NHS Resolution’s Annual report and accounts for 2023/24, published today, demonstrates that the organisation’s continued innovation in dispute resolution, and a collaborative approach, have continued to deliver benefits and enhance opportunities to learn and improve safety.
In line with NHS Resolution’s strategy to keep patients and healthcare staff out of court, a record 81% of claims in England were resolved in 2023/24 without resorting to legal proceedings, continuing a trend seen over the last seven years.
This means that over 10,800 claims were resolved for patients and their families through our various dispute resolution processes rather than formal legal processes.
The report also describes how the continued development of ‘upstream’ approaches such as our Early Notification (EN) scheme have helped families to access compensation for immediate needs more rapidly.
NHS Resolution has built on the success in resolving clinical claims for compensation against the NHS in England without exposing patients, families and healthcare staff to distressing and costly court proceedings. Last year, eighty-one percent of clinical claims were resolved without litigation, reflecting our ambition to minimise the use of formal legal action in settling claims. This has been achieved by strengthening our relationships with our NHS partners and the legal market. Throughout our work, our focus has been to deliver an efficient and effective service that provides the best possible value for public funds, and this has driven many of the programmes to invest in our people and our systems.
Helen Vernon, Chief Executive of NHS Resolution
NHS Resolution has also produced five insights papers and hosted a range of webinars and events for the NHS. All of this work has complemented the focus on dispute resolution and patient safety.
The annual report and accounts show that claims trends have remained broadly steady in 2023/24 in terms of the numbers of claims reported and resolved. In 2023/24, around half of clinical claims were closed with compensation being payable, similar to the previous year. This demonstrates NHS Resolution’s continued commitment to investigating claims robustly and fairly, while making damages payments where the merits of the case warrant it.
The overall value of damages, particularly for the most severely harmed patients, has continued to increase, as have claimant legal costs, but with some welcome positive signs such as a further reduction in damages inflation, which has reduced the overall provision for clinical negligence.
£2.8 billion was paid out in 2023/24 for compensation and associated costs on all of NHS Resolution’s indemnity schemes for clinical negligence claims, compared to £2.64 billion in 2022/23 for clinical negligence claims. 41%, or £1.15 billion, are maternity-related payments, the same percentage as 2022/23.
There has been an increased demand for NHS Resolution’s expert Practitioner Performance Advice (Advice) service, which responds to concerns about practitioner performance. This has been driven by the wider challenges in the NHS. There was a substantial increase of 21% in new requests for advice and a particularly high demand for assessments of professional behaviours with a clear focus on patient safety. Over 2023/24 there has also been a high demand for the Advice’s educational programmes, with income from this source exceeding expectations demonstrating the value placed on this important service to the NHS.
The estimated ‘annual cost of harm’ for incidents in 2023/24 for the main clinical scheme, Clinical Negligence Scheme for Trusts (CNST) was over £4.7 billion. In 2022/23 the ‘annual cost of harm’ for CNST was £6.3 billion. This figure is lower than the previous year’s figure mainly owing to increases in HMT discount rates, which has placed a lower value on projected claims costs.
The number of clinical claims resolved in 2023/24 was 13,382, compared to 13,552 in 2022/23. The total number of new clinical negligence claims and reported incidents in 2023/24 totalled 13,784, an increase of 273 on 2022/23 (13,511).
In the Clinical Negligence Scheme for General Practice (CNSGP) there were 202 more claims (2,382 in 2023/24 compared to 2,180 in 2022/23), an increase of 9% compared to 2022/23.
NHS Resolution’s provision as of 31 March 2024 was £58.5 billion (£58,480 million), compared to £69.6 billion in 2022/23. The reduction is primarily due to the change in HM Treasury long-term discount rates, an accounting estimate which places a value in today’s prices on liabilities that are expected to fall due for settlement in the future. If the discount rate changes for 2023/24 were not applied, the equivalent cost of harm for CNST for 2023/24 would have been £6.1 billion (£6,137 million). This figure is slightly lower than the corresponding 2022/23 cost of harm figure of £6.3 billion (£6,278 million).
The volume of non-clinical claims reported in 2023/24 (3,299) is comparable to 2022/23 (3,136) although remains lower than pre-pandemic levels.
NHS Resolution’s Annual report and accounts 2023/24 is now available.
NOTE: Unfortunately we have identified an error in Figure 22, details are available in this correction note.
Notes to editors:
- Negligence claims form a very small proportion of both the number of incidents and complaints reported in the NHS, and the many millions of individual episodes of care that are delivered by the NHS each year. There are many factors influencing the reasons why individuals bring a claim against the NHS, including factors in the legal market. There is also a significant time lag between an incident occurring and a claim being received – on average 3.1 years. It may also take several years to settle a claim, particularly those high-value claims where brain damage has occurred at birth, and payments may be made on those claims many years into the future. Taken together, this means that what NHS Resolution receives in terms of claims currently is only a very partial indicator of patient safety in the NHS in past years, and also what we can expect to pay out in settlement of those claims in the future.
- The ‘provision’ is the best estimate of the expenditure required to settle the present obligation at the balance sheet date or transfer to a third party (for claims made and predicated to be made, called ‘incurred but not reported claims’). The figure is updated annually and is an informed estimate that depends on assumptions about future developments and therefore lies within a range of possible results. When considering the provision, it is important to note that if there is a value allocated to a future periodical payment order this will change in response to changing needs and the lifespan of the individual claimant concerned.
- All schemes are run on a pay-as-you-go basis and so we only collect from members, or receive funding from the Department of Health and Social Care for what we calculate we will be paying out on claims on a year-on-year basis. We do not ‘collect’ nor ‘set-aside’ billions of pounds in anticipation of the future outgoings of our schemes. This is to ensure that money is not diverted from delivering the services and helps spread the burden of costs into the future, as and when they need to be paid out.
- The cost of harm is the value of the claims that have been reported, along with an actuarial estimate of claims NHS Resolution expects to receive in the future arising from incidents in that financial year. The annual cost of harm is not the same as the amount actually paid out in compensation. Our schemes work on a ‘pay-as-you-go’ basis which means Trusts only pay in what we expect to pay out in any given year.
- The total of paid out in 2023/24 for compensation and associated costs on all of NHS Resolution’s indemnity schemes for clinical and non-clinical negligence claims was £2.87 billion.
- The volume of non-clinical claims reported including Liabilities to Third Parties Scheme (LTPS) and Property Expenses Scheme (PES) is 3,359. For 2022/23, including DHSC liabilities and PES, the figure was 3,192.
