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Clinical Negligence Claims

Volume 815: debated on Wednesday 10 November 2021


Asked by

To ask Her Majesty’s Government what assessment they have made of the increase in the value of clinical negligence claims, which are expected to cost £8.3 billion from incidents in 2019-20.

The costs of clinical negligence are rising at an unsustainable rate, eating into resources for patient care. Annual cash payments have quadrupled in the last 15 years to £2.2 billion in 2020-21. That is equivalent to 1.5% of the NHS budget and these costs are forecast to continue rising. This is despite our substantial safety programmes. The Department of Health and Social Care is working intensively across government to address these issues.

I thank the Minister for his reply. I have raised this issue every year and have heard a similar response from the Minister sitting there every year. When a child is born severely disabled, the parents have to fight to get compensation or money to be able to look after that child. That can often take years. Does the Minister agree with the former Secretary of State for Health, Jeremy Hunt, that we should look at the Swedish model in which, if a child is born severely handicapped, the money is made available straightaway and the parents do not have to wait for the courts to provide support?

The Government have looked at a number of different schemes from abroad. It is always very important to learn from good and bad practice, but what happens in a number of those cases is that the costs of compensation end up increasing. So We are looking at various solutions.

My Lords, the new indemnity scheme for historical clinical negligence that was brought into effect last year, the Existing Liabilities Scheme for General Practice, initially applied only to general practice members of the Medical & Dental Defence Union of Scotland, with general practice members of the Medical Protection Society due to come under its purview a full year later, in April just past. So I ask the Minister to update the House of any formal or informal assessments of the workings of this scheme in Scotland, the level of uptake and lessons learned, before it was further rolled out.

Before I respond, I wish to give a belated welcome to my noble friend Lady Davidson. I have worked with her often in the past, and she displays a wisdom beyond her years and a sense of humour that excels that of many on our Benches. To answer my noble friend, the Existing Liabilities Scheme for General Practice covers the historical liabilities of GPs, where the department has agreed commercial transactions with the previous indemnity providers. The scheme applies only to general practice in England and is part of the state indemnity reforms introduced in England in 2019. These 2019 reforms mean that GPs in England now benefit from more stable and affordable indemnity to cover future negligence claims. I understand that similar arrangements were introduced in Wales at the time. I am afraid that the policy on state indemnity is a devolved matter, but officials in the department are in regular contact with their counter- parts in the devolved Administrations.

My Lords, some 10 years ago the NHS Litigation Authority concluded in its maternity claims report that

“the most effective way to reduce the financial and human cost of maternity claims is to continue to improve the management of risks associated with maternity care, focusing on preventing incidents involving the management of women in labour”.

Yet, in the intervening 10 years, the number of claims has gone up from 391 in 2009 to 765 in 2019-20. Is it not about time that we put patient safety first in these considerations rather than looking at what happens to lawyers, and take some lessons from the airline industry where, if something goes wrong, we start by looking at no-fault and do not allocate blame but look at improving the system?

The noble Baroness raises an important point. However, in looking at the system overall, there is no evidence to suggest that the rise in overall costs is due to a decrease in NHS safety. Nevertheless, safety and learning from incidents are essential in their own terms. Our ambition is for the NHS to be the safest in the world and for maternity safety to be a priority, and there are various schemes in place.

My Lords, can the Minister tell me why the Government do not move to repeal Section 2(4) of the Law Reform (Personal Injuries) Act 1948, which essentially disregards treatment that the claimant may receive under the NHS? Can he also do something about the record of NHS Resolution in paying damages in 80% of litigated cases, with its lawyers being paid on a win-or-lose basis and therefore incentivised to carry on with unsustainable defences?

The noble Lord raises an important point about how we resolve a number of these issues. As many noble Lords will be aware, when the NHS does a wonderful job, we all support it but, sadly, when it does not do such a good job, there is a culture of delay, defend and deny. Sometimes it is incredibly difficult, and I have heard of people who have had terrible experiences in trying to get someone to resolve their issue. I heard of a very sad case: a young official in the department told me that a friend of hers, a young Afro-Caribbean lady, 24 years old, lost a baby and, miraculously, the papers have disappeared. They are now trying to gaslight this poor patient. It is really important that we resolve this.

In terms of the cost, NHS Resolution negotiates large-scale contracts for defendant legal services, using its position as a bulk purchaser to obtain the best expertise. NHS Resolution is looking to resolve claims promptly and most claims are often settled without court proceedings or going to trial. It is a difficult balance because while we may be concerned about the fees of the injury lawyers, they are able to shine a spotlight on the NHS delay and denial, as it were, and go further when many patients themselves or their families are in distress.

My Lords, the element of compensation in clinical negligence cases which relates to the cost of further health treatment is based on the cost of care in the private sector. Why is this so when NHS treatment is as good or better? Should not private health costs be provided only where the patient cannot get treatment on the NHS?

Quite often patients choose to go on the NHS and when they are unable to do so because of various factors they will go private. I wonder whether we should be giving preference. We want to treat all patients equally.

My Lords, given that the key to reducing the overall cost of clinical negligence is to have less of it, the real issue is the need to increase joined-up patient safety learning across the NHS. Does my noble friend the Minister accept that the cost of current legislation—that is, damages and claimant legal costs—is reducing in any event, as detailed in the NHS Resolution annual reports of 2020 and 2021, and that the overall payment for claims in 2019-20 was therefore £2.2 billion?

My noble friend raises an important point. The Government remain committed to continuous safety improvement, particularly on developing learning cultures in our health system and tackling the issues of denial and delay. While we strive towards this goal, we have seen that the cost of clinical negligence claims has quadrupled in the last 15 years, and there is no guarantee that reducing harm would necessarily result in fewer claims. In many cases, the overall costs are being driven by increases in the average cost per claim. Indeed, claims have recently levelled out, falling from £2.26 billion to £2.17 billion but this is largely due, in least in part, to the coronavirus pandemic.

My Lords, the annual cost of clinical negligence has risen from £1 million in 1975 to £2.2 billion last year, as we have just heard. The Medical Defence Union’s evidence to the Health and Social Care committee’s inquiry into NHS litigation reform predicted that any money raised by the new health and social care levy would be entirely swallowed up by the amounts being paid out each year in NHS clinical negligence claims. What assessment have the Government made of this claim, how does it impact their plans to reduce the huge NHS waiting lists for treatments, and what money will be left for social care?

The noble Baroness raises an important point that spending more on compensation means less money for the care of patients. That is why we are committed to looking at various ways of reducing this and are working with the Ministry of Justice. Issues include the role the royal colleges play and the training they give to their medical staff, while needing to instil a culture of more openness when things go wrong. When things go right, we are ready to praise but when things go wrong, they have to stop hiding, delaying and denying, and be open.

Thank you. I accept entirely what the Minister says about learning from experience but was this not supposed to have been baked into the NHS after numerous reports in recent years? Does he accept that we need to look again at the way in which the NHS trusts are often slow in learning from their mistakes, rather than allowing this culture to continue?

I completely agree with the sentiments behind the question. It is important that at all stages we bake in a culture of openness in the NHS so it can no longer hide behind the fact that we are full of praise for it when it does things well. However, when things go wrong, I am afraid that it shuts up shop and hides behind various techniques. It is important that we are as open as possible in trying to make sure we tackle some of the problems and learn in the future.