CLAIMS MANAGEMENT POLICY

CLAIMS MANAGEMENT POLICY Last Review Date Approving Body N/A Audit Committee Date of Approval 13 th March 2014 Date of Implementation 1 st April 2014 Next Review Date April 2017 Review Responsibility Chief of Corporate Services Version 1.0

REVISIONS/AMENDMENTS SINCE LAST VERSION Date of Review March 2014 Amendment Details Development of PCT policy into CCG policy, matched to CCG responsibilities. Page 2 of 21

CONTENTS Page Definitions 4 Section A Policy 6 1. Policy Statement, Aims & Objectives 6 2. Legislation & Guidance 7 3. Scope 7 4. Accountabilities & Responsibilities 7 5. Dissemination, Training & Review 9 Section B Procedure 11 1. The CCG approach to claims management Being Open 11 2. The NHS Litigation Authority 11 3. Who may make a claim? 13 4. Who is covered by the NHSLA indemnity schemes? 14 5. Triggers for invoking the claims procedure 14 6. Claims Handling 15 7. Record Keeping 16 8. Confidentiality 16 9. Claims for compensation for lost, damaged or stolen property belonging to staff 17 10. How NHS Doncaster CCG makes a claim 17 11. Communications and the Media 17 Appendices A Guidance from the NHSLA on issuing apologies 19 Page 3 of 21

DEFINITIONS Term NHS Doncaster CCG Claim Claimant Clinical Negligence Scheme for Trusts (CNST) Definition NHS Doncaster Clinical Commissioning Group Where the context allows, any action against the organisation initiated by a claimant or any claim lodged by the organisation under the Property Expenses Scheme. Any patient or their representative, member of the public, or employee who instructs solicitors to act on their behalf to pursue a claim against the organisation, or who enters legal proceedings against the organisation or who pursues compensation. The Clinical Negligence Scheme for Trusts handles all clinical negligence claims against member NHS bodies where the incident in question took place on or after 1 April 1995 (or when the body joined the scheme, if that is later). Clinical Negligence claims may arise out of any incident where it is alleged that a service or individual clinician failed to provide adequate care, resulting in harm to a patient. Clinical claim Clinician Liabilities to Third Parties Scheme (LTPS) Non Clinical Claim Pre-Action Allegations 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 organisation. A health professional engaged in the care of patients. Covers employers' liability claims, from straightforward slips and trips in the workplace to serious manual handling, bullying and stress claims. In addition, LTPS covers public and products liability claims, from personal injury sustained by visitors to NHS premises to claims arising from breaches of the Human Rights Act, the Data Protection Act and the Defective Premises Act. There is also cover for defamation, professional negligence by employees and liabilities of directors. A demand for compensation made following an adverse incident resulting in damage to property and/or personal injury. Aims to achieve settlement of claims without the need for Page 4 of 21

Term Protocol Property Expenses Scheme (PES) Risk Pooling Schemes for Trusts (RPST). Definition expensive and risky court proceedings. Deals with property claims arising on or after the CCG s Membership of the Scheme of which NHS Doncaster CCG is a member. Two separate schemes covering non-clinical risks, the Liabilities to Third Parties Scheme (LTPS) and the Property Expenses Scheme (PES) that are collectively known as the Risk Pooling Scheme for Trusts. Page 5 of 21

SECTION A POLICY 1. Policy Statement, Aims & Objectives 1.1 This policy and procedure has been produced to ensure NHS Doncaster Clinical Commissioning Group (CCG) has a robust system for the management of claims. 1.2. The National Health Services Litigation Authority (NHSLA) governs the financial risk pooling schemes: o Clinical Negligence Scheme for Trusts (CNST) o Risk Pooling Scheme for Trusts (RPST) i.e. and Liabilities to Third Parties Scheme (LPTS) the Property Expenses Scheme (PES) Membership of these schemes is voluntary and is open to all NHS Trusts and CCGs. NHS Doncaster CCG is a member of these schemes. 1.3 Adherence to this policy should ensure that NHS Doncaster CCG complies with the requirements of our insurers, so avoiding the cost penalties associated with non-compliance. 1.4. The CCG is committed to a fair blame approach when handling claims, which will always be directed at the organisation rather than the individual. This commitment will not, however, prejudice any subsequent disciplinary action where breaches of law, professional misconduct, or unacceptable repetitious acts have occurred. 1.5 The aims of this policy are: To establish a mechanism within NHS Doncaster CCG to ensure all claims are dealt within a timely manner, meeting the requirements of the insurers. To enable NHS Doncaster CCG to protect the public purse against malicious or false claims. NHS Doncaster CCG will seek to defend any claim where liability is in doubt. It is, however, acknowledged that the legal process could have a significant impact from both a financial, social and personal perspective and where liability can be proven, NHS Doncaster CCG will seek to settle claims promptly and fairly, without court proceedings. To ensure opportunities to learn from claims are fed back into the organisation. 1.6. To ensure continuous improvement, the organisation has a range of key performance indicators (KPIs) which it uses for monitoring purposes: No. Key Performance Indicator Method of Assessment 1. Reporting arrangements. Quarterly Corporate Page 6 of 21

Assurance Report. 2. Lead Officer. Job Description. 2. Legislation & Guidance 2.1. The following legislation and guidance has been taken into consideration in the development of this procedural document: NHS Litigation Authority guidance Data Protection Act 1998 Access to Health Records Act 1990 Common law duty of confidentiality 3. Scope 3.1. This policy applies to those members of staff that are directly employed by NHS Doncaster CCG and for whom NHS Doncaster CCG has legal responsibility. For those staff covered by a letter of authority / honorary contract or work experience this policy is also applicable whilst undertaking duties on behalf of NHS Doncaster CCG or working on NHS Doncaster CCG premises and forms part of their arrangements with NHS Doncaster CCG. As part of good employment practice, agency workers are also required to abide by NHS Doncaster CCG policies and procedures, as appropriate, to ensure their health, safety and welfare whilst undertaking work for NHS Doncaster CCG. 4. Accountabilities & Responsibilities 4.1. Overall accountability for ensuring that there are systems and processes to effectively manage claims lies with the Chief Officer. The Governing Body is responsible for promoting a climate of openness, participation and learning, and ensuring claims management forms part of NHS Doncaster CCG s overall approach to risk management. Responsibility is also delegated to the following individuals: Chief of Corporate Services or equivalent Has delegated responsibility for: Ensuring that NHS Doncaster CCG has the necessary insurance arrangements in place as required Advising the Governing Body of major developments and significant risks on claims management issues Recommending the approval of the payment of settlements recommended by the insurers to the Chief Officer for final approval Page 7 of 21

Compliance with the Data Protection Act 1998 in so far as it relates to claims management Ensuring that the organisation s policy and systems for claims management are continually reviewed to ensure that they meet the requirements of the insurer Providing and/or sourcing legal advice Providing technical advice on claims management and litigation matters Corporate Governance Officer or equivalent Has delegated responsibility for: The portfolio of CCG claims Ensuring all requests for claims received are acknowledged within specified timescales Performance managing compliance with the Personal Injury Pre-Action Protocol Preliminary investigation of each claim and preparation of the preliminary analysis Grading of claims in line with the organisations risk matrix Complying with the Data Protection Act 1998 in so far as it relates to claims management and NHS guidance Monitoring the progress and outcome of claims, including expected settlement dates Ensuring items of significant risk are brought to the attention of the Chief of Corporate Services or equivalent Corporate reporting and information sharing Considering trends identified between claims, incidents and complaints and the lessons learnt and make recommendation for remedial action to improve the service and the working environment Chiefs and Line Managers Have delegated responsibility for: Ensuring that staff are appropriately trained to undertake their role and responsibilities Assisting the Corporate Governance Manager in obtaining reports/statements from members of staff as requested within the timescales identified for the purpose of processing the claim or legal matter. It is important to note that some reports may be disclosable in law. Care should be taken by Chiefs/Line Managers and others compiling reports and should restrict themselves to facts and not to express opinions which could adversely affect NHS Doncaster CCG if litigation is commenced Notifying the Claims manager immediately (at most within 2 days) of any letter or documentation received, which relates to a claim or court proceedings Page 8 of 21

Staff Responsibilities of Staff (including all employees, whether full/part time, agency, bank or volunteers) are: Notifying the Corporate Governance Manager immediately (at most within 2 days) of any letter or documentation received, which relates to a claim or court proceedings Promptly reporting incidents, ensuring investigation and ensuring that actions are taken to eliminate or reduce the risk of reoccurrence in line with the organisation s Incident Policy Co-operating with Senior Managers and the insurers in the investigation and handling of claims and potential claims. Ensuring compliance with all records management and related policies and procedures so that comprehensive records are available to support the investigation and management of current and potential claims 5. Dissemination, Training & Review 5.1. Dissemination 5.1.1. The effective implementation of this procedural document will support openness and transparency. NHS Doncaster CCG will: Ensure all staff and stakeholders have access to a copy of this procedural document via the organisation s website. Communicate to staff any relevant action to be taken in respect of complaints issues. Ensure that relevant training programmes raise and sustain awareness of the importance of effective complaints management. 5.1.2. This procedural document is located in the General Policy Manual. A set of hardcopy Procedural Document Manuals are held by the Governance Team for business continuity purposes and all procedural documents are available via the organisation s website. Staff are notified by email of new or updated procedural documents. 5.2. Training 5.2.1. All staff will be offered relevant training commensurate with their duties and responsibilities. Staff requiring support should speak to their line manager in the first instance. Support may also be obtained through their HR Department. Page 9 of 21

5.3. Review 5.3.1. As part of its development, this procedural document and its impact on staff, patients and the public has been reviewed in line with NHS Doncaster CCG s Equality Duties. The purpose of the assessment is to identify and if possible remove any disproportionate adverse impact on employees, patients and the public on the grounds of the protected characteristics under the Equality Act. 5.3.2. The procedural document will be reviewed every three years, and in accordance with the following on an as and when required basis: Legislatives changes Good practice guidelines Case Law Significant incidents reported New vulnerabilities identified Changes to organisational infrastructure Changes in practice 5.3.3. Procedural document management will be performance monitored to ensure that procedural documents are in-date and relevant to the core business of the CCG. The results will be published in the regular Governance Reports. Page 10 of 21

SECTION B PROCEDURE 1. The CCG approach to claims management Being Open 1.1. The CCG acknowledge that: It is rarely the case that NHS staff set out to deliberately harm either themselves or others; Staff are usually doing their best to carry out their work in a safe and effective manner in order to benefit patients; Adverse events which lead to claims often occur due to system errors rather than due to an error by an individual alone; Claims against the CCG may be withdrawn following further investigation and/or successful letters of response prepared with the assistance of staff; Being involved in a case which is being investigated as a possible claim can be a stressful experience for anyone involved and every effort will be made to keep staff informed of the progress of a claim throughout. 1.2. The CCG encourages staff to be open and honest with patients/service users, their families and carers and their colleagues when there has been an unexpected outcome and expects apologies, explanations and expressions of sympathy to be made in good faith. An apology or an admission that something has gone wrong is not an admission of negligence or breach of statutory duty. The NHSLA has produced guidance in relation to apologies and explanations which is detailed in a letter from their Chief Executive in May 2009 (see Appendix 1). 1.3. Staff should not indicate that they believe the CCG to be liable in a matter or that they consider that compensation is due. For the CCG to be liable and for compensation to be due there must be a breach of our duty of care to the patient which has directly caused compensatable damage. 1.4. Exceptionally, some claims may be considered false and could be deemed to be fraudulent. Details of any concerns associated with a suspected false claim will be passed to the Counter Fraud Specialist. 2. The NHS Litigation Authority 2.1. The NHSLA is a Special Health Authority set up under Section 11 of the NHS Act 1977 and thus part of the NHS. It indemnifies NHS bodies in respect of both clinical negligence and non-clinical risks and manages claims and litigation for both clinical and non-clinical claims. NHS clinical claims are managed via the Clinical Negligence Scheme for Trusts (CNST) and for non-clinical claims via the Liabilities to Third Parties Scheme (LTPS) and the Property Expenses Scheme (PES.). NHS Doncaster CCG pays a premium to the NHSLA on an annual basis for this service. General guidance and information about the Page 11 of 21

NHSLA is contained on their website at www.nhsla.com. There are currently three risk pooling schemes which are detailed below. 2.2. Clinical Negligence Scheme for Trusts (CNST): This scheme handles all clinical negligence claims against NHS organisations where the incident in question took place on or after 1st April 1995 (or when the organisation joined the scheme if this is later). Although membership of the scheme is voluntary, the CCG has chosen to join it. The costs of the scheme are met by membership contributions. The projected claims costs are assessed in advance each year by professional actuaries. Contributions are then calculated to meet the total forecast expenditure for that year. Individual member contribution levels are influenced by a range of factors, including the type of organisation, the specialities it provides and the number of whole time equivalent clinical staff it employs. When a claim is made against a member of CNST, the NHS body remains the legal defendant. However, the NHSLA takes over full responsibility for handling the claim and meeting the associated costs. The scope of the scheme is set out in the CNST rules (available from NHSLA website www.nhsla.com or the policy author), while the CNST reporting guidelines (see Procedures for the Handling of Clinical Claims) set out how claims should be reported by trusts to the NHSLA. 2.3. Existing Liabilities Scheme (ELS). The Existing Liabilities Scheme covers clinical negligence claims made against the NHS in England where the incident in question took place before April 1995. It is not a membership scheme, as it is funded centrally by the Department of Health. Claims under the ELS are often made against NHS bodies which no longer exist, because of subsequent restructuring within the NHS. The legal defendant in such ELS claims will be the legal successor body to the now defunct NHS body. If a CCG is notified that a patient intends to make a claim relating to an incident before April 1995, the same reporting guidelines as for current CNST claims will be followed. 2.4. Risk Pooling Scheme for Trusts (RPST). Two separate schemes covering non-clinical risks, the Liabilities to Third Parties Scheme (LTPS) and the Property Expenses Scheme (PES) are known collectively as the Risk Pooling Schemes for Trusts (RPST). Both schemes date from 1st April 1999, and cover begins from that date, or from the date when the NHS body joined the scheme where that is later. LTPS covers employers liability claims, from straightforward slips and trips in the workplace to serious manual handling, bullying and stress claims. In addition, LTPS covers public and products liability claims, from personal injury sustained by visitors to NHS premises to claims arising from breaches of the Human Rights Page 12 of 21

Act, the Data Protection Act and the Defective Premises Act. There is also cover for defamation, professional negligence by employees and liabilities of directors. PES provides cover for first party losses such as theft or damage to property. Detailed information on the scope of the schemes is set out in the LTPS and PES rules (Available from the NHSLA website www.nhsla.com or policy author), while the RPST reporting guidelines (see the Procedures for the Handling of Non-Clinical Claims) set out how members should report claims. LTPS / PES claims are subject to excesses, with member bodies responsible for handling and funding below-excess claims themselves. 3. Who may make a claim? 3.1. A legal claim can be made by anyone to whom the CCG owes a duty of care and who feels they have suffered an injury, loss or damage as a result of a breach of that duty of care. This can include: staff (including students and temporary staff), visitors, patients/services users, contractors and members of the public. 3.2. There are timescales within which a claim should be brought the limitation period. The Limitation Act 1980 seeks to strike a balance between the competing interests of Claimants and Defendants and avoid the litigation of claims which are too old and where the evidence may no longer be available. In practice the commencement of a claim means the issue of the Claim Form by the Court. 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 exceptions to this are: Children the 3 year period does not commence until they reach the age of majority at 18 years i.e.: their primary limitation period expires at age 21. People with a disability i.e.: of unsound mind who are incapable of managing their own affairs. Such people may bring an action at anytime whilst the disability exists. In view of their ongoing disability the claim is usually brought on their behalf by a Litigation Friend. For claims for deceased patients being brought by their Personal Representative under the Law Reform (miscellaneous provisions) Act 1934 or the Fatal Accidents Act 1976 the following applies: o If the person injured dies before the expiration of the 3 year period, the period applicable, as respects the cause of action surviving for the benefit of his estate by virtue of S.1 of the Law Reform (Miscellaneous Provisions) Act 1934, shall be 3 years from the date of death or the date of the personal representative's knowledge, whichever is the later. Page 13 of 21

o The time limit for bringing an action on behalf of dependants under the Fatal Accidents Act 1976 for bereavement damages or a dependency claim is 3 years from the date of death, or from the date of knowledge of the person for whose benefit the action is brought, whichever is later. o However, an action for bereavement/dependency under the Fatal Accidents Act 1976 shall not be brought if the death occurred when the person injured could no longer maintain an action to recover damages in respect of the injury (Limitation Act 1980 S.12 (1)). 3.3. Date of knowledge is when the claimant first had knowledge that the damage was significant and attributable in whole or part to the act or omissions of the Defendant. Significant case law in recent years has led to the concepts of actual and constructive date of knowledge i.e.: when did the Claimant first obtain knowledge and when should they have first obtained knowledge. Even though the Defendant may seek to put up a limitation defence the court has the discretion to disapply the limitation period under Section 33 of the Limitation Act. Before doing so, the Court will consider the facts of the case, the reasons for the delay etc, and whether or not the Defendant will be prejudiced if the action goes ahead. 4. Who is covered by the NHSLA indemnity schemes? 4.1. NHSLA indemnity covers the actions of all staff in the course of their legitimate NHS employment. It also covers people in certain other categories whenever the NHS body owes a duty of care to the persons harmed e.g. locums, medical academic staff with honorary contracts, students on placement, those conducting clinical trials, charitable volunteers and people undergoing professional education, training and examinations. 5. Triggers for invoking the claims procedure 5.1. The CCG should consider activating the claims procedure in the following circumstances: a request for a copy of medical records is received; an adverse incident which could lead to a claim for compensation; a complaint which could lead to a claim for compensation; a human rights issue; an issue involving media attention; a request for records pursuant to the pre-action protocol for clinical negligence disputes which intimates a claim against NHS Doncaster CCG; receipt of a letter of claim; other matters identified through the risk management process. Page 14 of 21

5.1. It is therefore important that all staff understand the need to report such triggers to the corporate risk and assurance manager at the earliest opportunity. The Chief of Corporate Services will decide whether to inform the NHSLA. 6. Claims Handling 6.1. All claims are handled on behalf of NHS Doncaster CCG by the Corporate Governance Team. Any correspondence received relating to a claim must be forwarded immediately to the Corporate Services Team. 6.2 When a claim is made against a CCG who is covered by the NHSLA, the CCG remains the legal defendant but the NHSLA takes over full responsibility for handling the claim and meeting the associated costs. The NHSLA reporting guidelines set out how claims should be reported to the NHSLA. 6.3. When a claim is received it should be referred immediately to the Corporate Governance Manager who will ensure that the claim is notified to the NHSLA. 6.4. The NHSLA have a maximum of three months from the date of acknowledgement of the claim to investigate. No later than the end of that period the NHSLA will reply, stating whether liability is denied and, if so, giving reasons for their denial of liability including any alternative version of events relied upon. 6.5. According to each individual case, the Corporate Governance Manager will need to gather information for the case, for the NHSLA and the instructed Solicitor. Time frames are usually reasonable and staff that have been requested to provide information should ensure that they do their utmost to keep to the deadlines. 6.6. Staff must not enter into any correspondence directly with the claimant, their solicitors or any other third party. 6.7. It will be the responsibility of the Corporate Governance Manager to complete all official insurance claim forms. These will be signed by the Chief of Corporate Services. 6.8. The Corporate Governance Manager and Chief of Corporate Services will ensure that all claims are dealt with promptly and efficiently and in accordance with agreed procedures. Claims falling under the NHSLA schemes will be dealt with in accordance with scheme rules which are available on: http://www.nhsla.com/pages/home.aspx Page 15 of 21

6.9. During the course of defending a claim if may be necessary for legal documents to be signed. This will be undertaken by the Chief of Corporate Services unless otherwise required by law. 6.10. Authority to admit liability and/or settle a claim must be made in accordance with this policy and will be subject to the requirements of the NHS Litigation Authority. This includes authority to settle any claim. Where the NHSLA (or panel solicitors) is handling a claim, the CCG agreement is required before any admissions of liability are made. The Chief Officer is responsible for agreeing any admission of liability / settlement of claim. 6.11. Summary claims information will be reported to the Governing Body to provide assurance that claims are being handled in line with the relevant guidance and policies. 7. Record Keeping 7.1. High standards of record keeping documentation are essential to ensure that the facts are available in the event of a claim being made. 7.2. All claims, both formal and informal will be recorded by the Corporate Services Team. A claim file will be opened for formal claims and detailed file notes on the progress of the claim will be maintained. Claims information will be indexed and paginated as appropriate to keep it in order to aid an efficient and effective investigation and claims management process. 9.2 When staff are asked to provide reports, statements or comments, they will be reminded as necessary on whether their reports are potentially disclosable in the event of a claim proceeding. Documentation must be provided to the Claims Manager. 8. Confidentiality 8.1. Any information gathered for a claim investigation will be treated with appropriate confidentiality and information will be disclosed only in accordance with relevant legal protocols and legislation such as the Data Protection Act 1998 and the Access to Health Records Act 1990. 8.2. Information gathered in relation to a legal claim will contain person identifiable information (such as date of birth, address, National Insurance numbers and possibly NHS numbers etc) along with information relating to the particulars of the claim incident (this can be sensitive) and any accompanying information (such as earnings information, medical reports and records, witness statements and incident report forms). This information must be kept secure and confidential at all times, and transferred appropriately and in Page 16 of 21

accordance with the CCG s Information Governance procedures to external organisations such as the NHSLA. 8.3. Staff involved in the investigation of claims and corporate affairs team staff that have a role in the handling of claims are bound by the CCG code of confidentiality as set out in employment contracts and terms and conditions. 8.4. Advice on the appropriate and legal disclosure of information can be sought from the Caldicott Guardian and Senior Information Risk Owner. 9. Claims for compensation for lost, damaged or stolen property belonging to staff 9.1. These claims are handled internally through NHS Doncaster CCG s losses and compensation procedure. 9.2. Details of losses as a result of claims will be reported to the Finance Department so that they can be recorded on the Losses & Special Payments Register. 10. How NHS Doncaster CCG makes a claim 10.1. If NHS Doncaster wishes to make a claim, full details of the potential claim must be forwarded to the Chief of Corporate Services and Chief Finance Officer, who will together analyse the details of the claim, and ascertain that all relevant information is to hand and that the organisation s excess is not more than the claim is worth. Once all the correct information is available, the CCG will write to: NHSLA s Risk Pooling Department 2nd Floor, 51 Buckingham Palace Road, London, SW1W 9SZ. 11. Communications and the Media 11.1. It should be noted that all staff of NHS Doncaster, and in particular Governing Body Members and Senior Managers, have a role to play in representing the organisation and communicating the corporate view with staff and the public. 11.2. All communication with the media should be in line with Media Relations guidance as provided by the Head of Communications, who can also be contacted for further advice/support. Page 17 of 21

11.3. It is essential to maintain absolute discretion in relation to all matters pertaining to potential legal action so as not to prejudice the outcome. Page 18 of 21

APPENDIX A May 1st 2009 To: Chief Executives and Finance Directors All NHS Bodies Dear Colleagues Apologies and Explanations I am pleased to report that the Authority s letter of 15 August 2007, on providing apologies and explanations to patients or their relatives, has been updated and endorsed widely by other organisations, so it seemed appropriate to reissue it with those endorsements included. To ensure the widest possible distribution to staff in the NHS and beyond, the co-signatories have all incorporated links to this letter on their own websites. To reduce the possibility of misunderstandings by front-line staff, the original letter has been reworded slightly in places. Apologies It is both natural and desirable for clinicians who have provided treatment which produces an adverse result, for whatever reason, to sympathise with the patient or the patient s relatives; to express sorrow or regret at the outcome; and to apologise for shortcomings in treatment. It is most important to patients that they or their relatives receive a meaningful apology. We encourage this, and stress that apologies do not constitute an admission of liability. In addition, it is not our policy to dispute any payment, under any scheme, solely on the grounds of such an apology. Explanations Patients and their relatives increasingly ask for detailed explanations of what led to adverse outcomes. Moreover, they frequently say that they derive some consolation from knowing that lessons have been learned for the future. In this area, too, the NHSLA is keen to encourage both clinicians and NHS bodies to supply appropriate information whether informally, formally or through mediation. Explanations should not contain admissions of liability. For the avoidance of doubt, the NHSLA will not take a point against any NHS body or any clinician seeking NHS indemnity, on the basis of a factual explanation offered in good faith before litigation is in train. We consider that the provision of such information constitutes good clinical and managerial practice. To assist in the provision of apologies and explanations, clinicians and NHS bodies should familiarise themselves with the guidance on Being Open, produced by the National Patient Safety Agency and available at www.npsa.nhs.uk/nrls/alerts-and-directives/notices/disclosure/ Page 19 of 21

Formal Admissions In keeping with our financial and case management responsibilities, the NHSLA will make or agree the terms of formal admissions within or before litigation. This circular is intended to encourage scheme members and their employees to offer the earlier, more informal, apologies and explanations so desired by patients and their families. Medical Defence Organisations It is critically important to note that all of the above applies to the provision of NHS indemnity to NHS bodies and employees. Should any individual clinicians wish to adopt a particular policy vis a vis apologies and explanations, in a matter which might expose them to an action brought against them as an individual, they should seek the advice of their medical defence organisation and/or professional body. Staff Support We should not lose sight of the traumatic effect that adverse outcomes, and their aftermath, might have on NHS staff as well as on patients and their relatives. Some may find compliance with these recommendations cathartic or therapeutic; others will not. None will find compliance easy. Recognising this, employers should do whatever is necessary by way of offering training, support, counselling or formal debriefing. Yours sincerely Stephen Walker CBE Chief Executive Page 20 of 21

Professional Bodies: We endorse the NHSLA guidance on apologies and explanations. For many years we have advised our members that, if something goes wrong, patients should receive a prompt, open, sympathetic and above all truthful account of what has happened. Any patient who has had the misfortune to suffer through an error of whatever nature should receive a full explanation and a genuine apology. We encourage members to adopt this approach. There are no legal concerns about taking this course of action: it is quite different from admitting liability. Dr Michael Saunders Chief Executive Medical Defence Union Dr Stephanie Bown Director of Policy and Communications Medical Protection Society Dr Jim Rodger Head of Professional Services Medical and Dental Defence Union of Scotland Dr Peter Carter Chief Executive and General Secretary Royal College of Nursing Martin Fletcher Chief Executive National Patient Safety Agency Dr. Hamish Meldrum Chairman of Council British Medical Association: The GMC fully supports this advice from the NHSLA. If something goes wrong, patients deserve an apology and a full explanation. In Good Medical Practice we say if a patient under your care has suffered harm or distress, you must act immediately to put matters right, if that is possible. You should offer an apology and explain fully and promptly to the patient what has happened and the likely short-term and long-term effects. Finlay Scott Chief Executive General Medical Council Page 21 of 21