Professional Medical Indemnity Insurance
(Limited Text - Ministerial Extracts only)
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The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)
I thank my hon. Friend the Member for Mole Valley (Sir Paul Beresford) for securing this important debate. It is a niche area, but it is also a very important one relating to patient safety. Indemnity cover supports professionals in carrying out their practice. Even in the safest healthcare system in the world, mistakes will happen and it is important that patients are covered. Like my hon. Friend, I declare an interest: as a practising nurse, I have to have indemnity cover in order to maintain my registration.
Patient safety is the priority. Our focus is on making the NHS the safest healthcare system in the world. We are redoubling our efforts to deliver that, including in underpinning quality and safety. The national patient safety strategy, which was published in 2019, sets out exactly how we aim to do that. It is also important to learn the lessons when things go wrong. We want to make, and are making, changes to the culture of the NHS, to learn from mistakes and to be honest and open when mistakes happen.
There are legal requirements in place. All regulated healthcare professionals in the UK must hold adequate and appropriate indemnity to be able to practise. Healthcare professionals both in the NHS and in the independent sector need to have that in place. As my hon. Friend has said, the type of indemnity varies: it could be discretionary or it could cover all eventualities. Sometimes, when a claim is made where discretionary indemnity is in place, it is not paid out.
Most staff in the NHS benefit from state indemnity for clinical negligence. Decisions about state indemnity arrangements are a devolved matter, and they vary across the four nations. Broadly speaking, however, where state indemnity is in place in primary and secondary care, it provides cover for NHS professionals carrying out NHS work. Patients can be assured that, if something goes wrong, it will cover them, and cover is available to provide compensation where needed.
For work that is not covered under a state indemnity—many professionals, including dentists and GPs, provide NHS services under an NHS contract rather than being direct employees—discretionary indemnity is available. There have been problems with that, which the Paterson review very much highlighted. Although the Government did not accept all the recommendations in the Paterson review, we accepted a number of them partially. I am concerned about some of the issues that my hon. Friend raised in his speech, so we will be reviewing the Paterson recommendations shortly. I am keen that, where we have introduced measures in the NHS to improve an indemnity, the independent sector takes them up. We want to give the independent sector a chance to make those changes, but if it does not, we will have no hesitation about taking action.
Sir Paul Beresford
The Minister is absolutely right that every medical practitioner has to have indemnity. If a case arises in which there is a challenge to the clinician, if the indemnity is covered by a society that has discretion, and if that discretion is exercised, the cover that is insisted on by law is annulled.
Maria Caulfield
My hon. Friend is absolutely right. We have looked into reform: between 2018 and 2019, we consulted on whether to change the legislation to require all healthcare professionals to hold regulators’ insurance, rather than the discretionary indemnity. Unfortunately, covid came along and disrupted much of that work, and the response to the consultation was not published, but I am very happy to look at it again.
My hon. Friend is right that there is a gap in the system, not only for patients who may need compensation to deal with whatever outcome has happened as part of their care, but for healthcare professionals who need cover for a specific reason. Publication of the consultation that we ran in 2018 and 2019 was delayed, initially because of Paterson and then because of covid, but we hope to publish it fully this year. I will take the response very seriously; I hope to work with my hon. Friend on it so that, if changes to legislation are needed in relation to discretionary indemnity, we can make them.
The gap in the market that means that discretionary payments may not pay out will sometimes affect healthcare professionals admitting when mistakes have been made and learning from them. It does not help patients either. I very much take on board my hon. Friend’s points and am happy to work with him, because we remain committed to supporting healthcare workers across England in the clinical negligence sphere.
In 2019, in our response to concern about the rising costs of clinical negligence we touched on fixed recoverable costs—the second point my hon. Friend talked about. We recognise that costs are a significant part, albeit not the largest part, of lower level compensation payment to patients. Very often, legal fees make up a large percentage of the cost, and although we are improving patient safety we are not seeing clinical negligence costs fall in parallel. There is no correlation. To manage the rising costs of clinical negligence, we have consulted on fixed recoverable costs and capping them for the lower level of compensation payments. Such measures would not cap the compensation paid to patients, but they would cap the cost of the lawyers. We would do this in part to reduce costs, so the money could be spent on frontline services for patients instead, and in part because we recognise that legal costs can increase the cost of insurance for healthcare professionals who need indemnity cover.
The consultation on fixed recoverable costs finished recently and we are working our way through the responses. We hope to introduce measures fairly soon, and I will set out the detail as soon as I can. The Health and Social Care Committee carried out a review of patient safety and the cost of clinical negligence, and this is one area where, when I was before the Committee a few months ago, we promised reform. I am very committed to doing that.
We are also committed to acting on the recommendations of the Paterson inquiry, which looked at discretionary indemnity and highlighted the points my hon. Friend made about potential gaps in clinical negligence indemnity, in particular in the independent sector. I am committed to ensuring that lessons are learned from the inquiry, that the report is taken up and that we address those gaps. We have to look across healthcare, both the national health service and the independent sector, and consider a range of options. We will build on the work that we were doing before the inquiry and the consultation we started then, but also take forward the inquiry findings.
I hope that I have reassured my hon. Friend that by introducing the changes to fixed recoverable costs for clinical negligence with a value up to £25,000, we will not affect the payments to patients when claims are made, but instead tackle rising legal costs. I am happy to look into the indemnity issue he raises, because there is a gap and I recognise the points he made.
Question put and agreed to.