Big negligence payouts do not make a bad hospital but trends need explaining

In 2012 on February 13, 2012 at 12:58 pm

BBC Radio Oxford was concerned last week about the scale of payments made by Oxford University Hospitals in relation to clinical negligence.  Although the figures came out last summer, attention was drawn to clinical negligence payments by a large amount in damages in a local case involving a GP. Jonathan Montgomery suggested to the Radio station that the amount paid out in damages was a poor guide to the quality of care in a hospital. Data from the NHS Litigation Authority (NHSLA) show that while the sums of money are large (£13m for the Oxford Radcliffe hospital in 2010-11) they relate to a relatively small number of claims (only 59 claims were received in that year).  About 40% of the payments related to obstetrics where a small mistake can have catastrophic effects.

One interesting way of considering the implications of the NHSLA data might be to compare the payments that are made into the Clinical Negligence Scheme for Trusts (CNST) with those paid out. The contributions in are based on an assessment of risk and therefore if payouts exceed the contributions, the damages paid are more than expected. If payouts are less, then hospital has been less prone to damages claims than its risk profile would predict. On this measure  the Oxford hospitals payouts in 2001/11 were only 1.5% higher than expected, a marginal figure. Southampton hospitals paid in £7.93m in that year and the CNST paid out only £3.46 million on its behalf, so they had a relatively cheap year for claims. Over the five-year period, 2006-11, payments in respect of Oxford have been 20.43% higher than their contributions. For Southampton, the difference is only 0.67%. This data can only generate questions and does not indicate poor services but perhaps there is something for Oxford to explain here.

Jonathan Montgomery

  1. Interesting post! I was at the 2nd UK Primary care Ethics Conference recently where Dr Suzanne Shale spoke about the moral challenges facing primary care practitioners. As part of this talk she asked the audience to raise their hand if they thought that when a medical mistake had been made the doctor apologise (show of hands was overwhelmingly yes). She then showed a video of a medical apology used in teaching–asking the audience to vote if it was a ‘good’ or ‘bad’ example. Her point was that the ethical decision might be clear but putting that decision into moral action is hard. Talking to a few medical students who had been in the audience I expressed my amazement that they were taught how to apologise. Their answer was “of course, because then the person is less likely to make an official complaint”. Perhaps Southampton staff are just better trained in saying sorry!

  2. One of the amendments proposed for the Health and Social Care Bill concerns a ‘Duty of Candour’ , on which the Department of Health has consulted over the past few months (http://www.dh.gov.uk/en/Consultations/Liveconsultations/DH_130400). The consultation suggested an obligation to give an apology (defined as ‘a sincere expression of sorrow or regret for the harm caused during the treatment or care. Saying sorry is not an admission of liability and is the right thing to do’) as well an investigating mishaps so as to provide a ‘step-by-step explanation’ of what happened. The draft provisons set out in amendment 17, due to be debated this afternoon, talk more vaguely about ‘fully informing’ patients about incidents. See http://www.publications.parliament.uk/pa/bills/lbill/2010-2012/0119/amend/ml119-ii.htm

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

%d bloggers like this: