Litigation Authority Annual Review 2013/14 Forward Look for 2014/17 &
Catherine Dixon Chief Executive, NHS Litigation Authority Welcome to the NHS LA s Annual Review for 2013/14 and Forward Look for the next three years. We are proud to present our achievements in 2013/14 and a high level summary of our future plans. The NHS LA s strategic objectives aim to ensure that we engage with the NHS and offer efficient and effective services which demonstrate value for money, as well as support the NHS to learn from things that go wrong, to reduce harm and improve patient safety.
Litigation Authority In our commitment to support the NHS in 2013/14: We launched an extranet web portal to provide our members with real time direct access to their claims and learning materials to give them greater knowledge of the claims and to support them to identify areas where claims can be reduced. The extranet has been nominated for two National Awards. We met the challenge of dealing with a large increase in the volumes of claims with clinical claims volumes growing by almost 18%, generated predominantly by changes in the legal market following changes to no-win no-fee agreements (see figure 1). We continued to pay fair claims quickly and robustly defend claims without merit. However, almost half the clinical claims we received (44%) had no evidence of negligent care. This meant we were able to resolve them without paying damages, saving the NHS more than 1.4 billion (see figures 3 and 4 and figures 5 and 6 for non-clinical claims). We have seen claimant solicitors charging, in some cases, very high costs that are much higher than the value of damages payable. We are concerned that we are paying, in some cases, more to claimant lawyers than to harmed patients and we have robustly challenged excessive costs saving the NHS more than 75m (see figures 2 and 4). In its first year with the NHS LA, NCAS dealt with more referrals, undertook more assessments and put in place more back on track plans than ever before. We have reduced the waiting time for assessments from longer than one year to 3-4 months. We have made assessment reports shorter, more focused and understandable. NCAS core services remain free for referring bodies. We are making changes to improve and enhance NCAS and to develop new services to meet the changing needs of the NHS (see figure 8).
We developed a safety and learning service which aims to support the NHS to reduce its claims. We listened to our members feedback and we stopped carrying out assessments against standards to remove duplication with other agencies and free up front line staff to provide care. Over 2014/15 we will continue to develop our safety and learning service to support our members and to take forward the Sign up to Safety campaign which will enable us to make incentive payments to member organisations whose safety plans robustly show they will reduce claims (figure 7 shows the highest value clinical claims specialties). We changed the way we price our indemnity cover so that organisations with fewer and less costly claims pay less. This incentivises members to reduce claims thereby improving patient and staff safety. We launched new member services throughout the year including a new inquest service that supports our members in dealing with inquests that may result in a claim. During the year, we supported members through over 500 inquests. We put in place a new legal panel for all Department of Health agencies and Arm s Length Bodies which enabled them to take advantage of high quality, value for money, legal services together with value added benefits such as secondees, use of legal offices and library services. We were finalists for our collaborative work on establishing the legal panel in the GO National Procurement Awards. We kept 100% of our NHS members and significantly grew our membership, with more than 50 new independent sector members providing NHS care joining our Clinical Negligence Scheme for Trusts. We created our vision to achieve timely fair resolution, enhance learning and improve safety supported by our values of being Professional, Expert, Ethical and Respectful, in line with our commitment to the NHS Constitution.
Litigation Authority NHS LA key facts Figure 1: New claims reported Figure 2: Clinical claims legal costs as a percentage of damages paid, by damages tranche, for claims closed in 2013/14 Number of new claims 14,000 12,000 10,000 8,000 6,000 4,000 2,000 0 6,652 8,655 4,074 4,346 Clinical Non-clinical 9,143 10,129 4,618 4,632 11,945 2009/10 2010/11 2011/12 2012/13 2013/14 Financial year 4,802 %age Legal Costs of Damages 300% 250% 200% 150% 100% 50% 0% 273% 43% % Defence Legal Costs as a %age of Damages % Claimant Legal Costs as %age of Damages 153% 107% 74% 54% 27% 20% 16% 37% 13% 10% 1-10,000 10,001-25,000 25,001-50,000 50,001-100,000 100,001-250,000 250,001-500,000 500,001-1M Damages by Tranche 24% 7% 15% 4% 1M+ Figure 3: Clinical negligence expenditure 2013/14 (including interim payments) Figure 4: Damages and costs saved in clinical claims resolved in 2013/14 92,533,500 (8%) 92,533,500 (8%) 67,934,017 (5%) 16,922,080 67,934,017 (1%) (5%) 16,922,080 (1%) 259,252,650 (22%) 259,252,650 (22%) 1,192,538,084 1,192,538,084 1,438,894,721 1,438,894,721 840,751,934 (70%) 840,751,934 (70%) 1,354,038,624 (94%) 1,354,038,624 (94%) Claimant legal costs Claimant legal costs Damages paid to claimants Damages paid to claimants Defence legal costsdefence legal costs Successfully defended Successfully at trial defended at trial Resolved without damages Resolved payable without damages payable Legal costs challenged Legal and costs saved challenged and saved
Figure 5: Non-clinical expenditure 2013/14 (including interim payments) Figure 6: Damages and costs saved in non-clinical claims resolved in 2013/14 649,000 (1%) 649,000 (1%),934,372 6,934,372 (13%) 19,489,453 (13%) 19,489,453 (38%) (38%) 6,787,627 (9%) 6,787,627 (9%) 51,574,564 51,574,564 71,878,621 71,878,621 25,150,739 (49%) 25,150,739 (49%) 64,441,994 (90%) 64,441,994 (90%) laimant legal costs Claimant legal costs amages paid to claimants Damages paid to claimants efence legal costs Defence legal costs Successfully defended at Successfully trial defended at trial Resolved without damages Resolved payable without damages payable Legal costs challenged and Legal saved costs challenged and saved Figure 7: Value of clinical negligence claims received in 2013/14 by specialty 21% Figure 8: NCAS Action Plan Outcomes 2008-13 Shows a successful return to work for 68% of practitioners who go through an NCAS action planning process. 2% 3% 7% 7% 3% 2% 2% 2% 51,574,563 35% 5% 5% 3% 3% 6% 6% 10% 10% 68% Obstetrics Orthopaedic surgery Casualty/A&E Paediatrics General surgery General medicine Neurosurgery Gynaecology Radiology Neurology Other (aggregated specialities) Return to work Referral to regulator Local exclusion/suspension Retired on grounds of age Retired on grounds of health Resigned from performers list/hospital Self erasure/removal from register Unknown
Litigation Authority Forward Look our three year plan Our plans for 2014-17 Our plans for the next three years aim to make sure we are in the right shape to provide all our services to the highest standards and to provide excellent value for money to the taxpayer. Being efficient and effective We never forget that our work has an impact on patients, on NHS services and on taxpayers. The people making claims want to be compensated fairly and speedily. Taxpayers who fund the NHS want to see the best possible value. This is why improving our performance as an organisation is at the heart of our three-year plan. We will make sure we maintain our excellent record of efficiency and control costs so that, wherever possible, NHS resources go to front line services. Supporting and developing our staff is also at the centre of our plans because their skills and commitment are the driving force behind our achievements. We will continue to challenge claims which do not evidence negligent care and claimant solicitors costs where they are excessive and disproportionate to damages payable. This ensures NHS money is spent on providing patient care. Improving patient safety With nearly 20 years experience of what goes wrong in the NHS, we are in a unique position to help improve the safety of healthcare services. We have already developed a new Safety and Learning Service. Over the next three years we will build on this. Because of the information we have gathered on claims against the NHS, we already know what goes wrong. We plan to thoroughly analyse this information to make sure we understand how and why things go wrong. We will share this knowledge and work closely with the NHS to improve patient safety. We will support the NHS with the Sign up to Safety campaign making incentive payments to organisations where plans demonstrate that they will reduce claims. Supporting safe practice We will develop and improve our work to maintain the professional standards of doctors, dentists, pharmacists and other healthcare professionals. Just as we will learn about safety from claims against the NHS, we will make sure that our work to improve the practice of health care professionals leads directly to improvements in patient safety.
Find out more about how the NHS LA is supporting the NHS at www.nhsla.com Any enquiries regarding this publication or to request another format including braille, audio tape, large print, another language or any other format, please contact communications@nhsla.com Publication date July 2014 Reference DSLP/Comms/00001 NHS LA FAIR RESOLUTION SHARING LEARNING IMPROVING SAFETY www.nhsla.com