At a time when the fortunes of the NHS continue to dominate the news, I was fortunate this week to attend a medico-legal training day. Rather than bore people with the latest legal positions on various aspects of healthcare, I would instead prefer to concentrate on some of the frankly extraordinary facts which emerged on the day. I found many of them so astonishing, I felt the need to share them with a wider audience for reasons I will explain later.
Before I dive in to a statistical frenzy, let me quote the words of the Health Secretary of Tony Blair's first Cabinet in 1997, "The best place for a lawyer is on the operating table.......Lawyers are milking the NHS of millions of pounds every year - money that would be better spent on healthcare". But do we all appreciate the validity of those words?
In 1996/7, there were around 4,000 claims for clinical negligence - negligence being the breach of a legal duty of care owed to one person by another which results in damage being caused to that person. By 2014/15, that figure had risen to nearly 12,000. We also know from a BMJ article in 2001 that nearly 11% of patients suffer an adverse event with half of these being preventable. A MORI poll of 2002 found that 5% of the public reported an illness, injury or impairment which they attributed to their medical care. Of this group, 30% claimed the event to have had a permanent impact on their health. The effect of this on hospital in-patients in terms of additional days in hospital equates to an annual bill in England of about £2 billion.
It is important to point out that it is impossible to accurately assess the relationship between errors and claims with some errors not constituting a suitable basis for a claim. It is also true that many potential claimants have no interest in claiming. Equally, errors themselves can be hidden. Finally, it is also important to recognise that some patients complain but do not sue.
But here is the juicy bit. In 1990, claims against the NHS amounted to £65.5 million (that is million with an m). By 2011, the estimated outstanding claims in England alone amounted to £16 billion (that is billion with a b). By any reckoning, that is a huge increase. It is pertinent to note that obstetricians, gynaecologists and surgeons are the biggest recipients of these claims with medics quite a way behind that. It is interesting to note that the two healthcare groups who incur the least claims are nurses and general practitioners. But male doctors are two and a half times more likely to be sued than their female counterparts.
But consider the plight of general practice. Over 95% of all NHS clinical contacts are made in general practice with around 80% of patients being managed within primary care. A staggering 300 million consultations with GPs take place annually in the UK. Given the fact the general practice is evidently the workhorse of the NHS, it is sobering to observe that funding for general practice as a percentage of the total NHS budget has dropped from a paltry 10.33% in 2004/5 to an frankly insulting 8.4% in 2011/12. Yet daily we read of emergency departments in our hospitals which are bursting at the seems. Based on these figures, I wonder that they are still even in existence.
But let us return to the subject of negligence claims. In a 2001 poll of British doctors, two thirds admitted to practising defensive medicine. Given the stratospheric rise in claims previously alluded to, I'm amazed that the figure was so low. But since 2001, I don't doubt that defensive medicine has now become the rule rather than the exception even though it is prohibited in the GMC's own guidance document for doctors.
But if patients are making money out of their claims, the amounts being made by their solicitors are truly eye-watering. Solicitors now charge £600 per hour and solicitor fees in England now cost the NHS £90 million annually - a 122% rise from just 4 years ago. An NHSLA report from 2008 finds that solicitors cherry pick the cases they are most likely to win. For their part, the solicitors refer to the risks of the "no win no fee" as justification for their higher fees. To bring this in to focus, solicitors in 2009 charged £152 million to obtain £807 million compensation for their clients. 10,129 new claims were lodged in the year 2012/13 and that figure rose to an ominous 11,945 claims the following year.
A number of headline cases have prompted calls for a cap on legal costs. Here are some of them; a lawyer received £175,000 while the patient received just £11,800 in damages. Another lawyer received £80,000 while their patient received £1,000.
In Wales from 2008 until 2011, £89 million was paid out in compensation with over a quarter of that amount being paid to two very sad cases of brain damge - one to a baby and one to a 15 year old who had been brain damaged at birth.
So the question is this; is the NHS being handicapped by excessive legal claims? Certainly it has never been easier to start a claim and it is worth noting that an estimated 98% of claims are settled before they even go to court - a fact not lost on the legal fraternity. The media loves reporting on cases of clinical negligence because even though they are mercifully rare, they make for good print and serve to perpetuate the existing crisis. It is true to say that the law has traditionally treated the medical profession with undue deference but it is also undeniable that the pendulum has now swung in favour of the public.
So if we all want the NHS to be the same "free at the point of access for every man, woman and child" as espoused by Bevan in 1947, something has to give. The way things are going at present, the words of Bevan seem far more a concept than a reality.
Before I dive in to a statistical frenzy, let me quote the words of the Health Secretary of Tony Blair's first Cabinet in 1997, "The best place for a lawyer is on the operating table.......Lawyers are milking the NHS of millions of pounds every year - money that would be better spent on healthcare". But do we all appreciate the validity of those words?
In 1996/7, there were around 4,000 claims for clinical negligence - negligence being the breach of a legal duty of care owed to one person by another which results in damage being caused to that person. By 2014/15, that figure had risen to nearly 12,000. We also know from a BMJ article in 2001 that nearly 11% of patients suffer an adverse event with half of these being preventable. A MORI poll of 2002 found that 5% of the public reported an illness, injury or impairment which they attributed to their medical care. Of this group, 30% claimed the event to have had a permanent impact on their health. The effect of this on hospital in-patients in terms of additional days in hospital equates to an annual bill in England of about £2 billion.
It is important to point out that it is impossible to accurately assess the relationship between errors and claims with some errors not constituting a suitable basis for a claim. It is also true that many potential claimants have no interest in claiming. Equally, errors themselves can be hidden. Finally, it is also important to recognise that some patients complain but do not sue.
But here is the juicy bit. In 1990, claims against the NHS amounted to £65.5 million (that is million with an m). By 2011, the estimated outstanding claims in England alone amounted to £16 billion (that is billion with a b). By any reckoning, that is a huge increase. It is pertinent to note that obstetricians, gynaecologists and surgeons are the biggest recipients of these claims with medics quite a way behind that. It is interesting to note that the two healthcare groups who incur the least claims are nurses and general practitioners. But male doctors are two and a half times more likely to be sued than their female counterparts.
But consider the plight of general practice. Over 95% of all NHS clinical contacts are made in general practice with around 80% of patients being managed within primary care. A staggering 300 million consultations with GPs take place annually in the UK. Given the fact the general practice is evidently the workhorse of the NHS, it is sobering to observe that funding for general practice as a percentage of the total NHS budget has dropped from a paltry 10.33% in 2004/5 to an frankly insulting 8.4% in 2011/12. Yet daily we read of emergency departments in our hospitals which are bursting at the seems. Based on these figures, I wonder that they are still even in existence.
But let us return to the subject of negligence claims. In a 2001 poll of British doctors, two thirds admitted to practising defensive medicine. Given the stratospheric rise in claims previously alluded to, I'm amazed that the figure was so low. But since 2001, I don't doubt that defensive medicine has now become the rule rather than the exception even though it is prohibited in the GMC's own guidance document for doctors.
But if patients are making money out of their claims, the amounts being made by their solicitors are truly eye-watering. Solicitors now charge £600 per hour and solicitor fees in England now cost the NHS £90 million annually - a 122% rise from just 4 years ago. An NHSLA report from 2008 finds that solicitors cherry pick the cases they are most likely to win. For their part, the solicitors refer to the risks of the "no win no fee" as justification for their higher fees. To bring this in to focus, solicitors in 2009 charged £152 million to obtain £807 million compensation for their clients. 10,129 new claims were lodged in the year 2012/13 and that figure rose to an ominous 11,945 claims the following year.
A number of headline cases have prompted calls for a cap on legal costs. Here are some of them; a lawyer received £175,000 while the patient received just £11,800 in damages. Another lawyer received £80,000 while their patient received £1,000.
In Wales from 2008 until 2011, £89 million was paid out in compensation with over a quarter of that amount being paid to two very sad cases of brain damge - one to a baby and one to a 15 year old who had been brain damaged at birth.
So the question is this; is the NHS being handicapped by excessive legal claims? Certainly it has never been easier to start a claim and it is worth noting that an estimated 98% of claims are settled before they even go to court - a fact not lost on the legal fraternity. The media loves reporting on cases of clinical negligence because even though they are mercifully rare, they make for good print and serve to perpetuate the existing crisis. It is true to say that the law has traditionally treated the medical profession with undue deference but it is also undeniable that the pendulum has now swung in favour of the public.
So if we all want the NHS to be the same "free at the point of access for every man, woman and child" as espoused by Bevan in 1947, something has to give. The way things are going at present, the words of Bevan seem far more a concept than a reality.
Comments
Post a Comment