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NHS: Clinical Negligence

Volume 788: debated on Wednesday 31 January 2018


Asked by

To ask Her Majesty’s Government what progress they have made in reducing (1) the amount set aside in NHS budgets for clinical negligence claims, and (2) the annual level of payment for such claims.

My Lords, the Government are committed to tackling clinical negligence costs. To do so, we have proposed to fix the amount that legal firms can recover from clinical negligence claims, proposed a scheme so that families whose babies experience severe, avoidable birth injuries have an alternative to lengthy court proceedings, and brought forward our ambition to halve maternal and neonatal deaths, brain injuries and stillbirths from 2030 to 2025.

I thank the Minister for that Answer. Last year, the NHS paid out £1.7 billion in settlements for negligence claims—a 15% increase on the year before. A substantial part of that enormous amount was intended for the provision of private sector care. That is because Section 2(4) of the Law Reform (Personal Injuries) Act 1948 requires claims to be calculated on the basis of private healthcare, not the NHS. Allowing claims to be made on the basis of costs to the NHS would dramatically reduce costs. Does the Minister agree that repealing Section 2(4) would save the NHS an enormous amount of money?

I recognise the issue the noble Lord has raised; it has been raised by a number of people who are concerned about and interested in this issue, as we all are. The problems are significant. The annual costs of dealing with these injuries and other issues has quadrupled over the last 10 years. That is the scale of what we are dealing with. We have to act—indeed, the National Audit Office has implored us to act. It is one of the issues we are considering as part of a cross-government strategy that will report in September. I am not in a position to give more detail at this stage, but it is an area we are looking at.

My Lords, I have acted for the NHS and the MDU on a number of occasions. However, perhaps the Minister will help me. One of the reasons why these claims have increased in value is because of the rather mysterious decision by the Government to alter the discount rate, which has often resulted in the doubling of the size of claims. Can he tell the House whether the Government are seriously considering placing a cap or tariff on damages, as is often done in other jurisdictions? That would not only clarify the amount of damages obtained, but significantly reduce the legal costs involved in such disputes.

The noble Lord knows more about this issue than anyone in the House, I think. The issue of reform to tort law is difficult. We have to be very careful when stepping across the idea of full compensation. It is one of the issues we are looking at. Other countries, such as Australia, have looked at this and we are considering it as part of the cross-government strategy. As I said, we will report by September this year on our plans in this area.

My Lords, it is estimated that a relatively small number of clinical negligence cases end up as claims filed with the NHS. Has the NHS undertaken additional efforts to understand what factors cause certain cases to be escalated, in particular the attitude of lawyers in the NHS and trusts? How can escalation be prevented and, if so, when might the results be published?

I point the noble Baroness in the direction of a five-year strategy that was published by NHS Resolution, the body that acts on behalf of what used to be the NHS Litigation Authority. The strategy looked at many issues, not only how we can prevent escalation. One of the drivers of cost is unsuccessful claims; more of those are going on. It also looked at how we can reduce incidents in the first place and learn from deaths and injury throughout the system, so that we can start to reduce the burden overall.

My Lords, it is telling that if you google “clinical negligence”, the first four or five pages that come up are companies offering their services to support people making claims. According to the Medical Protection Society report last year, the annual costs to the NHS in England of settling clinical negligence claims was equivalent to training 6,500 doctors. That is expected to double by 2023, so the noble Lord is quite right that this is a terrible drain. I am very pleased to hear that the Government have plans to reduce the number of claims. Have they included taking into account the recommendations in the PAC report published at the end of last year?

We absolutely have. Indeed, the PAC investigation and the National Audit Office report on this issue are very thorough and looked at the causes and drivers behind it. One is increased NHS activity—not worse safety but the fact that the NHS is doing more. The investigation also looked at the legal environment and some of the changes that have occurred. The noble Baroness is right: a number of firms offer these services. That is important for access to justice but we also need to fix the costs that they can claim so that we get this budget under control.

My Lords, the statistics show that 46% of the litigation cases involve misdiagnosis and 34% involve surgical errors. However, the largest settlements are for obstetric cases, particularly those related to babies who have suffered brain damage at birth. The important thing is to prevent these accidents occurring. The key issue here is better and continuous training in interpreting foetal heartrate patterns during labour. That is what we should focus on—preventing these cases happening.

I completely agree with the noble Lord and make two points in response. He will know of the Secretary of State’s great passion for this area and of the maternity safety training funding and other training funding. From April, we will introduce the healthcare safety investigation branch, which will investigate each of the 1,000 incidents noted by the Each Baby Counts project which occur at birth, whether brain damage or neonatal death, precisely so that we can learn from that experience and make sure that those who provide these services are properly trained to avoid these incidents wherever humanly possible.

My Lords, we need to do something to tackle this issue much more urgently as the total cost of the litigation in the pipeline is some £65 billion—half the NHS budget. Until and unless we do something about changing Section 2(4) of the relevant Act we will have a continuing problem with patients claiming for private care when they should have their care provided by the NHS.

I agree with my noble friend; this is an issue, not least because, when that Act was brought in, the NHS was a very different creature and did not offer the extensive range of care that it does now. We need to make sure that we are not effectively paying twice. However, this is a difficult and complex legal issue. It is important that we take our time to investigate how we tackle it properly so that those who are unfortunately affected by poor care are not put at a disadvantage for the rest of their lives.