HILL DICKINSON FORUM 6 TH MARCH 2014 Catherine Dixon Chief Executive NHS Litigation Authority
NHS LA Special Health Authority part of NHS, established 1995; An indemnity pool (not an insurance company) for the NHS in England; Contributions (premiums) paid on a pay as you go basis; Schemes: CNST (Clinical Negligence Scheme for Trusts) clinical negligence LTPS (Liabilities to Third Parties) other third party liabilities PES (Property Expenses Scheme) property ELS (Existing Liabilities Scheme) pre 1995 claims 200+ employees; and Outsourced services, including legal panel.
NHS LA roles Handle clinical and non clinical negligence claims made against organisations providing and commissioning NHS care; Encourage good risk management practices; Help to learn lessons from claims; Coordinate equal pay and age discrimination claims; Provide human rights act information service for the NHS; Resolve disputes between the NHS and independent contractors; Help to resolve concerns about the professional practice of doctors, dentists and pharmacists National Clinical Assessment Service.
Expenditure 2012/13
New Claims Reported (All Trusts) 50% of all claims we receive resolved WITHOUT damages; 80% success at trial. 66% increase in clinical claims since 2008/09
New Claims Reported (All Trusts) Number of Claims Received Monthly as at 31/01/2014 1,200 1,100 Number of Claims Received 1,000 900 800 700 600 500 400 300 200 CNST 100 0 2003/04 2004/05 2005/06 2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13 2013/14 NHSLA Notification Year and Month
Average Duration of Claims (time taken to resolve claims) Maternity Claims average time from receipt of claim by NHS LA to admission status is 0.94 years; average time from admission to first payment is 0.71 years; average time from receipt of claim by NHS LA to first damages payment is 1.64 years.
Ratio of Legal Costs to Damages for Clinical Claims Closed 80% of costs claimant solicitors costs; Disparity between costs and damages for lower value claims.
Number Of Clinical Negligence Claims Received by Claimant Funding and NHSLA Notification Year 8,000 7,000 No. of Claims 6,000 5,000 4,000 3,000 BTE Insurance Conditional Fee Agreement Funding Protocol in Place Legal Services Commission Self Funded Not Known 2,000 1,000 0 07/08 08/09 09/10 10/11 11/12 12/13 NHSLA Notification Year
2008/09 2009/10 2010/11 2011/12 2012/13 Total 000 000 000 000 000 000 Annual Payments 57,807 63,208 75,579 118,949 125,971 441,514 Annual Contribution 43,737 77,439 87,077 99,266 107,295 414,814 Variance 14,071 14,231 11,498 19,682 18,675 26,699 Clinical Negligence Scheme for Trusts Recent History Cumulative Payments Made Cumulative Contributions received Annual Payments Annual Contribution 500,000 140,000 Cumulative '000s 450,000 400,000 350,000 300,000 250,000 200,000 150,000 120,000 100,000 80,000 60,000 40,000 Annual 000's 100,000 50,000 20,000 - - Years
Contribution Setting Aim to ensure costs are smoothed over time demonstrate VfM. Reduce gaps between what is paid in and what is paid out. Fair, equitable and transparent. Pay as you go. Take into account: Claims history/experience known claims Risk profiling of activities (level of activity, number of people undertaking activities).
RAG Rating
Safety and Learning What are we doing? Stopping assessments from March 2014; Focusing on improving outcomes which for NHS LA means reducing claims thereby reducing harm. Why are we stopping assessments? Member feedback; Reduce bureaucracy and burden on front line staff; Avoid duplication with other organisations (CQC); Ensure we are proportionate and measure outcomes.
Safety and Learning How are we doing this? By supporting the NHS reduce their claims by : Information and analytics EXTRANET o Raising awareness claims information and how it could be used to learn the lessons from claims. Developing a safety and learning service o o o o o o Case studies; Seminars, Webinars, Blogs; Clinical engagement; Safety and learning library; Advisory Groups; Offers of support NCAS. Price incentivisation o Fewer less costly claims will reduce the cost of CNST contributions.
Risk Management Discounts Risk management standards the level the trust achieved at 31 st March 2013 will be used as a base line to transition away from risk management discounts; CNST Maternity standards the level the trust achieved at 31 st March 2014 will be used as a base line to transition away from CNST maternity discounts; Coinciding with us stopping mandatory assessments; Risk Management discounts will be paid in full in 2014/15; After 2014/15 will transition away over time avoiding any large swings in price.
Duty of Candour Following the Governments response to the Mid Staffs Public Inquiry on 19 November there will be a DH consultation on proposals to enhance candour: how to improve patient safety incident disclosure to patients and their families, including consistency with other reporting requirements; what encourages professionals to disclose incidents; and the bureaucratic and other impacts of any changes to current arrangements; the different arguments for and against including incidents leading to moderate harm, alongside death and serious harm, within the definition of the statutory duty of candour; and the incentive to more openness about patient safety incidents by requiring Hospitals to reimburse the NHS Litigation Authority for part or all of their compensation costs. Saying Sorry guidance available at www.nhsla.com/currentactivity/pages/news.aspx
Questions & Feedback catherine.dixon@nhsla.com