Legal Aid, Sentencing and Punishment of Offenders Bill

Neil Carmichael Excerpts

Monday 31st October 2011 Commons Chamber

[Guy Opperman]

I totally endorse that point and such defendants are punished accordingly, particularly in the punitive elements of costs when they are assessed. There are punitive factors that my hon. and learned Friend as a judge would know one is able to impose in a civil court whereby—[Interruption.] I accept that he is not a civil judge—it shows. There is an ability to punish the offending NHS institution or doctor, but the fair point that has been raised and must be addressed is that the powers that would exist to a civil judge, were my hon. and learned Friend to be one, would arise quite far down the track in civil litigation and not at the outset. I come back to the legitimate and fair point that we should address this issue to NHS trusts and particularly to two types of individual, including, first, to chief executives. Regrettably, there are examples of a failure of leadership by chief executives because, clearly, they are mindful of their budgets and they do not like the idea of a culture of openness in which mistakes are admitted. In those circumstances, whether implicitly or directly, efforts are made to suppress litigation against NHS trusts.

The second group of individuals who should be involved is doctors and consultants. Because theirs is such a hierarchical profession, instead of having a culture of openness in which mistakes are readily admitted, there is, sadly, from time to time—I have professional experience of this—a failure to admit mistakes. As the hon. Member for Kingston upon Hull East will sadly and tragically have discovered—and I have been involved in several such meetings—there is a post-operative debrief within the health service.

[Neil Carmichael (Stroud) (Con)]

This is not really my field, but I know from my constituents that a large number of them who have experienced difficulties in the NHS are extraordinarily concerned about the lack of transparency and the weight of expertise against them, because they are not, of course, particularly skilled in that area. Does my hon. Friend agree that that is one of the big problems we need to address, as I hope we are doing in the Bill?

[Guy Opperman]

I am grateful to my hon. Friend for his intervention, but I will not deal with it in any great detail—I mean no disrespect to him—because I wish to go back to the point I was making. We must have a system within the medical profession that allows its members to start to accept that it is perfectly understandable that mistakes are made, because they are human beings, and that there is insurance to cover such matters when they take place. With the best will in the world, that should be accepted. That recognition, however, does not exist to the degree that it should.

--- Later in debate ---

[Mr Djanogly]

As I have said before, we estimate that the vast majority of the £6 million will be for complex and lengthy cases that concern cerebral palsy, brain-damaged children or adult paralysis. We believe that no-win conditional fee agreements will still be available to fund these claims in the new regime. In addition, our reforms provide for a power allowing recoverability of after-the-event premiums in clinical negligence claims to help cover the cost of expert reports in complex clinical negligence cases. We have also announced plans to implement qualified one-way cost shifting in clinical negligence cases, which would mean that claimants would not be at risk of paying their opponents’ costs, as is the case with legal aid. Where CFAs are not available, the exceptional funding scheme will allow funding to be granted in individual excluded cases where the failure to provide funding would be likely to result in a breach of the individual’s human rights.

[Neil Carmichael]

CFAs are awarded in circumstances where the parents will be in a state of considerable grief, or at least have a huge amount of concern, about the well-being of their child, so will there be a sensitive enough arrangement for making the awards and assessing the circumstances?

[Mr Djanogly]

Indeed. As is currently the case, the solicitors awarding the CFA would have to look at the merits and decide whether they wanted to proceed with it. Obviously, the person has to want to instruct the solicitor and the solicitor has to want to take the case; it would cut both ways.

There have been a lot of comments about what assessment has been made of the effects on the NHS of removing clinical negligence from the scope of legal aid. In response to a parliamentary question, the Department of Health indicated that

“the potential effect on the national health service of removing clinical negligence from the scope of Legal Aid will be cost neutral.”—[Official Report, 14 September 2011; Vol. 532, c. 1231W.]

In annexe B of the impact assessment on the reforms, we estimate savings of £50 million to the NHS Litigation Authority as a result of the abolition. My officials are in ongoing consultations and discussions with the NHSLA and stakeholders about how the commissioning of expert reports can be improved so that, for instance, joint reports can be commissioned wherever possible. This, in turn, would help to encourage early notification of claims.

One particular aspect of clinical negligence cases is the significant up-front costs involved in obtaining expert reports. Following consultation, the Government are seeking a tightly drawn power in the Bill to allow the recoverability of after-the-event insurance premiums in clinical negligence cases. The details will be set out in regulations. My hon. Friend the Member for Hexham (Guy Opperman), who lent us the benefit of his considerable experience in the clinical negligence field, made some important points in this regard.

We have to make some difficult choices about legal aid, and we need to focus our limited resources on those who need it most.