This summary outlines the new indemnity schemes and clinical negligence cases handled by NHS Resolution. It includes the new measures undertaken in response to the coronavirus pandemic. The full report can be viewed here: NHS Resolution annual report and accounts 2019/20 which details the performance and future plans of the NHS.
New indemnity schemes
2019/2020 saw an increase in the number of schemes managed by NHS Resolution to seven, with the introduction of three new indemnity schemes:
- Clinical Negligence Scheme for General Practice (CNSGP);
- Existing Liabilities for General Practice (ELGP) and Existing Liabilities Scheme for General Practice (ELSGP); and
- Clinical Negligence Scheme for Coronavirus (CNSC).
The CNSGP covers clinical negligence claims for incidents occurring in general practice on or after 1 April 2019. CNSGP provides an assurance of comprehensive and unlimited cover for GPs, practice nurses, receptionists and anyone who plays a part in delivering care to patients in GP practices.
The ELGP is an arrangement under which NHS Resolution perform the responsibilities of the Secretary of State to oversee and govern the interim arrangements relating to existing liabilities (liabilities arising from incidents prior to 1 April 2019) agreed with the Medical and Dental Defence Union of Scotland (MDDUS) and the Medical Protection Society (MPS). ELSGP launched on 6 April 2020 and on the same date MDDUS claims fully transferred to NHS Resolution. The transfer of claims from MPS into ELSGP proposed for the end of the 2020/21 financial year.
The CNSC is a new scheme launched on 3 April 2020, over a week after the Coronavirus Act 2020 received Royal Ascent on 23 March 2020. The scheme is designed to provide additional indemnity coverage for clinical negligence liabilities that may arise when health workers and others are working as part of the coronavirus response. The additional indemnity is provided in the event that other schemes, namely the Clinical Negligence Scheme for Trusts (CNST) and CNSGP, do not cover particular activities.
Update on clinical negligence claims management
In 2019/20 the cost of clinical negligence claims against the secondary care system is £82 billion. There are 11,682 new clinical negligence claims and incidents. This is an increase of 998 or 9.35% compared to 2018/19. Of these, 401 new claims and incidents are for CNSGP.
Excluding the data from the Early Notification Scheme (ENS), CNSGP and historical claims from MPS and MDDUS, clinical negligence claims increased by 1.53% in 2019/20.
The report notes of an increase of 148% in 2019/20 for gynaecology speciality claims when compared to 2018/19. NHS Resolution notes that the increase is due to the large number of vaginal mesh related incidents being reported.
In 2019/20, NHS Resolution received a lower volume of claims valued at £2 million+ than in the last three financial years. There is an increase in the number of mid-value cases between £25,001 and £50,000 when compared to 2018/19.
Emergency medicine and orthopaedic injuries account for 24% (12% each) of clinical negligence claims. Obstetrics accounts for a further 9% of overall claims by volume.
When looking at the overall value of clinical negligence claims reported in 2019/20, the top three categories are obstetrics at 50%, emergency medicine at 8% and orthopaedic surgery at 5%.
Overall, maternity claims represent 40% of claim payments for all clinical schemes (£2.3 billion), 50% of claims by value (£4.8 billion), 70% of the total CNST provision (77.6 billion) and 69% of the £8.3 billion incurred cost of harm to the CNST.
Early Notification Scheme update
A joint letter from NHS Resolution, RCOG, MBRRACE-UK and the Healthcare Safety Investigation Branch (HSIB) outlined the reporting requirements for the Early Notification scheme. From 1 April 2020, it is no longer necessary for trusts to report Early Notification cases to NHS Resolution. Trusts are now required to report cases which meet the Early Notification Criteria to HSIB. HSIB will triage all the cases and prioritise those where there is evidence of harm (brain injury) to the baby and will share these cases directly with NHS Resolution. An Early Notification liability investigation will commence once the HSIB report is received, and the Early Notification team will liaise directly with the trust. The changes in reporting requirements are due to be reviewed in September 2020.
Maternity Incentive Scheme (MIS) update
The trusts have been informed in March 2020 that the majority of reporting requirements relating to MIS had been paused due to the unprecedented challenges for the NHS during the Covid-19 pandemic. The trusts are encouraged to apply the principles of the MIS safety actions. NHS Resolution outlined to the trusts the importance of maintaining external reporting of eligible cases of perinatal deaths to MBRRACE-UK and where possible, to make a monthly Maternity Services Data Set submission to NHS Digital.