONSIBILITIES 6.1 The NtPCT Board has ultimate responsibility for ensuring the NtPCT has adequate claims management policies and procedures and internal structures for claims management to operate effectively. 6.2 The Governance Committee is a sub-committee of the Board and has responsibility for ensuring the proactive, progressive and continuous improvement in the NtPCT s approach to risk management. This includes overseeing the management and settlement of claims. 7 INDIVIDUAL RESPONSIBILITIES 7.1 The Chief Executive has overall accountability for ensuring a robust claims management policy and process is in place. 7.2 The Director of Corporate Services and Human Resources has delegated responsibility for ensuring there are robust systems and process to clinical governance including the management of, and learning from, claims. The Director of Corporate Services and Human Resources will keep the Board informed of major developments on claims-related issues. 7.3 The Director of Corporate Services and Human Resources is responsible for co-ordinating the management of clinical risks including the development of appropriate strategies and policies to minimise clinical risk. 7.4 The Associate Director of Governance is responsible for the administration of the NtPCT s Claims Management Policy and will request authority from the Chief Executive and Director of Finance in advance of admitting liability and/or settling. 7.5 The Chief Executive and Director of Finance will grant or refuse authority, stating their reasons to admit liability and/or causation and/or settling claims. 7.6 Directors and Directorate Managers will notify the Associate Director of Governance of serious adverse incidents that are likely to be the subject of a claim and will make appropriate arrangements for risk management issues identified through the claims handling process to result in a change of practice, new protocol or guideline and identify/implement training and audit. GOV 08 Claims Management Policy 3.docPage 6 of 12

7 7.7 Directors and Directorate Managers will be responsible for ensuring appropriate levels of investigation into the claim in line with the Incident and Near Miss reporting policy and investigation procedure. 7.8 Individual Staff will: - Notify the Associate Director of Governance immediately of any correspondence from solicitors or other individuals in respect of a claim. Report incidents in accordance with the Incident and Near Miss Reporting Policy. Take part in investigations as required Provide comments on reported incidents as required by the Associate Director of Governance 7.9 Training Staff will be provided with training in the investigation of claims as per Incident and Near Miss reporting policy and investigation procedure Communication This policy and procedure is available on the intranet; nww.northants.nhs.uk 8 REVIEW 8.1 This Claims Management Policy, and the levels of delegated arrangements, will be reviewed in Oct 2008 and annually thereafter or sooner in light of relevant changes. 9 CLAIMS PROCEDURE 9.1 General Principles All claims will be promptly notified to the relevant NHSLA scheme in accordance with the appropriate NHSLA guidelines within 24 hours of receipt of a letter of claim and an acknowledgement sent to the sender/claimant within 14 days Claims investigation will be carried out by the Risk Management Team with assistance from the appropriate NtPCT staff following the Incidents and Near Miss Policy and investigation procedure. The Associate Director of Governance will inform the Director on Call where necessary whose responsibilities are laid out in the Incident and Near Miss Policy, including dealing with any anticipated media interest. Lessons learned will be shared with individual NtPCT staff involved, Directors and managers and at the Governance Committee All claims will be recorded on the DATIX electronic database GOV 08 Claims Management Policy 3.docPage 7 of 12

8 9.2 Employer/Public Liability (RPST/LTPS) Will be reported by the Associate Director of Governance to NHSLA s RPST in accordance with RPST reporting guidelines and Personal Injury pre-action protocol. The Associate Director of Governance will undertake preliminary analysis and obtain standard disclosure documentation and will liaise with the appointed NHSLA case manager and RPST Panel Solicitor as required until conclusion of the claim. Risk management lessons will be reported to appropriate clinical or non-clinical staff, Directors and managers and at the Governance Committee. 9.3 Property Claims (PES) Property claims are managed by the NHSLA. Property claims will be notified to the Director of Finance who will refer the claim to the NHSLA s PES together with relevant information and will continue to liaise with the appointed NHSLA case manager until the conclusion of the claim in accordance with NHSLA PES Reporting Guidelines. 9.4 Clinical Negligence (CNST/ELS) Letter of claim received or proceedings issued Any letter received by any member of staff must be passed to the Associate Director of Governance and depending on the quantum of the claim will be handled in accordance with the Protocol for Delegated Authority or CNST Reporting Guidelines Incidents Where a clinical incident is followed by an allegation of clinical negligence and/or demand for compensation, or the clinical incident is identified as carrying a significant litigation: The Head of Risk Management and Business Continuity will consider the results of the incident investigation and if necessary seek further clinical advice in order to prepare a preliminary analysis and report to the NHSLA where necessary in accordance with Protocol for Delegated Authority and CNST Guidelines Complaints Where a complaint includes, or is followed by, an allegation of clinical negligence or a request for compensation or is identified as a significant litigation risk, the Complaints Manager will liaise with the Associate Director of Governance to consider the result of the complaints investigation and Letter of Response, whether an admission of liability is required and whether Alternative Dispute Resolution (ADR) is suitable. GOV 08 Claims Management Policy 3.docPage 8 of 12

9 9.4.5 Applications for Healthcare Records All requests for records in respect of clinical negligence, staff or third party personal injury claims will be passed to the Information Governance Team. All NtPCT managers are to notify the Associate Director of Governance of any requests for records that may indicate a future clinical negligence claim. The Information Governance Team will administrate the copying, checking and dispatch of healthcare records to patients or Claimants Solicitors within 40 days of the request and receipt of payment of fee, in accordance with Data Protection Act 1998 or Access to Health Records Act 1990 and the local PCT Policy (pending). 10 CLAIMS MANAGEMENT PROCEDURE 10.1 The management of claims will be carried out by the Associate Director of Governance, who will report on these matters directly to the key staff involved and if necessary the Director of Corporate Services and Human Resources The Associate Director of Governance will maintain a secure database (DATIX) of all claims relating to the NtPCT, including information about the nature of each claim, financial data and other information The investigation of claims will follow the same process as describe in the Incidents and Near Miss Reporting Policy and investigation procedure Management of the claim will include the following processes, which will be undertaken by the Associate Director of Governance unless allocated to an appropriate Manager/Director: - Receiving, acknowledging and assessing all new claims that may arise against the NtPCT. Identifying and arranging for the preservation of relevant records and other items, such as equipment involved in incidents Investigation to establish an objective account of the original incident by contacting the relevant service head and arranging for interviews of staff involved to be held and to obtain statements as per the Incidents and Near Miss Reporting Policy Assessing general and specific damages with the advice of the NHSLA guidelines Obtaining expert clinical or other advice (within or outside the organisation as appropriate) Obtain Counsel s advice GOV 08 Claims Management Policy 3.docPage 9 of 12

10 Signing the Statement of Truth and commenting on the Court record as the trust s Legal Advisor as required Reporting promptly to and briefing NHSLA and Panel Solicitors as required Analysing, with expert advice (legal, financial and from Governance Committee members as appropriate) whether individual claims should continue to be defended Recommending authorisation of and negotiate out-of-court settlements within delegated limits Supporting staff and former staff involved in the litigation process, and ensure that the views of those involved in the case are considered carefully before a decision is made to settle or contest the claim Ensuring that information emerging during claims investigation is shared with staff directly involved in the case, the relevant Director and/or manager and Complaints Manager as appropriate for risk management purposes. Ensuring that lessons learnt in the process of claims management are used for clinical risk management purposes in the context of future service provision Contributing to educational and training programmes for the benefit of staff Give due consideration to the possibility of using alternative dispute resolution methods Liaise with the Complaints Manager over the response to complaints where an admission of liability is appropriate and/or the patient has requested compensation Assist in the investigation of Serious Adverse Events as required by the appropriate NtPCT Director. NOTE: Where an incident or complaint investigation requires staff to prepare a formal statement or where staff may expect that they may be called to give evidence as a witness, for example, at an inquiry, court case or Coronial Inquest, they are to be actively supported by their manager in accessing appropriate advice. This will usually be through the Risk or Complaints Teams but may also be through a professional union or registration body. Where necessary the Corporate Services and HR Directorate will obtain appropriate external legal advice to support the PCT and its staff. 11 EXTERNAL AGENCIES 11.1 The Head of Risk and Business Continuity will liaise with the appropriate Directors/Managers to determine if external agencies should become involved. GOV 08 Claims Management Policy 3.docPage 10 of 12

11 11.2 The Medical Director and Director of Quality Standards and Learning will report cases of gross professional negligence to the GMC and NMC In cases of criminal conduct the police will be informed If health and safety issues arise and the matter has not previously been reported, the Health & Safety Adviser will report to the Health and Safety Executive The Head of Risk Management and Business Continuity will report to the National Patient Safety Agency as appropriate. 12 CLAIMS INFORMATION 12.1 The Associate Director of Governance will maintain the Claims Database with details of the nature of each claim, the current insurance reserve estimate and actual spend The Associate Director of Governance will provide the NtPCT with quarterly reports on new, open and closed claims and inquests as required by the NtPCT Board, Finance, auditors, insurers (for relevant Personal Injury, Employers Liability and Public Liability claims), including reports on: The number and aggregate value of claims and details or any individual claims The progress and likely outcome of these claims, including the expected settlement date The final outcome of the claim 13 POICY MONITORING 13.1 The effectiveness of this Policy shall be monitored through the Governance Committee looking at the performance of Claims Management and Reporting against the timeframes required as well as the implementation of change following lessons learned from Claims analysis and investigation. GOV 08 Claims Management Policy 3.docPage 11 of 12

12 Appendix 1 Policy Impact Assessment Screening Tool Name of Directorate: Corporate Services and Human Resources Policy being assessed: Claims Management Policy Date of Assessment: 08/10/07 Assessment Carried out by: David Thomas POLICY TITLE Who is affected Statutory requirements Full Assessment Needed Yes / No Priority High / Medium / Low Claims Management Policy All staff employed by NtPCT NHSLA No Low GOV 08 Claims Management Policy 3.doc Page 12 of 12