Asked by: Lord Storey (Liberal Democrat - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty's Government, further to the Written Answer by Lord O'Shaughnessy on 19 December (HL12113), how many clinical negligence cases resolved in 2017–18 had proceedings issued because of issues in dispute, including (1) breach of duty, and (2) causation; and of such cases, how many resulted in a payment of damages to the claimant.
Answered by Baroness Manzoor
NHS Resolution has advised that the information is not collated by them in the format requested.
Asked by: Lord Storey (Liberal Democrat - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty's Government, further to the Written Answer by Lord O'Shaughnessy on 13 December (HL12091), how much of their total spend on clinical negligence legal defence costs in (1) 2016–17, and (2) 2017–18, was used for (a) NHS Resolution services, and (b) external solicitors including disbursements.
Answered by Lord O'Shaughnessy
NHS Resolution has advised that the figures provided for legal defence costs in my Written Answer of 13 December were for external solicitors including disbursements.
NHS Resolution has provided the following table which shows its own administration costs for dealing with clinical negligence claims in 2016/17 and 2017/18.
| Admin Costs £000s |
2017/18 | 11,634 |
2016/17 | 9,982 |
Asked by: Lord Storey (Liberal Democrat - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty's Government whether they have undertaken forward planning or modelling to estimate the cost of clinical negligence claims in the period to 2020–21.
Answered by Lord O'Shaughnessy
NHS Resolution handles clinical negligence claims on behalf of National Health Service organisations and independent sector providers of NHS care in England.
NHS Resolution annually reviews and updates five-year forecasts for the cost of clinical negligence following an actuarial review of activity and key assumptions that underpin those costs, e.g. claims inflation, claims volumes. These key assumptions are published in the organisation’s Annual Report and Accounts. Clinical negligence costs relate to four indemnity schemes operated by NHS Resolution: Clinical Negligence Scheme for Trusts (CNST), which covers NHS providers of secondary health care, and the Existing Liabilities, Ex-Regional Health Authorities, and the Department of Health and Social Care’s Clinical schemes, all of which relate to legacy organisations.
The cost of clinical negligence claims covered by the figures in this response are damages, claimant legal costs, defence legal costs, and NHS Resolution’s administration costs. The costs reported here do not include costs incurred locally by NHS providers in dealing with claims, such as their own administration costs.
NHS Resolution’s Statement of Net Expenditure estimates costs of clinical negligence at £11.7 billion in its 2020-21 accounts. This the total of the two dimensions in relation to “costs” in the context of Government budgeting:
- Department Expenditure Limit costs – these are the costs of settling claims during the financial year and the administration of those claims. This is estimated to be £2.6 billion for 2020-21; and
- Annually Managed Expenditure costs – this is the change in the value of the liability arising from clinical negligence claims, both from those that have been received, and those that are expected to be received in relation to incidents up to 31 March 2021. This is estimated to be £9.1 billion for 2020-21.
The costs for 2020-21 have been estimated on the basis of the current personal injury discount rate of minus 0.75%. However, once the Civil Liability Bill becomes law, the Lord Chancellor is expected to review the rate promptly. The figures provided here may therefore, change as a result. NHS Resolution will also review its five-year forecasts again following the production of its 2018-19 Annual Report and Accounts, and any changes in the underpinning actuarial assumptions are likely to result in revised projections. The figures quoted should therefore be considered as broad estimates based on the latest available information and subject to change in the future.
Notes:
The Department Expenditure Limit costs are lower than the £3.2 billion costs for CNST only reported by the National Audit Office in their report Managing the costs of clinical negligence in trusts, published in September 2017. The £3.2 billion represents the 2016 forecast for CNST based on a personal injury discount rate of 2.5%. Actuarial reviews of assumptions undertaken by NHS Resolution in 2017 and 2018 have resulted in favourable movements in key assumptions.
The figures provided do not include claims brought against general practitioners, who are covered by separate indemnity arrangements through medical defence organisations and for which data is not centrally available.
Asked by: Lord Storey (Liberal Democrat - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty's Government what proportion of clinical negligence cases result in a legal action being (1) issued, and (2) decided by the courts; and, in the cases decided by a court, in what proportion the claimant fully, or partially, succeeds.
Answered by Lord O'Shaughnessy
NHS Resolution handles clinical negligence claims on behalf of National Health Service organisations and independent sector providers of NHS care in England.
NHS Resolution has provided the following information which is based on information for clinical negligence cases resolved in 2017-18.
Of the 11,896 clinical negligence cases that were resolved in 2017-18:
- 3,845 (32.4%) had proceedings issued;
- 76 of the 3,845 cases went to trial (representing around 2% of those clinical negligence cases where proceedings had been issued); and
- 28 of the 76 cases that went to trial in 2017-18 resulted in the claimant being successful (i.e. the claimant was awarded damages in 37% of cases).
Notes:
- Proceedings may need to be issued in claims where there are no substantive issues in dispute but the court’s approval of the settlement is required (for cases where the claimant lacks capacity – e.g. minors).
- A claim is defined as successful where the claimant is awarded damages.
NHS Resolution is unable to report on whether or not a claimant is partially successful – a claim is either successful or not. It should be noted that, in most cases, the claimant does not receive everything that was claimed for given the nature of clinical negligence litigation. The extent to which the final award is a departure from what was claimed for depends on an array of factors that impact on each party’s view of the risks inherent in pursuing the issue(s) to trial.
Asked by: Lord Storey (Liberal Democrat - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty's Government, further to the Written Answer by Lord O'Shaughnessy on 5 November (HL10962), whether the figures for the total government spend on clinical negligence in 2016–17 and 2018–19 include legal costs.
Answered by Lord O'Shaughnessy
NHS Resolution handles clinical negligence claims on behalf of National Health Service organisations and independent sector providers of NHS care in England.
As stated in my answer of 5 November, the total Government spend on clinical negligence was £1.7 billion in the financial year 2016-17 and £2.2 billion in the financial year 2017-18. These figures did include legal costs and NHS Resolution has provided the following information about legal costs in these two financial years.
Legal costs for 2016-17 were:
- Claimant costs: £498 million
- Defence costs: £126 million
Legal costs for 2017-18 were:
- Claimant costs: £467 million
- Defence costs: £129 million
Note:
Claimant costs are legal costs incurred by the claimant in bringing a claim for compensation.
Defence costs are legal costs incurred by NHS Resolution in dealing with the claim received.
Asked by: Lord Storey (Liberal Democrat - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty's Government what was the cost to the NHS of clinical negligence claims in (1) 2016, and (2) 2017; and what plans they have to reduce such costs in the future.
Answered by Lord O'Shaughnessy
The total Government spend on clinical negligence was £1.7 billion in the financial year 2016-17 and £2.2 billion in the financial year 2017-18.
The rising costs of clinical negligence is a serious concern which the Government is committed to tackling, given that National Health Service resources used on clinical negligence are not available for front-line care. Building on the National Audit Office report Managing the costs of clinical negligence in trusts, published in September 2017, we have been working intensively across Government and expect to set out more detail on the way forward in due course. A copy of the report is attached.
Following a recommendation by Right Honourable Lord Justice Jackson in Review of Civil Litigation Costs: Supplemental Report – Fixed Recoverable Costs, the Department and the Civil Justice Council (CJC) set up a working party to develop a new process for clinical negligence initially up to £25,000 alongside new fixed costs. This working party is underway and the CJC is due to make recommendations to the Government in December. A copy of the report is attached.
Asked by: Lord Storey (Liberal Democrat - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty's Government what support not available in other circumstances is provided by public services to families where a member of the family has died in a drowning accident.
Answered by Lord O'Shaughnessy
The provision of National Health Service bereavement services is a local matter. These services may offer a range of support to bereaved people and are typically designed to support people regardless of the circumstance of that bereavement.
There are also a number of charities and support networks that that specialise in providing support to those who have lost a loved one in particular circumstances, such as drowning.
Asked by: Lord Storey (Liberal Democrat - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty's Government by what mechanism units of dental activity are distributed to dental practitioners.
Answered by Lord O'Shaughnessy
Dental contracts and agreements are agreed with dental contract holders by NHS England. Contracts are held by the part of NHS England (the area team) responsible for that region. Each contract has a set value and agreed level of dental activity to be delivered for that value per year. Activity is measured in metrics known as units of dental activity.
Contracts are let by tender under public procurement regulations. The current system was established in 2006. Where a contract existed prior to 2006, it was transferred into the new system and values set under a national formula used to transfer all then existing contracts from the pre-2006 system to the current system.
Asked by: Lord Storey (Liberal Democrat - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty's Government what plans they have to improve the oral health of school children in England.
Answered by Lord O'Shaughnessy
Local authorities are responsible for assessing the oral health needs of their local population, including the needs of school children, developing oral health strategies and commissioning oral health improvement programmes.
Public Health England has published resources to support local authorities in improving the oral health of children, and is working locally with local authorities on this. These resources include Local authorities improving oral health: commissioning better oral health for children and young people: An evidence-informed toolkit for local authorities which assessed the community-based preventive services that reduce tooth decay, including those that increase fluoride availability. This toolkit supports local authorities to invest in programmes which have demonstrated improvement in children’s dental health. A copy of the toolkit is attached.
The National Institute for Health and Care Excellence (NICE) has published Oral health: local authorities and their partners (NICE guidance PH55). This guidance includes recommendations to consider supervised toothbrushing schemes and fluoride varnish schemes in nurseries and primary schools in areas where children are at high risk of poor oral health and also recommendations on raising awareness of importance of oral health as part of a whole school approach in all primary and secondary schools. A copy of the guidance is attached.
Sugary food and drinks are one of the main causes of tooth decay. The Government’s Childhood Obesity: A Plan for Action, launched in August 2016, contained proposals for a broad, structured sugar reduction programme to remove sugar from the categories of food that contribute the most to children’s sugar intakes. This Plan and the sugar levy which came into effect in April 2018, is expected to have a positive effect on improving children’s oral health.
Asked by: Lord Storey (Liberal Democrat - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty's Government what were the rates of tooth decay among children in England in each of the last ten years.
Answered by Lord O'Shaughnessy
The former National Health Service Dental Epidemiology Programme collected data in 2007/08 and 2011/12 for five year olds. It showed 31% and 28% were affected by tooth decay respectively. The programme also collected data for 12 year olds in 2008/09 and found 33% were affected by dental decay.
For all age groups, no data are available for 2010 and 2011.
The 2013 Child Dental Health Survey collected data on five year olds, eight year olds, 12 year olds and 15 year olds. It showed that: 31% of five year olds; 49% of eight year olds; 37% of 12 year olds and 44% of 15 year olds are affected by dental decay.
Data on three year olds was collected in 2012/13 by Public Health England (PHE) Dental Public Health Intelligence Programme and this shows that 12% of three year olds are affected by dental decay.
In 2013/14 PHE Oral Health Survey collected data on five year olds and 12 year olds attending special support schools which shows that, in England, 22% of five year olds and 29% of 12 year olds attending special support schools had experience of obvious dental decay.
In 2014/15 PHE Dental Public Health Intelligence Programme collected data on five year old and this shows that 25% of five year olds are affected by dental decay.
Results from the latest oral health survey of five year old children in England will be published in the oral health survey of five-year-old children 2016-17 report by Public Health England by June 2018.