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Presentatie Judith Clark

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Presentatie Judith Clark

  1. 1. Risk – The MDU experience Dr Judith Clark Clinical Risk Manager
  2. 2. © MDU Services Limited 2016  UK health care system and indemnity  Trends in UK claims  How do we mitigate risk  Do risk reduction strategies work  Trust in the UK  The impact of the discount rate change Overview
  3. 3. © MDU Services Limited 2016  Patient care provided for “free”  Medical staff indemnified by the NHS Litigation Authority UK Health Care system - NHS Hospitals
  4. 4. © MDU Services Limited 2016  Patient care provided for a fee  Medical staff require their own indemnity – often through MDOs UK Health Care System - Private practice
  5. 5. © MDU Services Limited 2016  Provide NHS primary care for patients  No cost to patient  Self-employed GPs  Medical staff require their own indemnity – often through MDOs UK Health Care System – General Practitioners
  6. 6. © MDU Services Limited 2016  Not favourable  Year on Year increases in GMC complaints  Unsustainable increases in medical negligence payments  Claims inflation continues to outstripping other forms of inflation The UK Medico-Legal Environment
  7. 7. © MDU Services Limited 2016 0 20 40 60 80 100 120 140 160 180 200 1990 1995 2000 2005 2010 1990 = 100 2010 = 181 2000 = 134 Retail Prices (1990 – 2010) (Wright, 2011)
  8. 8. © MDU Services Limited 2016 0 50 100 150 200 250 1990 1995 2000 2005 2010 1990 = 100 2010 = 221 2000 = 156 Wages (1990 – 2010) (Wright, 2011)
  9. 9. © MDU Services Limited 2016 House Prices (1990 – 2010) (Wright, 2011) 0 50 100 150 200 250 300 350 400 1990 1995 2000 2005 2010 2010 = 297 2000 = 149 1990 = 100
  10. 10. © MDU Services Limited 2016 Claims inflation 1990 - 2014 0 100 200 300 400 500 600 1990 1995 2000 2005 2010 Prices Wages House Prices
  11. 11. © MDU Services Limited 2016 The Longer Term View (1885 – 2010) (Wright, 2011)
  12. 12. © MDU Services Limited 2016  Frequency and size of claims brought against our members  Impact this has on membership subscriptions  Impact on members – time, trauma, opportunity cost  Impact on the public – – Could deter doctors from higher risk, higher cost activities within specialty eg GP “out of hours” work – Could deter doctors from entering specialties where indemnity costs are disproportionately high relative to income, like general practice Concern
  13. 13. © MDU Services Limited 2016  Clinical Risk  Indemnity Risk Why are claims increasing?
  14. 14. © MDU Services Limited 2016  The MDU successfully defended approximately 80% of medical claims in the 5-year period from 2010 to 2014  Usually the claim does not withstand detailed expert scrutiny  But this comes with substantial costs Most claims do not succeed
  15. 15. © MDU Services Limited 2016  Deteriorating claims environment does not reflect a deterioration in professional standards  Medicine and medical science has improved and we are seeing better outcomes but patient expectations have also increased  Improving standards of care redefine success upwards. If a doctor can do more, faster, there is more it can be said he/she didn’t do fast enough  We have an environment and a system that promotes litigation over resolving concerns through other routes No deterioration in clinical standards
  16. 16. © MDU Services Limited 2016  It has been noted that clinical error is not strongly associated with claims – headache is a good example in primary care – GP may see a patient with headache • No sinister features on history • Normal neurological examination and no papilloedema – Patient is later found to have a brain tumour, has surgery but suffers permanent neurological impairment – A claim may be brought alleging failure to diagnose early – damages (future cost of care and lost earnings) could be substantial  It is the nature of general practice that serious conditions can have common, non- specific presentations Often no error – but a common presentation could be a serious condition
  17. 17. © MDU Services Limited 2016  Investment in risk management and advice includes: • Communications skills workshops • Risk Management workshops • Complaints management training • Online assessments and self audits • Online learning • Practice risk audits and support • Publications, case studies and lectures • Open disclosure and apologies • Targeted advice e.g. Out of Hours MDOs’ risk management initiatives and advice to members in England
  18. 18. © MDU Services Limited 2016  There is not a strong correlation between adverse outcomes and claims and complaints • Only a small proportion of adverse outcomes result in a patient bringing a complaint or claim e.g. Goldsmith et al “Do clinical incidents, complaints and medico-legal claims overlap?” International Journal of Health Care Quality Assurance Vol 28. No 8. 2015 pp854-871 • Most claims and complaints are not upheld  Goldsmith: • “It may be considered that a perfect system with no errors would consequently have no complaints or medico-legal activity. In this hypothetical situation, this may be true. But our results suggest that even if we were in a low error system, there would still be considerable complaints and claims”. Link between adverse outcomes and complaints and claims
  19. 19. © MDU Services Limited 2016 Car Insurance Mortality, Morbidity and Accidents Safer Roads and Cars Motor Claims Premium
  20. 20. © MDU Services Limited 2016 Car Insurance Mortality, Morbidity and Accidents Safer Roads and Cars Motor Claims Premium
  21. 21. © MDU Services Limited 2016 Healthcare Improvement Adverse Outcomes Effective and Safe Healthcare Complaints and Claims Subscription/ Premium
  22. 22. © MDU Services Limited 2016 Healthcare Improvement Adverse Outcomes Effective and Safe Healthcare Complaints and Claims Subscription/ Premium
  23. 23. © MDU Services Limited 2016 The Clinical Negligence Triangle (Campbell, 2012) Information Effective Healthcare Legal Environment Spark
  24. 24. © MDU Services Limited 2016 Studdert’s theory . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. ... .. . . . .... . . . . . .. . . . . . . . . . . . . .. . . . . . . .. . . . . . . . .. . . . .. . .. . . . . . ... . . . . .. . . . . . . ... . . . . .. . . ... . . . . . .. . .. . . . . . . . . . . . . . .. . .. . .. . ... . . . . ... . . . . . .. . . . . . . . . .. . .. . . . . . . . . . . .... . . . .. . . . . . . .. ... . .. .... . .. . . . . . . . . . . . . . . .. . .. . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. ... .. . . . .... . . . . . .. . . . . . . . . . . . . .. . . . . . . ... .. . . . . . . ... . . . .. . .. . . . . . ... . . . . .. . . . . . . ... . . . . .. . . ... . . . .. . . .. . . . . . . . . . . . . . . . .. . .. . ... . . . . ... . . . . . .. . . . . . . . . . . . . .. . .. . . . . . . . . . . .... . .. . . . . . . .. .... . .. . . . . . . . . . ... . .. . .. . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. ... .. . . . .... . . . . . .. . . . . . . . . . . .. . . . . . . ... .. . . . ... . . . .. . .. . . . . . ... . . . .. . . . . . . ... . . . .
  25. 25. © MDU Services Limited 2016  “The NHS Litigation Authority will radically change its focus from simply defending NHS litigation claims to the early settlement of cases, learning from what goes wrong and the prevention of errors. As part of those changes, it will change its name to NHS Resolution.”  “Delivering fair resolution and learning from harm”  Reduction in legal costs by resolving disputes and keeping cases out of formal court proceedings  Provide intelligence and deliver safety interventions to drive improvement NHS Resolution – Trust?
  26. 26. © MDU Services Limited 2016  Aiming for reduction in “frustration” claims, reduction in litigation in courts and increased resolution by mediation  Claim management will not change, including robust defence of claims  Challenging over-charging by claimant lawyers, fighting fraud & excessive compensation claims NHS resolution – Trust?
  27. 27. © MDU Services Limited 2016  The discount rate was last set in 2001 at 2.5%  This was based on a three year average of real yields on Index Linked Gilts - since 2001, the real yields on Index Linked Gilts has fallen  New rate based on a three year average of real returns on Index Linked Gilts - at minus 0.75% Discount rate – February 2017
  28. 28. © MDU Services Limited 2016  “There will clearly be significant implications across the public and private sector. The Government has committed to ensuring that the NHS Litigation Authority has appropriate funding to cover changes to hospitals' clinical negligence costs. The Department of Health will also work closely with General Practitioners (GPs) and Medical Defence Organisations to ensure that appropriate funding is available to meet additional costs to GPs, recognising the crucial role they play in the delivery of NHS care.” Lord Chancellor’s comments
  29. 29. © MDU Services Limited 2016  “Cutting the discount rate to -0.75% from 2.5% is a crazy decision by Liz Truss. Claims costs will soar, making it inevitable that there will be an increase in motor and liability premiums for millions of drivers and businesses across the UK. We estimate that up to 36 million individual and business motor insurance policies could be affected in order to over- compensate a few thousand claimants a year. ABI reaction to discount rate change
  30. 30. © MDU Services Limited 2016  “We are very disappointed by Liz Truss’s decision to lower the discount rate. We are considering the impact of this decision on our subscriptions and working with the Department of Health and NHS England to find a solution to protect our GP members from the otherwise catastrophic impact this will have on them, the sustainability of general practice and on the public.”  Claims inflation continues – “Whatever measures are put in place, the fundamental problem of spiralling claims costs remains for the NHS with all the adverse effects this has on the delivery of healthcare. We need a long-term solution to the inflation-busting rises we are seeing in clinical negligence compensation payments. Personal injury law needs root and branch reform.” MDU reaction to discount rate change
  31. 31. © MDU Services Limited 2016  Case 1: age at settlement 42yrs with 17 years life expectancy £7.45m @ 2.5% to £10.82m @ -0.75%. An increase of £3.37m (45%).  Case 2: age at settlement 14yrs with 50 years life expectancy £8.4m award @ 2.5% to £17.5m @ -0.75%. An increase of £9.1m (108%).  Case 3: age at settlement 8yrs with 46 years life expectancy £9.85m @ 2.5% to £15.65m @ -0.75%. An increase of £5.8m (59%). Impact on MDU members – case examples
  32. 32. © MDU Services Limited 2016  The link between more effective/safe healthcare and claims outcomes is tenuous.  Little evidence to suggest that improving/safer healthcare reduces claims.  May be able to show link in cases where there is a gross change in the medical landscape. (e.g. eradication of a disease or illness)  Main factors driving litigation and premiums do not relate to patient safety nor healthcare improvement. Conclusions
  33. 33. Membership t 0800 716 376 e membership@themdu.com Medico-legal team t 0800 716 646 e advisory@themdu.com Website themdu.com @the_mdu
  34. 34. MDU Services Limited (MDUSL) is authorised and regulated by the Financial Conduct Authority for insurance mediation and consumer credit activities only. MDUSL is an agent for The Medical Defence Union Limited (MDU). MDU is not an insurance company. The benefits of MDU membership are all discretionary and are subject to the Memorandum and Articles of Association. MDU Services Limited, registered in England 3957086. Registered Office: One Canada Square, London E14 5GS

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