Asked by: Lord Sharkey (Liberal Democrat - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty's Government how many actions for clinical negligence were filed against NHS England institutions in each of the last ten years; how many of those actions were (1) brought to trial, and (2) withdrawn; and what was the average length of time between filing and conclusion.
Answered by Lord O'Shaughnessy
General practitioners’ (GPs) and dentists’ indemnity to cover clinical negligence payments is currently provided privately by Medical Defence Organisations. The Department does not have access to this information regarding primary care and dentistry.
NHS Resolution has provided the following information:
NHS Resolution has included all clinical negligence claims, excluding those against independent sector organisations.
NHS Resolution has advised that many of these claims have not been settled yet and so the number of claims that have been taken to trial and the number of claims that have closed with nil damages will increase over time. Likewise the time to resolution, i.e. notification to settlement of damages, is based on claims that have settled so far. This figure will change when further claims have been resolved, especially in the more recent years.
The following table shows clinical negligence claims notified 2007/08 to 2016/17 as at 31/03/2017 excluding claims against independent sector organisations.
Year of Notification | Number of Claims Received | Number of Claims Settled with Nil Damages | Number of Claims that have gone to Trial | Average Time from Notification to Settlement of Damages (years) |
2007/08 | 5,468 | 1,933 | 24 | 1.47 |
2008/09 | 6,092 | 2,121 | 37 | 1.44 |
2009/10 | 6,656 | 1,897 | 39 | 1.30 |
2010/11 | 8,642 | 2,651 | 48 | 1.26 |
2011/12 | 9,132 | 2,840 | 83 | 1.32 |
2012/13 | 10,117 | 3,343 | 68 | 1.33 |
2013/14 | 11,908 | 3,968 | 52 | 1.25 |
2014/15 | 11,404 | 3,758 | 28 | 1.08 |
2015/16 | 10,841 | 3,231 | 1 | 0.80 |
2016/17 | 10,441 | 1,314 | 1 | 0.48 |
Asked by: Lord Sharkey (Liberal Democrat - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty's Government, in each of the last five years, what was (1) the total provision made by NHS Resolution, and its predecessor bodies, against claims for clinical negligence, and (2) the total amount paid out in the settlement of claims for clinical negligence, broken down by legal costs and awards to claimants.
Answered by Lord O'Shaughnessy
NHS Resolution has provided the following information.
The total provision made by NHS Resolution and its predecessor bodies against claims for clinical negligence and the total amount paid out in the settlement of claims for clinical negligence, broken down by legal costs and awards to claimants is shown in the attached tables due to the size of the data.
Asked by: Lord Sharkey (Liberal Democrat - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty's Government what assessment they have made of recent rises in NHS Resolution's provision against claims for clinical negligence; what provision against claims for clinical negligence will be needed in each of the next three financial years; and what action they are taking to reduce the level of such provision.
Answered by Lord O'Shaughnessy
NHS Resolution’s provision for clinical negligence claims at 31 March 2017 was £64.7 billion. Recent rises in the provision are due to a number of factors including increases in the number of claims received, the amount of damages awarded, particularly in maternity claims and legal costs. This is also influenced by two discount rates:
- The long term Public Expenditure System, set by HM Treasury, enabling a present value to be placed on future liabilities for accounting purposes but not affecting the costs of settling claims, changed from +2.2% to -0.8% from 31 March 2016, and increased the provision by £25.5 billion in 2015/16.
- The personal injury discount rate (PIDR), set by the Lord Chancellor, places current value on future losses for settlement through lump sum payments, affecting the cost of settling claims. PIDR changed from +2.5% to -0.75% from 20 March 2017 and contributed £4.7 billion to the increase in the provision in 2016/17.
The Government published draft legislation in September to reform the legal framework governing how the PIDR is set. The proposals will help ensure that claimants continue to receive full compensation but should significantly reduce overpayment by more reliably reflecting how awards are invested. Subject to its consideration of the Justice Select Committee’s pre-legislative scrutiny report and comments received from stakeholders on the draft legislation, the Government plans to introduce legislation to reform the law as soon as possible.
The provision is calculated annually taking into account latest developments in the claims environment to inform assumptions about claims volumes, inflation in settlements and legal costs and time to settle claims. It is, therefore, not possible to provide an accurate provision for the next three years although it will continue to increase for some years to come for inflationary and other reasons.
NHS Resolution manages the costs of claims appropriately, challenging claims without merit, excessive claims for damages and claimant legal costs. It works with trusts to help them understand their claims data to better assess where local interventions would have the greatest impact in reducing high volume or high cost claims, and shares learning and best practice from its analysis of claims. Its new strategy, Delivering fair resolution and learning from harm: Our strategy to 2022 gives it an enhanced focus on mediation, learning and prevention, as well as litigation, and it will deliver increased insight into what drives the costs of harm and work with others to develop interventions that improve safety and save money for the NHS, as demonstrated by its recent report Five years of cerebral palsy claims: A thematic review of NHS Resolution data. A copy of both documents is attached.
Following recent reports by the National Audit Office and the Public Accounts Committee on clinical negligence costs, the Department is working with the Ministry of Justice, HM Treasury and NHS Resolution and others to develop a cross government strategy to reduce them. This work is supported by our pursuit of improved safety standards and a transparent, learning culture across the NHS.
Asked by: Lord Sharkey (Liberal Democrat - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty’s Government whether they intend to publish the NHS England Research and Development plan for 2016–17; if so, when, and if not, why not.
Answered by Lord Prior of Brampton
A draft version of NHS England’s Research and Development Plan for 2016/17 is currently out with stakeholders for information and comment. A copy of the final version will therefore be published on NHS England’s website in due course once it has been agreed and approved.
Asked by: Lord Sharkey (Liberal Democrat - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty’s Government what is the nature and extent of the relationship, including financial arrangements, between HMRC and Bounty, between NHS England and Bounty, and between NHS Foundation Trusts and NHS Trusts and Bounty.
Answered by Lord Prior of Brampton
National Health Service trusts may negotiate locally with commercial organisations to distribute advice, information and ‘try before you buy’ samples that they think would be useful for pregnant women.
Neither the Department nor NHS England centrally have any contracts with Bounty or influence over the contents of the packs nor does the Department benefit financially from such arrangements. We do not have any information about what contracts might exist between Bounty and individual NHS trusts.
Although we are aware of Bounty distributing their packs on maternity wards, we have no evidence of whether or not this is welcomed by parents.
Her Majesty’s Revenue and Customs (HMRC) use the services of Bounty to help distribute Child Benefit claim packs to new mothers in NHS hospitals. The contract for this service is held by HMRC’s Print Vendor Provider, Williams Lea. Using the Bounty pack as one channel for distributing Child Benefit forms has proved efficient and cost effective. The Child Benefit form can also be obtained through other channels, notably the HMRC website.
In 2012-13, HMRC paid £85,990.27 (excluding VAT) for Bounty to distribute a total of 857,939 English and Welsh language claim forms.
Asked by: Lord Sharkey (Liberal Democrat - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty’s Government which commercial organisations are permitted to promote or distribute their products or the products of other organisations in NHS maternity wards; what revenues accrue to the Government or the NHS from that activity; and what evidence there is that patients welcome such activity.
Answered by Lord Prior of Brampton
National Health Service trusts may negotiate locally with commercial organisations to distribute advice, information and ‘try before you buy’ samples that they think would be useful for pregnant women.
Neither the Department nor NHS England centrally have any contracts with Bounty or influence over the contents of the packs nor does the Department benefit financially from such arrangements. We do not have any information about what contracts might exist between Bounty and individual NHS trusts.
Although we are aware of Bounty distributing their packs on maternity wards, we have no evidence of whether or not this is welcomed by parents.
Her Majesty’s Revenue and Customs (HMRC) use the services of Bounty to help distribute Child Benefit claim packs to new mothers in NHS hospitals. The contract for this service is held by HMRC’s Print Vendor Provider, Williams Lea. Using the Bounty pack as one channel for distributing Child Benefit forms has proved efficient and cost effective. The Child Benefit form can also be obtained through other channels, notably the HMRC website.
In 2012-13, HMRC paid £85,990.27 (excluding VAT) for Bounty to distribute a total of 857,939 English and Welsh language claim forms.
Asked by: Lord Sharkey (Liberal Democrat - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty’s Government whether, before withdrawing supplementary funding for the highly specialist work carried out at tertiary and teaching hospitals in England, they carried out an impact assessment of the effects of such a withdrawal on medical research; if not, why they did not do so; and if so, whether they will publish that assessment.
Answered by Lord Prior of Brampton
The supplementary funding, known as Project Diamond funding, was provided by the former London Strategic Health Authority in recognition of arguments made by providers about the higher costs of tertiary and teaching hospitals both for research and service provision. The research component was subsequently taken on by the Department, and the service component was taken on by NHS England.
In the case of research funding, the Department’s view is that the approach to funding already recognises the higher costs of providing services. For example, a large part of funding is bids based. In bidding for research funding, providers will have taken into account all the costs they face. Any supplementary funding would be double-counting costs. Consequently the Department does not expect an impact on medical research from withdrawing funding as existing funding streams should meet all costs.
In the case of funding for specialised services to patients, 2014/15 was the final year of supplementary funding provided by NHS England. Refinements to the National Tariff are being made, including the introduction of HRG4+, that make a significant improvement in recognising the additional costs associated with patient complexity. However no payment system can perfectly reflect patient complexity and other local issues. Monitor have a published process for providers who wish to seek an amendment to tariff prices, known as the local modification process.
Asked by: Lord Sharkey (Liberal Democrat - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty’s Government how much has been paid out by the National Health Service in settlement of clinical negligence claims both in absolute terms and as a percentage of the NHS budget in each of the last ten years for which data are available<i>.</i>
Answered by Earl Howe - Deputy Leader of the House of Lords
The Department does not hold complete information on this centrally, as each National Health Service body is responsible for handling its own litigation except where they have the claims processed under the statutory NHS indemnity schemes, which are administered by the NHS Litigation Authority (NHS LA) on behalf of the Secretary of State. However, the vast majority of litigation claims against the NHS are handled by the NHS LA, and costs met from its schemes.
The following table shows the payments paid out by the NHS LA in settlement of clinical negligence claims both in absolute terms and as a percentage of the Department’s total departmental expenditure limit (TDEL) in each of the last ten years for which data are available.
Payments made by NHS LA in respect of clinical negligence claims against the NHS:
Year
| Total Payments £'000 | (TDEL) Outturn £’000 | Percentage
| |
2004-05 | 502,893 | 69,000,000 | 0.7% | |
2005-06 | 560,308 | 76,000,000 | 0.7% | |
2006-07 | 579,390 | 81,000,000 | 0.7% | |
2007-08 | 633,325 | 84,000,000 | 0.8% | |
2008-09 | 769,226 | 91,000,000 | 0.8% | |
2009-10 | 786,991 | 98,000,000 | 0.8% | |
2010-11 | 863,398 | 100,000,000 | 0.9% | |
2011-12 | 1,277,372 | 103,000,000 | 1.2% | |
2012-13 | 1,258,880 | 105,000,000 | 1.2% | |
2013-14 | 1,192,538 | 110,000,000 | 1.1% |
Note:
1. Numbers taken from the Department’s Annual Report and Accounts
2. During the Spending Review 2010 period (i.e. 2011-12 to 2014-15), there have been two significant Machinery of Government changes to transfer functions and spending from DH to the Department for Communities and Local Government. These changes were only backdated to 2007-08 and therefore the TDEL figures for financial years before this date are not directly comparable.
Asked by: Lord Sharkey (Liberal Democrat - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty’s Government by how much the provision for clinical negligence claims against the National Health Service has grown in the last year; why it has grown; and what strategy is in place for reducing that amount.
Answered by Earl Howe - Deputy Leader of the House of Lords
As at 31 March 2014, the National Health Service Litigation Authority (NHS LA) estimates that it has potential liabilities of £26.1 billion, of which £25.7 billion relates to clinical negligence. This is an increase of £3.1 billion from 31 March 201, which can mainly be attributed to a continual rise in clinical negligence claims over recent years. There are a number of factors driving this increase, including the rise in the number of patients cared for and in the complexity of their care; and the general rise in litigation across a number of sectors including the NHS, driven in part by ‘no win, no fee’ agreements. It is anticipated that the effect of the latter is likely to diminish as a result of the Government’s Legal Aid Sentencing and Punishment of Offenders Act of 2012.
The Department believes the best way to reduce negligence claims is to improve patient care and safety. In March 2014, the Secretary of State for Health issued a call to action to make the NHS the safest healthcare system in the world and achieve a three-year goal to halve avoidable harm and save 6,000 lives. The Sign up to Safety campaign embodies the ambition of the NHS to build a culture of safety, bringing together individuals and organisations with a contribution to make towards the patient safety goal. Elements of this campaign will focus on a reduction in avoidable harm that can lead to compensation claims. Organisations that sign up are setting out what they will do to strengthen patient safety, including a safety improvement plan which shows how their organisation intends to save lives and reduce harm for patients over the next three years. The NHS Litigation Authority, which already provides a “safety and learning service” to trusts, will support those organisations which have patient safety improvement plans that show a likely reduction in their higher volume, higher value claims.
Asked by: Lord Sharkey (Liberal Democrat - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty’s Government whether the "Nicholson Challenge" still operates within the National Health Service; if so, what efficiency savings have been identified to date; and, if not, why not.
Answered by Earl Howe - Deputy Leader of the House of Lords
The 2010 Spending Review protected health funding in real terms. However, in order to continue to meet rising demands while improving services, it was estimated that up to £20 billion of efficiency savings would be required over the four years from 2011-12 to 2014-15.
The National Health Service response to this challenge was organised through the Quality, Innovation, Productivity and Prevention (QIPP) initiative, also known colloquially as the ‘Nicholson challenge’ after Sir David Nicholson, who was Chief Executive of the NHS at the time that QIPP originated.
The NHS is on track to deliver up to £20 billion efficiency savings, having reported around £15 billion of efficiencies in the first three years, all of which will be reinvested into frontline care.