NHS Resolution’s Annual report and accounts reports on the first year of a new indemnity scheme for General Practice (CNSGP), bringing information on clinical negligence claims against the NHS in England under one roof for the first time. The report also describes the rapid launch of a new scheme, the Clinical Negligence Scheme for Coronavirus (CNSC) to provide a safety net for new healthcare arrangements arising out of the pandemic.
In addition to new indemnity arrangements, our response to the pandemic has included moving our staff to 100% remote working for the time being, pausing some of our reporting requirements, releasing our clinical staff back to the service and supporting NHS England and Improvement with the registration of returning practitioners. Whilst it is too early to evaluate the impact of the pandemic on our indemnity schemes and the other services we deliver at present, this will be closely monitored as the year ahead unfolds.
Complemented by a refreshed corporate strategy, CNSGP is now fully operational and working well with positive feedback, although claims volumes are, as expected, still low. NHS Resolution has grown its operation in Leeds in order to respond effectively to the expansion of its indemnity schemes. As NHS Resolution is now also administering claims for historic events for two Medical Defence Organisations.
Some positive trends are noted, including for the first time for many years, a reduction of the provisions for claims in secondary care, a continued reduction in court proceedings and a decline in average claimant legal costs, as reforms to no-win no-fee start to take effect.
Whilst new clinical negligence claims increased by 9.35% this is against a backdrop of increased NHS activity and increased numbers of incidents being reported to us, such as those arising from mesh. Claims for serious injuries at birth have shown small declines for three successive years and are now at their lowest level for over 10 years.
Maternity continues to dominate claims costs however, with continuing increases in claims values, representing almost 70% of the cost of harm[1]. It remains a focus of our work with partners across the healthcare system to drive improvements in safety. A conference launching the clinical findings from our Early Notification scheme was attended by maternity staff from across the country, engaging with the Royal Colleges and others in emerging themes and practical solutions for safer maternity care. We completed an evaluation of the maternity incentive scheme, which concluded that the scheme had delivered demonstrable progress in driving the ten essential actions which support the safety workstream of the national Maternity Transformation Programme. This highlighted in particular, improvements in safety culture and trust board engagement in maternity issues as well as additional funding being made available to recruit to key posts and greater influence for multi-disciplinary working.
Effective partnership working, in maternity, general practice and across the healthcare and justice systems is described in our annual report as a feature of the year and is key to our strategy to resolve cases fairly and learning from harm. The shift in how mediation is viewed by the clinical negligence legal market is a welcome signal of an increasingly collaborative approach for the benefit of patients and healthcare staff.
We have seen a more collaborative approach to investigating claims for compensation across the legal market. Litigation has reduced for the fourth year running and mediation is now seen as mainstream. The pandemic has placed enormous pressure on our colleagues across the NHS and it has been encouraging to see remote mediations taking place so that cases can continue to be resolved without added stress to patients and those who care for them. Together with the delivery of a new indemnity scheme, which has provided much needed assurance to those delivering healthcare during the pandemic, there is much to build on so we can see longer term benefits from these changes.
Helen Vernon, Chief Executive of NHS Resolution said:
A full copy of NHS Resolution’s Annual report and accounts 2019/20 is now available to review.
[1] The annual cost of harm for clinical negligence compensation for secondary care in England through our Clinical Negligence Scheme for Trusts from 2019/20 incident year activity.
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Notes to editors
- The annual cost of harm arising from clinical activity during 2019/20 covered by the Clinical Negligence Scheme for Trusts was £8.3 billion in 2019/20, reducing from £8.8 billion for 2018/19.
- The provision for the liabilities arising from claims for all financial years covered by all NHS Resolution schemes has increased by £0.7 billion from £83.4 billion to £84.1 billion.
- NHS Resolution’s longstanding schemes reduced by £0.6 billion offset by an increase of £1.3 billion in relation to general practice indemnity liabilities recognised for the first time. These costs will be met from annual budgets allocated to the NHS, and as such, NHS Resolution is not required to hold assets to cover the provision.
- The cost of settling claims in 2019/20 reduced by £103 million, to £2.3 billion on longstanding schemes. An additional
£61.4 million was spent on settling general practice claims. - 11,682 new clinical claims and reported incidents were recorded in 2019/20.
- Of the 15,550 claims resolved in 2019/20, 71.5% were resolved without court proceedings, 27.9% with proceedings and 0.6% at trial.
- Overall, the proportion settling with damages increased by 1% compared to 2018/19.
- Maternity claims remain the highest value area, representing 50% of the total value of all clinical negligence claims received, 69% of the incurred cost of harm and 72% of the total CNST provision.
- Practitioner Performance Advice received 775 new requests for advice in 2019/20 compared to 925 in the previous year.
- Primary Care Appeals received 162 appeals in accordance with the Pharmacy Regulations compared to 171 in the last financial year.
