What we know

There are multiple drivers of the costs of negligence. These include the level of activity undertaken, the type and amount of harm caused, how incidents are handled and the legal environment and framework by which compensation is determined. We have a unique insight into these drivers. There are some we can control, such as how claims are handled. There are some where we can work with others to deliver improvement, such as the response to an incident. Finally, there are some where we can inform solutions but cannot deliver change, such as legal reform.

Both the healthcare and legal systems are undergoing rapid change. The ambition of the NHS Five Year Forward View for the integration of health and social care provision means that new organisational structures will emerge. Consultations on costs reform and the small claims limit will influence future trends in claims volumes and values.

The impact of the historic volume and value of clinical negligence claims, together with a growing Periodical Payment Order (PPO) liability, means an increasing financial pressure on trusts. This will sharpen the focus on what can be done to contain the position and there will be a growing appetite for data analytics to support this effort.

In the meantime, improved technology will open up opportunities to undertake analysis in ways which have not proved possible before. Sharing of data across the healthcare system, within legal constraints, in order to learn and improve safety will need to increase.

Our aims

  • To understand and respond to the drivers of cost and our customers’ needs at a deeper level.
  • To share what we know to inform policy development and help organisations to address issues at a local level.
  • To diagnose the issues driving costs and use this information to devise and signpost interventions.

What we will do in year one

  • Explore the use of innovative technology to mine the 21 years’ of data we have on what goes wrong in healthcare, including learning from our international equivalents.
  • Create a dynamic model with actuarial support which enables changes to the various drivers of cost to be modelled and used to inform policy development.
  • Increase the focus of NHS trusts on the drivers of their claims costs by helping them to triangulate their claims data with other locally held data sources (such as incidents and complaints) and working with the 'Getting it Right First Time' (GIRFT) initiative to integrate claims data into national dashboards.
  • Put in place memoranda of understanding with all of our partners such as the regulators, Parliamentary and Health Service Ombudsman (PHSO) and the Royal Colleges to include ways of working, shared objectives and data sharing arrangements and how we will inform the regulators of outlying or other practice to protect future patients.

Over five years we will

  • Review international practice on the pricing of risk in indemnity schemes to further improve the Clinical Negligence Scheme for Trusts (CNST) pricing methodology and build a ‘forward view’ for all specialties.
  • Use the platform of membership of the indemnity schemes to publish and share best practice.
  • Focus on maternity as the single biggest driver of claims costs, moving upstream to improve our insight into maternity incidents resulting in brain damage and sharing what we know with the Royal Colleges, NHS Improvement, the Care Quality Commission (CQC) and commissioners as well as across our membership.
  • Publish annually, in-depth analysis of high cost and/or high volume areas of claims, drawing on national data to inform on trends and the potential for improvement, for example, learning from inquests, mental health claims, orthopaedics and emergency care.
  • Build an understanding of what constitutes an effective response to an incident (candour, investigation and learning) in conjunction with others such as PHSO and the Healthcare Safety Investigation Branch (HSIB), how this contributes to claims costs and how effectively this is being managed.
  • Ensure that indemnity costs, including the rising cost of PPO liabilities, are integral to the financial planning cycle of the NHS working in partnership with the Department of Health (DH), NHS Improvement and NHS England to inform this at a national level, whilst increasing the information we provide to NHS trusts at an earlier stage.
  • Use the expertise and communication channels of our legal panel to ensure that the NHS is informed promptly of legal decisions, regulatory change and trends and helped to share this information rapidly with frontline staff.
  • Evaluate interventions taken in maternity and other areas such as the ‘Sign up to Safety’ incentive scheme, share the outcomes and consider the case and mechanism for further financial incentives.
  • Review themes common in requests for advice from employing organisations and practitioners to identify areas for interventions and product development for earlier identification of issues at an individual and member level.

We will know we have succeeded when

  • The data we hold can be analysed and shared in a granular way and we are using the very latest technology to achieve this, in line with the best international comparators.
  • We have published and seen distributed widely, insight into high value and high volume claims areas and have evidence that this is being used by those who have responsibility for safety improvement to inform their actions.
  • The pricing for our main indemnity scheme responds to evidence of improvements in safety in order to incentivise further improvement, across all specialties.

Resolution (1/4)

(3/4) Intervention