The petition of residents of the UK,
Declares that private healthcare patients have less access to adequate redress and compensation following negligent treatment in comparison to NHS patients; further that insurance companies can withdraw cover from healthcare professionals who are alleged to have breached the terms of the insurance policy; and further that healthcare professionals under investigation for negligence should not be able to work in either the NHS or the private sector until the disciplinary proceedings have concluded to the satisfaction of the General Medical Council and patient or patients concerned and, in case of fatalities, the patients’ families.
The petitioners therefore ask the House of Commons to legislate to require insurance companies to provide affordable cover for every aspect of healthcare professionals' work including in cases where the work was found to be negligent, and for all healthcare professionals under investigation for negligence to be suspended until the complaint has been fully resolved.
And the petitioners remain, etc.—[Presented by Mrs Caroline Spelman, Official Report, 6 January 2016; Vol. 604, c. 402.]
[P001660]
Observations from the Parliamentary Under-Secretary of State for Health (Ben Gummer): There are nine independent healthcare regulatory bodies with statutory responsibilities in respect of the regulation of healthcare professionals in the UK. These are the General Chiropractic Council, the General Dental Council, the Health and Care Professions Council, the General Medical Council, the General Optical Council, the General Osteopathic Council, the General Pharmaceutical Council, the Nursing and Midwifery Council and the Pharmaceutical Society of Northern Ireland. A healthcare professional must be registered with the relevant healthcare regulatory body to practise in the UK.
The purpose of regulation is to protect the public by ensuring that all who practise a health profession are doing so safely. Legislation gives the healthcare regulatory bodies four main functions:
Setting the standards of behaviour, competence and education that health professionals must meet;
Dealing with concerns from patients, the public and others about health professionals who are unfit to practise because of poor health, misconduct or poor performance;
Keeping registers of health professionals who are fit to practise in the UK; and
The healthcare regulators can also remove healthcare professionals from their registers and prevent them from practising if they consider this to be in the best interests of the public.
In order to comply with the cross border healthcare EU directive, legislation came into force in the UK in July 2014 requiring all regulated practising healthcare professionals in the UK to hold adequate insurance or indemnity cover as a condition of their registration.
It is the healthcare professional’s responsibility to ensure that they have the cover required. This cover may be provided by the employer or directly through a Medical Defence Organisation or an insurance company to the individual practitioner. Where it is provided by the employer, it is the healthcare professional’s responsibility to ensure it is adequate and that additional indemnity or insurance is not needed. Regulatory bodies can remove a healthcare professional from their register if they do not have the appropriate cover.
The petition covers two distinct but separate points
(a) to legislate to require insurance companies to provide affordable cover for every aspect of healthcare professionals' work including in cases where the work was found to be negligent,
(b) for all healthcare professionals under investigation for negligence to be suspended until the complaint has been fully resolved
Taking the two points separately
(a) Legislate to require insurance companies to provide affordable cover for every aspect of healthcare professionals' work including in cases where the work was found to be negligent.
All employers should ensure that practitioners employed directly or under contracts for services, have both up to date registration with their relevant regulatory body to cover them for all procedures they are providing, and adequate indemnity or insurance to support their role in the organisation.
Commissioners have a role in ensuring that providers have adequate cover to sensibly manage their risk of exposure to potential claims where the work is found to be negligent.
Currently, in secondary care, staff working in NHS Trusts and NHS providers are covered by the Clinical Negligence Scheme for Trusts (CNST), which is a risk-pooling rather than an insurance system. The cost is not covered by the healthcare professional but through their employer.
In primary care, indemnity cover will be by the individual practitioner, usually through one of the Medical Defence Organisations (MDOs) or possibly a private insurance company.
For private healthcare, cover will usually be held by the individual practitioner through an insurance company, with rates set based on the risk of the individual and the role they fulfil in the organisation. This may include a cap on the value of the claim, or a restriction on practices that might be covered.
The insurance market is driven by market forces and probability of risk - so the higher risk attached to an individual practitioner the higher the premium.
There is currently joint work ongoing between Department of Health and NHS England looking at options that are available to improve affordability of insurance for primary and secondary care practitioners. There has been recognition that the increasing costs of indemnity have become problematic across the board. To this end, NHS England announced that £2.5 million has been made available in order to support indemnity cover for out of hours GP services during the winter period. Both NHS England and the Department of Health are continuing to identify possible solutions and areas for improvement to limit the rising costs of indemnity for medical professionals.
Providing affordable cover for all practitioners where an incidence of negligent practice is found would potentially increase the risk of an individual practitioner who may not meet the professional standards required in the UK continuing to practise.
Therefore it is not deemed appropriate to legislate to require insurance companies to provide affordable cover for healthcare professionals' work where that is found systematically to be negligent.
Already the GMC, or other relevant regulatory body, has a duty to investigate any incidents reported to them and, where necessary, take action to safeguard the health and well-being of the public.
In serious cases, fitness-to-practise proceedings can result in practitioners being removed from the register, thereby preventing them from legally practising in the UK.
(b) for all healthcare professionals under investigation for negligence to be suspended until the complaint has been fully resolved
Serious or persistent failure to follow regulatory guidance set out by the regulatory bodies will put the registration of a healthcare professional at risk.
If an allegation is made about a medic, or other healthcare professional, who may not meet the professional standards required in the UK, their regulatory body has a duty to investigate and where necessary take action to safeguard the health and well-being of the public.
In serious cases, fitness-to-practise proceedings can result in practitioners being removed from their respective register, thus preventing them from legally practising in the UK.
Interim orders can be put in place to stop a registrant from practising, or limit what they can do, during an investigation so patients are not put at risk.
In addition the employer has a role in ensuring that they are providing a duty of care to patients by ensuring where limitations are imposed on an individual by their regulatory body, they adhere to these requirements.
All healthcare professionals working in the UK have a responsibility to ensure they are following the guidance and best practice set out by their regulatory body and that they have the appropriate indemnity or insurance in place.
This is a requirement whether they are working in the private sector, not for profit sector or the NHS.
In order for the indemnity cover to be valid, it requires individuals to comply with any requirements and/or restrictions in place from (a) their relevant regulatory body and (b) their employer or contractor.