Partner Article

The NHS business plan to reduce malpractice cases

Much as it might be uncomfortable to think of it in such a way, the NHS is a business, albeit one with an awful lot at stake.

Sir Gerry Robinson, former chairman of Sky, ITN and the Arts Council, took part in a documentary in 2007 about cutting waiting lists, in which he memorably stated: “The NHS is not a business for God’s sake”.

But, however it is labelled, the NHS must provide a service to its customer, the patient, along with employing a vast amount of people and managing its budgets.

In a bid to be more transparent about the way the NHS is run, the Department of Health has released a public document outlining the business case for the NHS for the current and upcoming financial year.

The Francis Report, on avoidable deaths at the Mid Staffordshire Trust, made 290 recommendations, but the overarching theme was that people always need to be put first in the NHS.

The NHS business plan outlines its priorities as having high levels of patient satisfaction along with motivated and positive staff. Another aim is high quality financial management, something it says will be measured on actual spend versus budget.

“Excellent financial management is a foundation for maximising improvement in outcomes for patients,” says the plan. “Through enhanced professional leadership, and rigour in our investment decisions, budget monitoring and financial assurance systems, we shall ensure that the NHS remains in financial balance and spends every pound for the benefit of patients.”

The NHS has a £90.6bn budget to commission services for patients and its business plan says the service is committed to securing good value for money. “In the current economic climate, it is ever more important that the NHS can deliver better at lower cost,” it says. “From 2015/16, the same focus on driving quality improvements within a tight financial envelope will be required.”

It goes on to say: “It is vital that NHS England uses its limited resources to deliver maximum benefits in line with its mandate objectives and to get the greatest value out of every pound it spends.”

But, that is easier said than done when the NHS pays out jaw-dropping amounts in medical negligence compensation every year.

The NHS Litigation Authority’s annual review for the 2013/14 financial year reveals the authority received an unprecedented number of new clinical negligence claims, meaning for the first time, it was dealing with more than 1,000 claims per month.

The authority saved the NHS £1.4bn by defending unjustified clinical negligence claims. It has also contested solicitors’ fees it felt were unreasonable. In one case cited, solicitors were claiming an hourly rate of £1,440. In a move designed to alleviate anger, and therefore the desire to pursue a claim, the authority has also issued guidelines to help NHS trusts say sorry promptly and effectively when they are at fault.

There are, however, many occasions when sorry isn’t enough, where a patient has suffered failures in care leading to emotional, physical and financial suffering and loss.

In 2013/14, the NHS paid out a total of £1.192bn in clinical negligence damages and legal costs. That compares to £1.258bn the previous financial year, a fall of 5.25%. The number of new claims being lodged may change that picture again when figures are released for 2014/15.Such is the volume of claims that the NHS has increased the contingency fund it has to deal with them from £8.7bn in 2010 to £15.7bn last year.

While the NHS’s new business plan doesn’t directly address compensation, as that is the remit of the NHS Litigation Authority, it does set out measures to improve patient care, which should have a direct impact on claims. Health secretary Jeremy Hunt has previously said a high number of litigation claims is a good indicator of poor care in the system and, in a speech given in October, he said standards in safety and quality of care must improve to reduce avoidable costs.

Called Putting Patients First, the business plan sets out the need for greater openness and transparency so patients are more informed about their treatment. The NHS Outcome Framework within the plan covers five domains of care; preventing premature deaths, enhancing quality of life for those with long-term conditions, helping people to recover after injury or illness, ensuring people have positive care experiences and treating patients in safe environments. If all those standards are met, the likelihood of compensation claims should be reduced.

But, with claims pushed through before changes were made to the no-win, no-fee system in 2013 and latest figures, released at the end of January, showing NHS A&E departments missed their waiting time targets for the 80th week in a row, reducing medical negligence claims could be a challenge.

A King’s Fund report, released at the beginning of February, also proved damning. Radical changes to the way the NHS is organised were “disastrous” and “distracted” from patient care, said the think tank.

What impact the reorganisation and failures to meet targets are having on litigation claims will be seen when new statistics are released by the NHS Litigation Authority for the 2014/15 financial year.

This was posted in Bdaily's Members' News section by José Calvo .