Negligence claims will “spiral out of control” if government doesn’t act, say MPs

Authors: Abi Rimmer 

Publication date:  04 Dec 2017


The cost of clinical negligence claims will become uncontrollable if the government does not take action, MPs have warned.

Members of the House of Commons Public Accounts Committee said that a mixture of increasing efficiency targets, rising financial pressures, and patients waiting longer for treatment raised the risk of clinical negligence claims “spiralling out of control” without effective action.[1]

In a report on managing the costs of clinical negligence in hospital trusts, the committee said that the annual cost of claims had quadrupled over the past decade, from £0.4bn (€0.45bn; $0.54bn) in 2006-07 to £1.6bn in 2016-17, diverting resources away from frontline services.

The committee said that two main factors contributed to the rising costs. The first was rising damages for a small number of high value claims, mostly maternity related. These accounted for only 8% of all claims in 2016-17 but 83% of all damages awarded.

The second factor was rising legal costs from an increase in low value claims. Over 60% of successful claims resolved in 2016-17 were under £25 000, the committee said.

The report said that, despite longstanding concerns about the predictable rising costs of claims, the government had been “disappointingly slow and complacent” in its response.

In evidence to the committee, the Department of Health said that the only way it could bring down the costs of high value clinical negligence cases was to reduce the number of cases by improving patient safety, particularly in maternity cases.

The department also highlighted the possibility of changing current legislation that requires damages awards to assume that patients will require private care, even if they will receive free NHS care.

The committee said that the department, the Ministry of Justice, and NHS Resolution should review whether current legislation remains adequate and should report back to the committee by April 2018. It added that the departments should continue to focus on actions to reduce patient harm, particularly among maternity patients.

For low cost claims, the ministry told the committee that the government could have predicted their rise after legal reforms that capped fees for road traffic accident claims, leading to more clinical negligence firms moving into the market. The ministry added that it hoped to extend fixed recoverable costs to as many litigation areas as possible, particularly clinical negligence claims below £25 000.

After the publication of the committee’s report Action against Medical Accidents (AvMA), the Law Society, and the Association of Personal Injury Lawyers jointly agreed terms of reference for a working party to reduce legal costs in clinical negligence cases below £25 000.

Responding to the committee’s report, Helen Vernon, chief executive of NHS Resolution, said that her organisation had identified and reported on the multiple drivers of clinical negligence costs and had taken steps to tackle those in its control. “These include increasing the use of mediation and promoting candour and transparency as critical when something goes wrong in healthcare,” she said.

NHS Resolution agreed, she said, that tackling the costs of clinical negligence required far reaching action across government. “We look forward to being closely involved in that work and to responding to the [Public Accounts Committee’s] recommendations in detail,” said Vernon.

A government spokesperson said, “Clinical negligence costs are too high, so we are working on proposals to fix the amount that legal firms can recover from clinical negligence cases and provide families affected by severe avoidable birth injuries—a leading cause of clinical negligence costs—with an alternative to lengthy court disputes.”

The spokesperson said that the government was working on forming a strategy to tackle the rising costs, which would be supported by “our relentless pursuit of improved safety standards and a transparent, learning culture across the NHS.”

References

  1. Public Accounts Committee. Managing the costs of clinical negligence in hospital trusts. Nov 2017. [Link] .

Abi Rimmer The BMJ

 arimmer@bmj.com

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