CLINICAL/SOCIAL CARE NEGLIGENCE CASES IN NORTHERN IRELAND (2011/12) This statistical release summaries information collected from Health & Social Care (HSC) Trusts, Agencies and Legacy Health and Social Services (HSS) Boards on all clinical/social care negligence cases in Northern Ireland open during the year ending 31 st March 2012 Issue No: 1 Date of Publication: 27 March 2013 Theme: Clinical/Social Care Negligence Cases in Northern Ireland Issued by Hospital Information Branch Information & Analysis Directorate Department of Health, Social Services & Public Safety Stormont Estate Belfast, BT4 3SQ Statistician Michael O Donnell (028) 90 520064 Email Michael.O'Donnell@dhsspsni.gsi.gov.uk Internet http://www.dhsspsni.gov.uk/index/stats_r esearch/hospital-stats.htm Contents: Page Technical Notes 4 Cases Open During the Year 5 Cases at 31 st March 2012 7 Year of Incident 11 Age of Case 12 Age at Date of Incident 13 Nature of Alleged Incident 15 Specialty 18 Total Payments to Date 20 Background This statistical release is the first in the series and contains information on clinical/social care negligence cases that were open at any stage between 2009/10 and 2011/12. Key Points Year End (31 st March 2012): At 31 st March 2012, 2,540 clinical/social care negligence cases remained open in Northern Ireland (Table 2, Figure 2). Position During the Year Ending 31 st March 2012: During 2011/12, 3,158 clinical/social care negligence cases were open at any stage, a decrease of 77 (2.4%), from 3,235 during 2010/11 (Table 1, Figure 1). In 2011/12, 580 new cases were opened, 522 cases were closed and 96 cases were settled (Table 2, Figures 3, 4 & 5). For those clinical/social care negligence cases where the general nature of the alleged incident was recorded in 2011/12, over a quarter (875, 27.7%) referred to Treatment (Table 6, Figure 8). In 2011/12, almost a fifth (538, 17.0%) of clinical/social care negligence cases had been treated in the Obstetrics specialty, a decrease of 58 (9.7%) from 2009/10 (Table 8, Figure 10). A total of 42.1 million has been paid to date on the 3,158 clinical/social care negligence cases which were open at any stage during 2011/12 (Table 9). Over 32.1 million was awarded in damages and almost 10.0 million was paid out in legal costs (defence and plaintiff) on clinical/social care negligence cases which were open at any stage during 2011/12 (Table 9). Almost half (49.2%, 20.7m), of the amount paid out on clinical/social care negligence cases open at any stage during 2011/12 referred to the Obstetrics speciality with over four fifths of this (83.9%, 17.4m) paid on damages (Table 10). Published 27 March 2013
Reader Information Purpose Monitor and report the details of alleged clinical/social care negligence cases open at any stage during the year ending 31 st March 2012. Information includes all cases currently open and settled, including those withdrawn or closed with details of any monies paid. Authors Michael O Donnell, Kieran Taggart, Laura Smyth. Publication Date Wednesday 27 th March 2013 Reporting Period 1 st April 2011 31 st March 2012 Publication Issue 1 Statistical Quality Target audience Further copies from Internet address Price Copyright Information detailed in this release has been quality assured with HSC Trusts prior to release. DHSSPS, Chief Executives of HSC Board and Trusts in Northern Ireland, health care professionals, academics, Health & Social Care stakeholders, media and general public. statistics@dhsspsni.gov.uk http://www.dhsspsni.gov.uk/index/stats_research/hospital-stats.htm Free This publication is Crown copyright and may be reproduced free of charge in any format or medium. Any material used must be acknowledged, and the title of the publication specified. Clinical/Social Care Negligence Cases 2011/12 Page 2
About the Hospital Information Branch (HIB) Hospital Information Branch is responsible for the collection, quality assurance, analysis and publication of timely and accurate information derived from a wide range of statistical information returns supplied by the Health & Social Care (HSC) Trusts and the HSC Board. Statistical information is collected routinely from a variety of electronic patient level administrative systems and pre-defined EXCEL survey return templates. The Head of the Branch is the Principal Statistician, Mrs. Laura Smyth. The Branch aims to present information in a meaningful way and provide advice on its uses to customers in the HSC Committee, Professional Advisory Groups, policy branches within the DHSSPS, other Health organisations, academia, private sector organisations, charity/voluntary organisations as well as the general public. The statistical information collected is used to contribute to major exercises such as reporting on the performance of the HSC system, other comparative performance exercises, target setting and monitoring, development of service frameworks as well as policy formulation and evaluation. In addition, the information is used in response to a significantly high volume of Parliamentary / Assembly questions and ad-hoc queries each year. Information is disseminated through a number of key statistical publications, including: Inpatient Activity, Outpatient Activity, Emergency Care, Mental Health & Learning Disability and Waiting Time Statistics (Inpatient, Outpatient, Diagnostics and Cancer). A detailed list of these publications is available from: Website: http://www.dhsspsni.gov.uk/index/stats_research/hospital-stats.htm Clinical/Social Care Negligence Cases 2011/12 Page 3
Technical Notes This statistical release presents the findings of the annual collection of clinical/social care negligence cases open in Northern Ireland during the year ending 31 st March 2012. Information was provided by all Health & Social Care (HSC) Trusts including the Northern Ireland Ambulance Service (NIAS), the Northern Ireland Blood Transfusion Service (NIBTS), Legacy HSS Boards and Agencies. Data Collection The information presented within this release is based on the annual CN1 statistical return, which details the number of cases open during the financial year 2011/12. If no clinical/social care negligence cases were open at any time during the year, including those which were subsequently withdrawn or closed without payment of compensation against the HSC Trust, Legacy HSS Board or Agency, a nil return was submitted. For the 2011/12 CN1 return, a nil return was submitted by the Northern Ireland Guardian Ad Litem Agency (NIGALA). The CN1 statistical return was the first of two statistical returns introduced in June 2010 to monitor clinical/social care negligence cases in Northern Ireland. The CN1 return collects information on each case of clinical/social care negligence open during the year (1 st April 31 st March). It details information on: the type of case, gender of patient, patient postcode, date of incident, date of case, date settled, date closed, specialty to which case is associated, nature of the incident, legal stage, outcome of the case, amount paid in damages including defence and plaintiff costs, date of birth and date of death if appropriate. The second of these statistical returns on clinical/social care negligence (CN1a) is collected on a quarterly basis and presents a summary of activity during each quarter. It details the number of cases open on the last day of the quarter, new cases opened, cases closed and financial payments made during the quarter. Data providers are supplied with technical guidance documents outlining the methodologies that should be used in the collection, reporting and validation of each of these data returns. These documents can be accessed at the following link: http://www.dhsspsni.gov.uk/index/stats_resea rch/hospital-stats/hib_guidance_manuals.htm Rounding Percentages and financial information have been rounded to one decimal place and as a consequence these may not sum to the totals. Data Quality The data featured in this release has been provided by HSC Trusts, Legacy HSS Boards and Agency information staff and has been validated by Hospital Information Branch (HIB) prior to release. HIB carried out a detailed series of validations to verify that information was consistent both within and across returns. Queries arising from validation checks are returned for clarification and if required returns may be amended and/or resubmitted. It is important to note that some cases will have been settled and/or closed since 31 st March 2012 and these will be accounted for in the next publication for 2012/13. Main Uses of Data The main uses of these data are to monitor and report the details of alleged clinical/social care negligence cases open at any stage during the year, for corporate monitoring, to inform and monitor related policy, and to respond to assembly questions and ad-hoc queries from the public. Contextual Information for Using Complaint Statistics Readers should be aware that contextual information about Northern Ireland and the health services provided is available to read while using statistics from this publication. This includes information on the current and future population, structures within the Health and Social Care system, the vision for future health services as well as targets and indicators. This information is available at the following link: http://www.dhsspsni.gov.uk/index/stats_research/hos pitalstats/contextual_information_hopsital_statistics.h tm Clinical/Social Care Negligence Cases 2011/12 Page 4
What is Clinical/Social Care Negligence? For the purposes of this statistical release, clinical/social care negligence is defined as: A breach of duty of care by members of the health care and social professions employed by HSC organisations or by others consequent on decisions or judgments made by members of those professions acting in the course of their employment, and which are admitted as negligent by the employer or determined as such through the legal process. Clinical/Social Care Negligence Cases Open During the Year Table 1 details the number of clinical/social care negligence cases which were open at any stage during each of the last three years. Readers should note that if a case was open in each of the last three years it will be counted in each year. Table 1: Number of Clinical/Social Care Negligence Cases Open During the Year, by HSC Trust/Legacy HSS Board 1 (2009/10-2011/12) HSC Trust/Legacy HSS Board Cases Open During Year 2009/10 2010/11 2011/12 Number % Number % Number % % change 09/10-11/12 Belfast HSC Trust 1,025 32.4% 1,100 34.0% 1,108 35.1% 8.1% Northern HSC Trust 458 14.5% 485 15.0% 473 15.0% 3.3% South Eastern HSC Trust 497 15.7% 502 15.5% 476 15.1% -4.2% Southern HSC Trust 321 10.2% 345 10.7% 384 12.2% 19.6% Western HSC Trust 518 16.4% 500 15.5% 495 15.7% -4.4% Legacy Eastern HSS Board 168 5.3% 138 4.3% 78 2.5% -53.6% Legacy Northern HSS Board 26 0.8% 31 1.0% 26 0.8% 0.0% Legacy Southern HSS Board 74 2.3% 71 2.2% 60 1.9% -18.9% Legacy Western HSS Board 63 2.0% 52 1.6% 44 1.4% -30.2% NIAS/NIBTS 9 0.3% 11 0.3% 14 0.4% 55.6% Northern Ireland 3,159 100.0% 3,235 100.0% 3,158 100.0% 0.0% Between 2009/10 and 2010/11, the number of clinical/social care negligence cases open in each year increased by 76 (2.4%) from 3,159 to 3,235, but decreased by a similar number (77, 2.4%) between 2010/11 and 2011/12, from 3,235 to 3,158 (Table 1, Figure 1). Since 2009/10, the Belfast HSC Trust reported the largest increase in the number of clinical/social care negligence cases open (83, 8.1%), from 1,025 to 1,108 in 2011/12 (Table 1, Figure 1). Over the last three years, the Belfast HSC Trust has reported the largest number of clinical/social care negligence cases open during each year, accounting for over a third (1,108, 35.1%) during 2011/12 (Table 1, Figure 1). During the last three years, the number of clinical/social care negligence cases open, which were the responsibility of the Legacy HSS Boards decreased or remained the same in all four Boards, with the Legacy Eastern HSS Board reporting the largest decrease (90, 53.6%), from 168 in 2009/10 to 78 in 2011/12 (Table 1, Figure 1). 1 Legacy HSS Boards are responsible for alleged incidents that occurred prior to 1996, regardless of the date the claim is made. Clinical/Social Care Negligence Cases 2011/12 Page 5
Number Figure 1: Number of Clinical/Social Care Negligence Cases Open During the Year, by HSC Trust/Legacy HSS Board (2009/10-2011/12) 1,200 1,000 800 1,1001,108 1,025 2009/10 2010/11 2011/12 600 400 200 458 485 473 497 502 476 321 345 384 518 500 495 331 292 208 0 Belfast HSC Trust Northern HSC Trust South Eastern HSC Trust Southern HSC Trust Western HSC Trust Legacy HSS Boards 9 11 14 NIAS/NIBTS HSC Trust/Legacy HSS Boards Clinical/Social Care Negligence Cases 2011/12 Page 6
Clinical/Social Care Negligence Cases at 31 st March 2012 2,3 Table 2 details the number of clinical/social care negligence cases open during 2011/12, broken down by the outcome of the case (open, settled, closed) at 31 st March 2012 and the HSC Trust/Legacy HSS Board. Table 2: Number of Clinical/Social Care Negligence Cases Open, Settled and Closed, by HSC Trust/Legacy HSS Board (2011/12) HSC Trust/Legacy HSS Board Outcome of Cases at 31 st March 2012 Open Settled Closed All Cases Open During 2011/12 Belfast HSC Trust 931 84.0% 23 2.1% 154 13.9% 1,108 Northern HSC Trust 377 79.7% 20 4.2% 76 16.1% 473 South Eastern HSC Trust 373 78.4% 19 4.0% 84 17.6% 476 Southern HSC Trust 321 83.6% 25 6.5% 38 9.9% 384 Western HSC Trust 409 82.6% 0 0.0% 86 17.4% 495 Legacy Eastern HSS Board 56 71.8% 7 9.0% 15 19.2% 78 Legacy Northern HSS Board 19 73.1% 0 0.0% 7 26.9% 26 Legacy Southern HSS Board 6 10.0% 0 0.0% 54 90.0% 60 Legacy Western HSS Board 37 84.1% 0 0.0% 7 15.9% 44 NIAS/NIBTS 11 78.6% 2 14.3% 1 7.1% 14 Northern Ireland Total 2,540 80.4% 96 3.0% 522 16.5% 3,158 There were 3,158 clinical/social care negligence cases open at any stage during 2011/12, of which 1,108 (35.1%) were open in the Belfast HSC Trust, 495 (15.7%) in the Western HSC Trust, 476 (15.1%) in the South Eastern HSC Trust, 473 (15.0%) in the Northern HSC Trust, 384 (12.2%) in the Southern HSC Trust, 208 (6.6%) in the Legacy HSS Boards, 14 (0.4%) in the NIAS/NIBTS (Table 2). Over four fifths (2,540, 80.4%) of these 3,158 clinical/social care negligence cases remained open at the 31 st March 2012, 522 (16.5%) were closed and 96 (3.0%) were settled (Table 2). 2 The total number of clinical/social care negligence cases refers to the number of cases that were open at any stage during 2011/12. The number of open, settled, closed and unknown cases is given as at 31 st March 2012, the sum of which equals the total number of clinical/social care negligence cases open during the year. 3 Refer to Definitions, Notes 2, 3 & 4. Clinical/Social Care Negligence Cases 2011/12 Page 7
Number Outcome of Clinical/Social Care Negligence Cases (31 st March) The outcome of clinical/social care negligence cases open at any time during each of the last two years is detailed for the position at 31 st March each year. It is not possible to provide information on the outcome of cases open during 2009/10 due to a high level of uncoded records. However, following notable improvements in the coding of this data from 1 st April 2010 onwards, it is possible to present the outcome of cases at 31 st March for both 2011 and 2012. Cases Open An open case refers to any case open on the last day of the financial year. An open case refers to cases for which an official letter of notification of the intention to proceed with a case has been received, and which was not settled or closed on the last day of the year. At 31 st March 2012, 2,540 clinical/social care negligence cases remained open in Northern Ireland. Across HSC Trusts, the number of cases open ranged from 931 in the Belfast HSC Trust to 11 in the NIAS/NIBTS. It should also be noted that at this time, 118 clinical/social care negligence cases which remained open were the responsibility of the Legacy HSS Boards (Table 2, Figure 2). Since 2010/11, the Belfast HSC Trust reported the largest increase in the number of clinical/social care negligence cases open at 31 st March (44, 5.0%), from 887 to 931 in 2011/12. During this time, the Legacy HSS Boards reported the largest decrease (64, 35.2%), from 182 to 118 in 2011/12 (Figure 2). Figure 2: Number of Clinical/Social Care Negligence Cases Which Remained Open at 31 st March, by HSC Trust/Legacy HSS Board (2010/11-2011/12) 1,000 900 800 700 887 931 2010/11 2011/12 600 500 400 300 200 100 0 Belfast HSCT 393 377 379 373 Northern HSCT South Eastern HSCT 282 321 Southern HSCT 414 409 Western HSCT 182 118 Legacy HSS Boards 8 11 NIAS/NIBTS HSC Trust/Legacy HSS Boards Cases Settled A settled case refers to any case settled on or between the first and last days of the year. These cases may not be closed until the following year. During 2011/12, 96 clinical/social care negligence cases were settled in Northern Ireland. Of these, 25 (26.0%) were settled in the Southern HSC Trust, 23 (24.0%) in the Belfast HSC Trust, 20 (20.8%) in the Northern HSC Trust, 19 (19.8%) in the South Eastern HSC Trust, 7 (7.3%) in the Legacy HSS Boards and 2 (2.1%) in the NIAS/NIBTS (Table 2, Figure 3). Since 2010/11, the Southern HSC Trust reported the largest increase in the number of clinical/social care negligence cases settled at 31 st March (9, 56.3%), from 16 to 25 in 2011/12. During this time, the Northern HSC Trust reported the largest decrease (10, 33.3%), from 30 to 20 in 2011/12 (Figure 3). Clinical/Social Care Negligence Cases 2011/12 Page 8
Number Number Figure 3: Number of Clinical/Social Care Negligence Cases Open During the Year, which had been Settled by 31 st March, by HSC Trust/Legacy HSS Boards (2010/11-2011/12) 35 30 25 20 15 20 23 30 20 14 19 16 25 13 2010/11 2011/12 10 5 0 Belfast HSCT Northern HSCT South Eastern HSCT Southern HSCT 1 0 Western HSCT 7 Legacy HSS Boards 2 2 NIAS/NIBTS Cases Closed HSC Trust/Legacy HSS Boards A closed case refers to: (i) (ii) a case were the decision has been made to withdraw or not proceed with no money being awarded; or a case were all monies awarded have been paid, and there is no longer any activity. A case is officially closed when the Directorate of Legal Services (DLS) issue a letter that the case has been closed. During 2011/12, 522 clinical/social care negligence cases were closed in Northern Ireland. Of these, 154 cases (29.5%) were closed in the Belfast HSC Trust, 86 (16.5%) in the Western HSC Trust, 84 (16.1%) in the South Eastern HSC Trust, 83 (15.9%) in the Legacy HSS Boards, 76 (14.6%) in the Northern HSC Trust, 38 (7.3%) in the Southern HSC Trust and 1 (0.2%) in the NIAS/NIBTS (Table 2, Figure 4). Since 2010/11, the Northern HSC Trust reported the largest increase in the number of clinical/social care negligence cases closed at 31 st March (14, 22.6%), from 62 to 76 in 2011/12. During this time, the Belfast HSC Trust reported the largest decrease (39, 20.2%), from 193 to 154 in 2011/12 (Figure 4). Figure 4: Number of Clinical/Social Care Negligence Cases Open During the Year, which were Closed by 31 st March, by HSC Trust/Legacy HSS Board (2010/11-2011/12) 250 200 150 100 50 193 154 62 109 76 84 47 38 85 2010/11 2011/12 97 86 83 0 Belfast HSCT Northern HSCT South Eastern HSCT Southern HSCT Western HSCT Legacy HSS Boards 1 1 NIAS/NIBTS HSC Trust/Legacy HSS Boards Clinical/Social Care Negligence Cases 2011/12 Page 9
Number New Cases A new case refers to any case opened during the financial year i.e. 1 st April 2011 and 31 st March 2012. Between 1 st April 2011 and 31 st March 2012, 580 new clinical/social negligence cases were opened in Northern Ireland. Across HSC Trusts, the number of new cases opened ranged from 198 in the Belfast HSC Trust to 5 in the NIAS/NIBTS (Figure 5). Since 2010/11, the Southern HSC Trust reported the largest increase in the number of new clinical/social care negligence cases opened during the year (13, 14.3%), from 91 to 104 in 2011/12. During this time, the Belfast HSC Trust reported the largest decrease (38, 16.1%), from 236 to 198 in 2011/12 (Figure 5). Figure 5: Number of New Clinical/Social Care Negligence Cases Opened During the Year, by HSC Trust/Legacy HSS Board (2010/11-2011/12) 250 200 150 100 236 198 92 103 78 100 91 104 75 85 2010/11 2011/12 50 0 Belfast HSCT Northern HSCT South Eastern HSCT Southern HSCT Western HSCT 10 Legacy HSS Boards 10 2 5 NIAS/NIBTS HSC Trust/Legacy HSS Boards Clinical/Social Care Negligence Cases 2011/12 Page 10
Year of Incident Table 3 details the number of clinical/social care negligence cases that were open at any stage during each of the last three years (2009/10-2011/12), by the year in which the alleged incident occurred. Information on the date of the alleged incident was recorded for 98.4% of all clinical/social care negligence cases open in 2011/12 4, slightly higher than the proportion in 2010/11 (97.7%) (Table 3). It should be noted that clinical/social care negligence cases may not be lodged for several years after the date of the alleged incident. This would be expected in cases such as those relating to pregnancy and childbirth, where there may be a delay in the outcome of the disease or disorder. Table 3: Number of Clinical/Social Care Negligence Cases Open at any Stage During the Year, by Year of Incident (2009/10 2011/12) Year of Incident Cases Open During Year 2009/10 2010/11 2011/12 Number % Number % Number % Pre 1993 303 9.6% 267 8.3% 191 6.0% -37.0% 1993/94 37 1.2% 33 1.0% 23 0.7% -37.8% 1994/95 54 1.7% 51 1.6% 35 1.1% -35.2% 1995/96 59 1.9% 42 1.3% 32 1.0% -45.8% 1996/97 54 1.7% 38 1.2% 20 0.6% -63.0% 1997/98 76 2.4% 62 1.9% 39 1.2% -48.7% 1998/99 80 2.5% 64 2.0% 44 1.4% -45.0% 1999/00 111 3.5% 80 2.5% 61 1.9% -45.0% 2000/01 105 3.3% 88 2.7% 70 2.2% -33.3% 2001/02 144 4.6% 110 3.4% 90 2.8% -37.5% 2002/03 197 6.2% 156 4.8% 113 3.6% -42.6% 2003/04 241 7.6% 178 5.5% 126 4.0% -47.7% 2004/05 273 8.6% 230 7.1% 167 5.3% -38.8% 2005/06 326 10.3% 283 8.7% 239 7.6% -26.7% 2006/07 325 10.3% 342 10.6% 300 9.5% -7.7% 2007/08 313 9.9% 396 12.2% 406 12.9% 29.7% 2008/09 258 8.2% 345 10.7% 390 12.3% 51.2% 2009/10 120 3.8% 274 8.5% 358 11.3% 198.3% 2010/11 121 3.7% 270 8.5% 2011/12 132 4.2% % change 09/10-11/12 Unknown 83 2.6% 75 2.3% 52 1.6% -37.3% Total 3,159 100.0% 3,235 100.0% 3,158 100.0% 0.0% Almost half (1,556, 49.3%) of the 3,158 clinical/social care negligence cases open in 2011/12, referred to incidents which occurred between 2007/08 and 2011/12. A further 191 (6.0%) cases referred to incidents which occurred prior to 1993, of which 170 (89.0%) were the responsibility of the Legacy HSS Board (Table). Almost a fifth (605, 19.2%) of all cases which were open, referred to alleged incidents which took place over 10 years ago (Table 3). 4 Where the date of the alleged incident was not recorded, the year of incident has been recorded as unknown. Clinical/Social Care Negligence Cases 2011/12 Page 11
Number Age of Case 5 6 Table 4: Number of Clinical/Social Care Negligence Cases Open at any Stage During the Year, by Age of Case (2011/12) Length of Time Open Outcome at Year End Open Settled Closed No. Open During Year Less than 1 year 564 1 32 597 1 year to < 3 years 966 20 132 1,118 3 years to < 5 years 489 23 101 613 5 years to < 10 years 405 42 169 616 10 years to < 15 years 83 9 37 129 15 years to < 20 years 26 1 41 68 20 years or more 4 0 9 13 Unknown 3 0 1 4 Total 2,540 96 522 3,158 Of the 2,540 clinical/social care negligence cases that remained open at 31 st March 2012, almost two fifths (966, 38.0%) had been open for between one and three years, 564 (22.2%) had been open for less than one year and 113 (4.4%) had been open for more than 10 years (Table 4). Of the 96 clinical/social care negligence cases settled during 2011/12, over two fifths (42, 43.8%) had been open for between five and ten years. Almost all clinical/social care negligence cases (95, 99.0%) that were settled during 2011/12 had been open for more than one year (Table 4). Of the 522 clinical/social care negligence cases closed during 2011/12, almost a third (169, 32.4%) had been open for between five years and ten years, 32 (6.1%) had been open for less than one year and 87 (16.7%) had been open for more than 10 years (Table 4). Figure 6: Number of Clinical/Social Care Negligence Cases Open at any Stage During the Year, by Age of Case (2011/12) 1,200 1,118 1,000 800 600 597 613 616 400 200 0 Less than 1 year 1 year to < 3 years 3 years to < 5 years 5 years to < 10 years 129 10 years to < 15 years HSC Trust/Legacy HSS Boards 68 15 years to < 20 years 13 4 20 years or more Unknown 5 The length of time the case was open was calculated as the difference between the date the case was opened and 31 st March 2012 or the date the case was settled or closed. 6 The length of time has been recorded as unknown for cases where the date of case was not recorded. Clinical/Social Care Negligence Cases 2011/12 Page 12
Age at Date of Alleged Incident 7 Table 5 presents information on the age group of the claimant at the time of the alleged incident, for all clinical/social care negligence cases open during the last three years. Age, at the time of the alleged incident, was available for 3,057 (96.8%) of all clinical/social care negligence cases open at any stage during 2011/12. The relevant HSC Trust/Legacy HSS Board may not have been informed of the date of birth of the patient or the date of the alleged incident initially and therefore age at the date of the alleged incident is unknown. Table 5: Number of Clinical/Social Care Negligence Cases Open at any Stage, by Age Group (2009/10 2011/12) Age Group (Years) Cases Open During Year 2009/10 2010/11 2011/12 Number % Number % Number % % change 09/10-11/12 0-1 435 13.8% 397 12.3% 356 11.3% -18.2% 2-18 318 10.1% 334 10.3% 346 11.0% 8.8% 19-34 724 22.9% 826 25.5% 847 26.8% 17.0% 35-50 628 19.9% 719 22.2% 728 23.1% 15.9% 51-64 413 13.1% 465 14.4% 503 15.9% 21.8% Over 65 225 7.1% 255 7.9% 277 8.8% 23.1% Unknown 416 13.2% 239 7.4% 101 3.2% -75.7% Total 3,159 100.0% 3,235 100.0% 3,158 100.0% 0.0% Over the last three years, the number of clinical/social care negligence cases involving persons aged over 65 years increased by almost a quarter (52, 23.1%), from 225 in 2009/10 to 277 in 2011/12 (Table 5, Figure 7). Since 2009/10, the number of clinical/social care negligence cases involving children aged under one year old decreased by 79 (18.2%), from 435 to 356 during 2011/12 (Table 5, Figure 7). In 2011/12, over a quarter of cases open (847, 26.8%) referred to cases involving persons aged 19-34 years. In addition, almost a quarter (702, 22.2%) referred to cases involving persons aged 18 years and under, over half of which (356, 50.7%) involved children under one year old (Table 5, Figure 7). 7 Age at date of alleged incident was calculated as the difference between the date of birth of the patient and the date of the alleged incident. Clinical/Social Care Negligence Cases 2011/12 Page 13
Number of cases Figure 7: Number of Clinical/Social Care Negligence Cases Open at any Stage, by Age Group (2009/10 2011/12) 900 800 700 600 500 400 300 200 100 435 397 356 318 334 346 724 826 847 628 719 728 413 465 503 225 2009/10 2010/11 2011/12 416 277 255 239 101 0 0-1 2-18 19-34 35-50 51-64 Over 65 Unknown Age Group (Years) Clinical/Social Care Negligence Cases 2011/12 Page 14
Nature of Alleged Incident 8 Table 6 details the number of clinical/social care negligence cases open at any stage during the last three years broken down by the nature of the alleged incident. The nature of the alleged incident was determined by data providers using the list provided in Appendix 1. If a number of these applied the most appropriate reason for the clinical/social care negligence case was recorded. The nature of the alleged incident was recorded in 2,959 (93.7%) of all clinical/social care negligence cases open at any stage during 2011/12 (Table 6). Table 6: Number of Clinical/Social Care Negligence Cases Open at any Stage, by Nature of Alleged Incident (2009/10 2011/12) Nature of Incident Group Cases Open During Year 2009/10 2010/11 2011/12 Number % Number % Number % % change 09/10-11/12 Admissions/Referral 9 0.3% 14 0.4% 9 0.3% 0.0% Assault (to patient & by patient) 7 0.2% 9 0.3% 10 0.3% 42.9% Consent/Failure to warn 27 0.9% 22 0.7% 23 0.7% -14.8% Diagnosis & Tests 645 20.4% 706 21.8% 645 20.4% 0.0% Discharge 23 0.7% 26 0.8% 27 0.9% 17.4% Facilities & Equipment 19 0.6% 24 0.7% 35 1.1% 84.2% Infections 151 4.8% 174 5.4% 142 4.5% -6.0% Level of Care/Supervision/Follow-up 149 4.7% 190 5.9% 188 6.0% 26.2% Medication/Bloods/Fluids 80 2.5% 91 2.8% 85 2.7% 6.3% Operation 315 10.0% 303 9.4% 267 8.5% -15.2% Pregnancy & Childbirth 262 8.3% 261 8.1% 211 6.7% -19.5% Treatment 716 22.7% 819 25.3% 875 27.7% 22.2% Unexpected death 16 0.5% 19 0.6% 15 0.5% -6.3% Other 335 10.6% 332 10.3% 427 13.5% 27.5% Unknown 405 12.8% 245 7.6% 199 6.3% -50.9% Total 3,159 100.0% 3,235 100.0% 3,158 100.0% 0.0% For those clinical/social care negligence cases where the general nature of the alleged incident was recorded in 2011/12, over a quarter (875, 27.7%) referred to Treatment, 645 (20.4%) to Diagnosis & Tests and 267 (8.5%) to Operations (Table 6, Figure 8). Admissions/Referrals, Assaults (to patient and by patient), Consent/Failure to warn, Discharge and Unexpected Death accounted for less than 1% each of all clinical/social care negligence cases open during 2011/12 (Table 6, Figure 8). In 2011/12, almost a quarter (274, 24.7%) of clinical/social care negligence cases open in the Belfast HSC Trust related to Treatment, 152 (32.1%) for the Northern HSC Trust, 144 (30.3%) for the South Eastern HSC Trust, 98 (25.5%) for the Southern HSC Trust and 171 (34.5%) for the Western HSC Trust (Appendix 4). 8 A list of definitions of nature of alleged incident can be found at Appendix 1 and category groups at Appendix 2. Clinical/Social Care Negligence Cases 2011/12 Page 15
Number of Cases Within the Legacy HSS Boards, the largest percentage of clinical/social care negligence cases related to the Pregnancy & Childbirth incident group (53, 25.5%) (Appendix 4). Figure 8: Number of Clinical/Social Care Negligence Cases Open, by Nature of Alleged Incident (2011/12) 1,000 900 2009/10 2010/11 2011/12 800 700 600 500 400 300 200 100 0 Nature of Alleged Incident Clinical/Social Care Negligence Cases 2011/12 Page 16
Table 7 provides a breakdown of the six largest groups identified in Table 6, by the nature of the alleged incident. Table 7: Number of Clinical/Social Care Negligence Cases Open at any Stage, Grouped by the Nature of the Alleged Incident (2011/12) Nature of Incident No. of Cases % of Northern Ireland Total Treatment Diagnosis & Tests Operation Pregnancy & Childbirth Level of Care/Supervision/ Follow-up Other Fail to / Delay treatment 384 43.9% Inappropriate treatment 344 39.3% Fail to recognise complication of treatment 120 13.7% Others under Treatment 27 3.1% Total 875 100.0% Failure to / Delay diagnosis 520 80.6% Wrong diagnosis made 68 10.5% Failure to interpret x-ray correctly 30 4.7% Others under diagnosis & tests 27 4.2% Total 645 100.0% Intra-operative problems 131 49.1% Operator error 51 19.1% Foreign body left in situ 27 10.1% Others under Operation 58 21.7% Total 267 100.0% Birth Defects 89 42.2% Fail to monitor 2nd Stage labour 29 13.7% Pregnancy/Childbirth 25 11.8% Others under Pregnancy & Childbirth 68 32.2% Total 211 100.0% Fail to supervise 67 35.6% Lack of assistance/care 55 29.3% Inadequate nursing care 24 12.8% Others under Level of Care/Supervision/Follow-Up 42 22.3% Total 188 100.0% Other 299 70.0% Removal & retention of organs 38 8.9% Not Specified 24 5.6% Others under Other 66 15.5% Total 427 100.0% Of the 875 clinical/social care negligence cases which referred to Treatment, over four fifths (728, 83.2%) referred to Fail to / Delay Treatment (384) and Inappropriate Treatment (344) (Table 7). Of the 645 incidents which referred to Diagnosis & Tests, over four fifths of cases (520, 80.6%) referred to Failure to / Delay diagnosis (Table 7). Within the Operation category, there were 267 cases, almost half of which (131, 49.1%) referred to Intra-Operative Problems (Table 7). Of the 211 clinical/social care negligence cases which referred to Pregnancy & Childbirth, over two fifths (89, 42.2%) referred to Birth Defects (Table 7). Clinical/Social Care Negligence Cases 2011/12 Page 17
Specialty 9,10 Table 8 details the specialty in which the patient was treated, for each clinical/social care negligence case open at any stage during 2011/12. The specialty to which the clinical/social care negligence case referred to was provided in 3,133 (99.2%) of all cases open in 2011/12. Table 8: Number of Clinical/Social Negligence Cases Open at any Stage, by Specialty 11 (2009/10 2011/12) Specialty Cases Open During Year 2009/10 2010/11 2011/12 Number % Number % Number % % change 09/10-11/12 Accident & Emergency 514 16.3% 539 16.7% 534 16.9% 3.9% Anaesthetics & Pain Management 41 1.3% 56 1.7% 56 1.8% 36.6% Burns, Plastic & Maxillofacial Surgery 37 1.2% 44 1.4% 35 1.1% -5.4% Cardiology 39 1.2% 42 1.3% 34 1.1% -12.8% Children & Young People Services 27 0.9% 44 1.4% 58 1.8% 114.8% Ear, Nose & Throat 53 1.7% 52 1.6% 44 1.4% -17.0% General Medicine 183 5.8% 194 6.0% 178 5.6% -2.7% General Surgery 381 12.1% 364 11.3% 373 11.8% -2.1% Geriatric Medicine 15 0.5% 20 0.6% 20 0.6% 33.3% Gynaecology 248 7.9% 230 7.1% 225 7.1% -9.3% Mental Health Acute 33 1.0% 38 1.2% 51 1.6% 54.5% Neurology 29 0.9% 27 0.8% 22 0.7% -24.1% Neurosurgery 37 1.2% 33 1.0% 33 1.0% -10.8% Obstetrics 596 18.9% 593 18.3% 538 17.0% -9.7% Opthamology 39 1.2% 33 1.0% 28 0.9% -28.2% Paediatrics 152 4.8% 134 4.1% 103 3.3% -32.2% Pathology (Laboratory Services) 20 0.6% 21 0.6% 42 1.3% 110.0% Radiology 51 1.6% 47 1.5% 38 1.2% -25.5% Trauma & Orthopaedics 257 8.1% 288 8.9% 340 10.8% 32.3% Urology 48 1.5% 49 1.5% 46 1.5% -4.2% Vascular 28 0.9% 33 1.0% 30 0.9% 7.1% Other 245 7.8% 250 7.7% 305 9.7% 24.5% Unknown 86 2.7% 104 3.2% 25 0.8% -70.9% Total 3,159 100.0% 3,235 100.0% 3,158 100.0% 0.0% Since 2009/10, the number of clinical/social care negligence cases relating to the Trauma & Orthopaedics specialty increased by 83 (32.3%), from 257 to 340 in 2011/12 (Table 8, Figure 9). In 2011/12, almost a fifth (538, 17.0%) of clinical/social care negligence cases had been treated in the Obstetrics specialty, a decrease of 58 (9.7%) from 2009/10 (Table 8, Figure 9). 9 A list of definitions of case specialties, including Other Specialties can be found in Appendix 3. 10 This list consists of Korner specialties plus additional categories to cover community related incidents. 11 Other refers to specialties with less than 20 cases during 2011/12, including 117 cases where the specialty was reported as Other. Clinical/Social Care Negligence Cases 2011/12 Page 18
Number of cases Over half (1,785, 56.5%) of all clinical/social care negligence cases referred to the following specialties; Obstetrics (538), Accident & Emergency (534), General Surgery (373) and Trauma and Orthopaedics (340) (Table 8, Figure 9). Figure 9: Number of Clinical/Social Care Negligence Cases Open at Any Stage, by Specialty (2011/12) 700 600 500 534 538 400 300 373 340 305 200 178 225 100 0 56 35 34 58 44 20 51 22 33 28 103 42 38 46 30 25 Specialty Clinical/Social Care Negligence Cases 2011/12 Page 19
Total Payments to Date (31 st March 2012) Table 9 details the total payments to date for all clinical/social care negligence cases open during 2011/12. However, it should be noted that costs associated with a case may not be paid out in the same financial year in which the case has been received and therefore the information below refers to the amount paid on each case up to and including 2011/12. Table 9: Amount Paid to Date on Clinical/Social Care Negligence Cases Open During 2011/12 HSC Trust/Legacy HSS Board Damages Paid Defence Costs Paid Plaintiff Costs Paid Total Amount Paid No. of Cases Open Belfast HSC Trust 10,651,217 1,485,075 2,784,071 14,920,363 1,108 Northern HSC Trust 1,884,018 276,634 478,146 2,638,798 473 South Eastern HSC Trust 1,763,331 385,771 692,637 2,841,739 476 Southern HSC Trust 4,537,027 444,429 620,262 5,601,718 384 Western HSC Trust 967,420 207,249 671,660 1,846,329 495 Legacy Eastern HSS Board 7,613,009 325,438 670,691 8,609,138 78 Legacy Northern HSS Board 200,000 25,733 59,188 284,921 26 Legacy Southern HSS Board 3,560,000 52,790 549,446 4,162,236 60 Legacy Western HSS Board 972,371 140,126 46,196 1,158,693 44 NIAS/NIBTS 2,250 907 1,125 4,282 14 Northern Ireland 32,150,643 3,344,152 6,573,421 42,068,216 3,158 At 31 st March 2012, 42.1 million had been paid on the 3,158 clinical/social care negligence cases open in 2011/12. Over 32.1 million was awarded in damages and almost 10.0 million was paid out in legal costs (defence and plaintiff) (Table 9, Figure 10). The Belfast HSC Trust paid the largest amount in damages and legal costs ( 14.9m) on clinical/social care negligence cases which were open in 2011/12, accounting for over a third (35.5%) of all monies paid (Table 9, Figure 10). Damages 12 Across HSC Trusts/Legacy HSS Boards, over a third ( 10.7m, 33.1%) of the total amount paid in damages was paid by the Belfast HSC Trust, 23.7% ( 7.6m) by the Legacy Eastern HSS Board, 14.1% ( 4.5m) by the Southern HSC Trust and 11.1% ( 3.6m) by the Legacy Southern HSS Board (Table 9, Figure 10). Of the 32.2 million paid in damages, over three fifths ( 19.4m, 60.5%) was paid out on only eight (0.3%) of the 3,158 cases open during 2011/12. 12 Refer to Definitions, Note 8 Clinical/Social Care Negligence Cases 2011/12 Page 20