Independent Sector Providers

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Independent Sector Providers the NHSLA

• Caroline Curtis
• Technical Claims Manager
• 31 July 2008

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Topics to be covered

• CNST Cover when available and how?
• Apologies Explanations
• Claims Reporting
• Claims Experience to date

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CNST Cover

• Only NHS bodies can be Members of the scheme
• An exception to that rule - Designated Department
  of Health contracts
• CNST cover provided via the referring PCTs
  membership of our Scheme

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Other Contracts to treat NHS Patients

• No CNST Cover
• The NHS Body will be advised to seek a full
  indemnity from the Independent Sector Provider
• Any Consultant utilised to fulfil the contract
  should be advised that they require their own MDO
  cover
• Contract and indemnity terms should be in writing

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Apologies Explanations

• www.nhsla.com gt Publications gtClaims Publications
  gt Circular apology
• Compensation Act 2006

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The Litigation Process

• What does the patient need to prove?
• That the treatment fell below a minimum standard
  of competence and
• That he/she has suffered an injury and
• That it is more likely than not that the injury
  would have been avoided, or less severe, with
  proper treatment

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How does the process begin?

• A claim is defined as-
• Allegations of clinical negligence and/or a
  demand for compensation made following an adverse
  clinical incident resulting in personal injury,
  or any clinical incident which carries
  significant litigation risk

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Clinical Negligence Reporting Guidelines

• www.nhsla.com gt Publications gt Claims
  Publications gt Clinical Negligence Reporting
  Guidelines
• Preliminary Analysis brief investigation
• Paragraph 3.8 what it should contain
• Paragraph 3.9 internal structure ideally one
  designated person co-ordinating claims
  investigations

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Reporting to the NHSLA

• Paragraph 4 of the Reporting Guidelines
• Incidents graded red/serious and investigated
  under the healthcare governance arrangements
  which reveal a possible breach of duty leading to
  a large value claim (damages over 250,000) must
  be reported immediately.

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• Claims arising from a complaints investigation
  where the response, on the facts, indicates that
  an admission of liability has been implied.
• Requests for disclosure of records where the
  preliminary analysis indicates the possibility of
  a claim with a significant litigation risk
  (regardless of value)
• Letter of Claim

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The Next Step

• On completion of the preliminary analysis and
  reporting to the NHSLA, the claim will either-
• - be handled in-house
• - be assigned to your designated Panel Firm

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Claims to date .

• Is a maturing portfolio
• Earliest reported incident date is 9 January 2004
• Majority of open claims incidents in 2005 and
  2006

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• 118 claims reported and registered on CMS
• 16 closed claims where damages have been paid
  totalling circa 227,000
• 97 open claims with outstanding reserves of circa
  9million

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Categories of Claims

• 55 Orthopaedic Surgery
• 49 General Surgery
• 10 - Opthalmology

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NHSLA Claims Experience

• Data from 01/04/97 31/03/2007
• 41 abandoned by Claimant
• 41 settled out of Court
• 4 settled in court, including approvals
• 4 yet to settle
• Of the 113 clinical negligence claims actually
  litigated in court over the past three
  financial years, 67 in favour of the NHS, 29
  settled in favour of the patient and 4 settled
  mid-trial