Freedom of information request details
FOI request date:
The following information was requested:
I am writing to request information under the Freedom of Information Act 2000.
I am seeking national information about whether, and to what extent, hospice-related care costs are captured and paid within damages (special damages / heads of loss) for clinical negligence claims handled by NHS Resolution, and also proxy “denominator” cohorts that would help estimate where such costs may be expected but are not present.
For the purposes of this request, “hospice-related care costs” means costs included within damages that relate to care delivered by a hospice provider (including hospice inpatient care and hospice-at-home/community hospice services), whether charitably funded or partially supported by NHS/statutory funding.
I have noted NHS Resolution’s published guidance on “Understanding NHS Resolution data”, including the use of structured codes and the limitations of free-text searches. I would therefore be grateful if you could prioritise responses based on structured/recorded data fields wherever possible.
Scope and preferred period
To minimise burden and avoid exceeding the Section 12 cost limit, my preference is that you provide the requested information for the most recent financial year available (e.g., 2024/25). If this can be provided without exceeding the cost limit, please also provide the same information for the most recent two financial years, and if feasible, the most recent five financial years.
All questions below relate to clinical negligence claims that were resolved/closed in the relevant year and where a damages payment was made, unless otherwise stated. I am not requesting any personal data.
1) Whether hospice-related care costs are recorded as a structured damages field/category Please confirm whether NHS Resolution’s case management system captures damages in a structured way (e.g., by head of loss / special damages category/sub-category) and whether any structured field, category, tag, or standard coding exists that would identify:
a) hospice-related care costs, and/or
b) charitable care provider costs (including hospices), and/or
c) any equivalent category where hospice care costs would ordinarily be recorded.
If yes, please provide: i) the relevant field name(s), category label(s), or tag(s); ii) a brief description of how they are recorded/used; and iii) whether the values are recorded as structured numeric amounts, free text, or both.
2) Headline totals where hospice-related care costs are identifiable (structured extraction) For the relevant year(s), please provide:
a) the number of resolved/closed claims with a damages payment where damages included any hospice-related care costs (as defined above);
b) the total £ value of hospice-related care costs included within damages across those claims;
c) where held, the mean and median hospice-related care cost per claim; and
d) the total £ value of damages paid across the subset of claims identified in (a), to enable hospice costs to be expressed as a proportion of damages;
e) where held, a split of (a) and (b) by settlement vs court judgment.
3) Proxy denominators (structured cohorts) to estimate “expected” hospice/palliative care involvement If hospice-related care costs are not identifiable as a structured damages field/category, or even if they are, I would be grateful for the following proxy cohort totals for the same year(s), as these cohorts are likely to include cases where palliative/hospice needs could arise.
For each cohort below, please provide:
– the number of resolved/closed claims with a damages payment, and
– the total £ value of damages paid for those claims, and where held, a split by settlement vs court judgment.
Cohorts requested (using NHS Resolution’s existing structured codes/labels):
a) Claims coded as fatal / death-related outcome (or the closest equivalent outcome/injury severity code used in your system).
b) Claims with cause codes relating to delay/wrong diagnosis, failure/delay to treat, failure to refer, failure to perform test, and radiology error (or the closest equivalent NHSR cause categories).
c) Claims where the recorded specialty is “Palliative Medicine” (or the closest equivalent specialty label used in your system).
d) Claims where special damages include any care-related heads of loss (e.g., paid care, gratuitous care, case management, or equivalent labels used by NHSR).
If hospice-related costs can be identified (per Question 1), then for each cohort (a) to (d) above, please also provide:
– the number/value where hospice-related care costs are present, and
– the number/value where hospice-related care costs are not present.
4) Alternative approaches if hospice costs are not coded (best endeavours) If hospice-related care costs cannot be identified via a structured damages field/category, please confirm whether NHS Resolution can identify hospice-related costs indirectly through any other structured damages categories (for example, care/case management or other treatment/care cost categories), and if so, describe what is feasible within the cost limit.
Only if no structured route exists, and only if feasible within the cost limit, please confirm whether NHS Resolution can provide a count of resolved/closed claims (with damages payments) in which hospice care is mentioned within any searchable claim record fields (excluding personal data), using search terms such as: “hospice, “hospice care”, “hospice at home”, “palliative care”, “end of life”. Please explain which fields are searchable and any significant limitations of this method.
5) Guidance / policy on hospice-related costs and avoiding double recovery Please provide copies of any internal guidance, policy, or briefing documents held by NHS Resolution that describe how hospice-related costs are treated within damages, including any
approach to:
a) distinguishing or accounting for charitable vs statutorily-funded elements of hospice care (where relevant), and/or
b) avoiding double recovery where hospice services may have received NHS/statutory funding.
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