BOARD OF DIRECTORS PAPER COVER SHEET. Meeting Date: 27 July 2011

Transcription

1 BOARD OF DIRECTORS PAPER COVER SHEET Meeting Date: 27 July 2011 Agenda Item: 1.9 Paper No: D Title: Annual Policy Review Report - Claims Purpose: Summary: To brief the Board on the Trust s compliance with the Policy and Procedure for the Management of Negligence Claims, Employer/Public Liability Claims and Property Expense Scheme Claims The Trust has a policy that describes the process governing the management of claims and compliance against the NHSLA criteria. This paper sets out the outcome of the monitoring and audit and provides assurance to the Trust that claims are being managed in accordance with NHSLA requirements. Recommendation: For approval Prepared by: CARRIE STONE Legal Services Manager Presented by: ROBERT TALBOT Medical Director This report is relevant to: (Please tick relevant box) Assurance Framework Yes Risk Register I/D No. Healthcare Standards: Financial implications NO Please specify which standard Monitor compliance Human Resources implications NO Internal monitoring Yes Legal implications NO

2 D ANNUAL POLICY REVIEW REPORT POLICY AND PROCEDURE FOR THE MANAGEMENT OF CLINICAL NEGLIGENCE CLAIMS EMPLOYER/PUBLIC LIABILITY CLAIMS AND PROPERTY EXPENSE SCHEME CLAIMS Date: July 2011 Presented to: Board of Directors Action Plan: Yes Date of Next Annual Report: July 2012 Author: Legal Services Manager 1

3 CONTENT 1. INTRODUCTION 3 2. MONITORING AND AUDIT AIMS AND OBJECTIVES METHODOLOGY RESULTS 4 3. CONCLUSIONS 5 4 NEW STANDARDS/LEGISLATION 6 5. RECOMMENDATIONS 6 6. ACTION PLAN 6 7. APPENDICES

4 1. INTRODUCTION This is the fourth annual report relating to the Policy and Procedure for the Management of Negligence Claims, Employers/Public Liability Claims and Property Expense Scheme Claims. The third annual policy review report was submitted and approved by the Board of Directors in July The updated action plan arising from this report was submitted and approved by the Board of Directors in January 2011 the issues identified from the July 2010 report being carried forward into this report. Six monthly reports on claims are provided to the Board of Directors. Aggregated data is reported to the Complaints, Claims, Incidents and PALS Review Group on a quarterly basis. The policy was revised and ratified by the Board of Directors in August 2006, and amended following revised CNST reporting guidelines in July 2007, September 2008 and November These minor amendments were approved by the Medical Director. The next review date is November MONITORING AND AUDIT 2.1 Aims and Objectives The aim of the monitoring and audit of the effectiveness of this policy provides assurance to the Trust that claims are being managed in accordance with the NHSLA requirements. 2.2 Methodology Review of NHSLA Reporting Guidelines The NHSLA guidance sets out reporting timescales for claims. These include for disclosure of information, preliminary analysis, reporting of cases to the NHSLA, Letters of Claim, Part 36 Offers, reporting of Court Proceedings and acknowledgement of employer s and public liability cases. Each case is managed against these time-scales. The timescales are:- negligence cases Requests for disclosure of healthcare records to be processed within 40 days. Preliminary analysis for each claim to be completed within 40 days of the disclosure request being received. Some complex cases will take longer Report relevant cases to the NHSLA within 2 months of request for records or sooner if the event is serious All Letters of Claim and Part 36 offers to be notified to the NHSLA within 24 hours. Acknowledge Letters of Claim within 14 days. All Court Proceedings to be notified within 24 hours. Liabilities to third parties (employers liability and public liability cases) Acknowledge Letters of Claim within 21 days. Report cases with standard disclosure list completed, to the NHSLA within 21 days. All cases were reviewed for the period April 2010 to March 2011 by reviewing data held on DATIX and each individual case file. 3

5 Communication with relevant stakeholders Each case is reviewed for reporting requirements to relevant stakeholders, which includes consideration of reporting to the NHSLA on the basis of the information obtained and sharing information with key members of staff. Aggregated Analysis On a six monthly basis claims themes are included in the Claims Review Report to the Board of Directors and in the quarterly reports to the Complaints, Claims, Incidents and PALS Review Group. Organisational Learning Any risk management issues are identified during the preliminary analysis performed for each clinical negligence claim. All red and amber graded claims are discussed with the Medical Director and risk management issues identified through that review are shared at the Complaints, Claims, Incidents and PALS Review Group, with relevant Leads and Consultant staff. The appropriateness of grading is also reviewed with the Medical Director. 2.3 Results The specific results for each criterion are as follows:- Review of NHSLA Reporting Guidelines There have been no Property Expense claims in the period April 2010 to March negligence cases Appendix 2 54 cases were notified to the Trust: of these, 50 requests for disclosure of healthcare records were received and all aside from one claim, due to late availability of notes as a result of patient s admission, were processed within 40 days. Of the 54 cases, 48 have had a preliminary analysis performed: It is not possible to identify from the DATIX system whether a preliminary analysis has been completed within 40 days. However, a review of the files has identified that 35 cases had a preliminary analysis completed within 40 days. Delays were due to a combination of notes notes not being available, timeliness of responses and availability of Legal Services Manager. 10 cases were identified as high probability and all were notified to the NHSLA, with completed preliminary analyses. The Trust received 15 Letters of Claim and 6 Court Proceedings and these were all notified to the NHSLA within 24 hours. Liabilities to third parties (employer s liability and public liability cases) 9 new employer s liability and public liability cases were opened. All were acknowledged and within 21 days. All 9 cases were notified to the NHSLA with standard disclosure lists completed: 7 were reported within 21 days. The average notification was 12 days. 4

6 Communication with relevant stakeholders For the 54 open clinical negligence claims, the relevant consultants have been given details of the claim and asked to provide a report on the clinical care received, an opinion as to whether the care represents a reasonable standard and an assessment of liability. Comment has also been requested on any allegations received at the time disclosure is requested. Following preliminary analyses, 15 claims were graded as amber. Of these 10 have been discussed with the Trust s Medical Director, to date in line with Trust policy. These reviews considered the appropriateness of the grading, the probability of settlement and action points arising from the analyses. Following review two cases were downgraded to yellow. 10 of the 54 new clinical negligence cases were reported to the NHSLA as they carried a high probability following preliminary analysis. Aggregated Analysis Claims themes were provided in the six monthly reports to the Board of Directors. Aggregated analysis was provided on a quarterly basis to the Complaints, Claims, Incidents and PALS Review group, which also considered key themes. Organisational Learning On closure of claims or in circumstances where it is clear there has been a breach of duty early on in the investigation of a claim, the Trust s policy on the management of clinical negligence claims requires the completion of an analysis and conclusion. The relevant consultant is asked to review the conclusions, identify, where appropriate, areas where a change in practice is required, additional training/education is needed and how the lessons arising from the case can be disseminated through the specialty. A claims management root cause analysis form is sent with a request for information, to ensure consistency of approach across the Trust. 44 claims were closed for the period April 2010 to March Of these, 37 have been through this process. The reasons for not completing analyses and conclusions were 3 cases had been through the Serious Untoward Incident process prior to closure and 4 cases were non-clinical. Appendix 3 3. CONCLUSIONS The monitoring and audit of this policy in respect of: NHSLA Reporting Guidelines Communication with relevant stakeholders Aggregated analysis Organisational learning confirms that: Preaction disclosure within 40 days was achieved in all but 1 clinical claim where requests had been received by the Trust 35 clinical claims had preliminary analyses completed within 40 days All letters of claim and particulars of claim were notified to the NHSLA within 24 hours 5

7 All 9 LTPS claims were acknowledged within 21 days and all cases were notified to the NHSLA with standard disclosure lists completed For all 54 clinical claims, the relevant consultant(s) were contacted and asked to provide reports on the clinical care received 10 amber claims were discussed with the Medical Director in line with Trust policy 10 of the 54 clinical claims were reported to the NHSLA as they carried a high probability following preliminary analysis Aggregated analysis was provided on a quarterly basis to the Complaints, Claims, Incidents and PALS Review Group (CCIP) and the Governance Committee (CCG) Evidence or organisational learning was demonstrated through the six monthly Claims Report to the Board of Directors, completed Analyses and Conclusions in 37 out of the 44 closed clinical claims and via the quarterly Aggregated Reports for the CCIP and CCG. The overall view therefore is that the monitoring and audit of this policy has provided assurance to the Trust that claims are largely being managed in accordance with the policy and the NHSLA requirements. 4. NEW STANDARDS/LEGISLATION None. 5. RECOMMENDATIONS Improve the number of preliminary analysis completed within 40 days. 6. ACTION PLAN The recommendations are included in the action plan at Appendix APPENDICES Appendix 1: Action Plan Appendx 2: Claims Compliance Open Appendix 3: Claims Compliance - Closed 6

8 Poole Hospital NHS Foundation Trust Appendix Appendix 1: Action Plan Annual Policy Review Report Action Plan for: Policy and Procedure for the management of clinical negligence claims, employer/public liability claims and property expense scheme claims Lead for Action Plan: Legal Services Manager Reviewing Committee: Board of Directors Date Action Plan Initiated: July 2011 Code: Red Amber Green Issue Identified Action Lead Target Date Progress Review Date Green Ratio of Improve the ratio Carrie Stone January 2012 January 2012 preliminary of preliminary analyses completed within analyses completed within 40 days 40 days 7

9 Appendix 2 LEGAL SERVICES DEPARTMENT CLAIMS COMPLIANCE 1 st half 2010/2011 Claim Claimant - Disclosure/Acknowledgement Preliminary Analysis Number anonymised L13/2010 Disclosure + NHSLA L15/2010 Disclosure L16/2010 Disclosure late due to cons. L17/2010 Disclosure L18/20 Disclosure L19/2010 Disclosure (Con.del.) L20/2010 Not applicable (51 days) L21/2010 Disclosure EL22/2010 Acknowledgement (13 days) NHSLA (13 days) L23/2010 Disclosure L24/2010 Disclosure L25/2010 Disclosure Consultant delay EL26/2010 Not applicable Not applicable L27/2010 Disclosure L28/2010 Disclosure L29/2010 Disclosure L30/2010 Not requested NHSLA (LOC) EL31/2010 Acknowledgement (14 days) NHSLA (8 days) L32/2010 Disclosure 46 days no notes L33/2010 Disclosure L34/2010 Disclosure L35/2010 Disclosure L36/2010 Disclosure L37/2010 Disclosure EL38/2010 Acknowledgement (14 days) NHSLA (16 days) EL39/2010 Acknowledgement (14 days) NHSLA (14 days) L40/2010 Disclosure L41/2010 Disclosure L42/2010 Disclosure L43/2010 Disclosure delayed= con L44/2010 Disclosure L45/2010 L46/2010 L47/2010 L48/2010 Disclosure Disclosure Not applicable Disclosure 2 ND HALF 2010/ NHSLA Claim Claimant - Disclosure/Acknowledgement Preliminary Analysis Number anonymised L49/2010 No no record of TCI L50/2010 L51/2010 NHSLA = high L52/2010 Not applicable NHSLA - LOC L53/ NHSLA L54/2010 late due to TCI No no records 8

10 available EL55/2010 Acknowledged (21 days) NHSLA (24 days) EL56/2010 Acknowledged (21 days) NHSLA () L57/2010 L58/2010 L59/2010 Closed - N/A L60/2010 L61/2010 L62/2010 NHSLA - LOC L1/2011 L2/2011 EL3/2011 Acknowledged (21 days) NHSLA (19 days) EL4/2011 Acknowledged (21 days) NHSLA (17 days) L5/2011 L6/2011 L7/2011 L8/2011 Not applicable NHSLA - LOC L9/2011 NHSLA - LOC L10/ days CLS A/L L11/2011 Not applicable not PHT patient Not applicable L12/ CLS A/L L Notes not available L14/2011 L15/ days CLS A/L L16/2011 NHSLA 9

11 Appendix 3 Litigation Type Claimant - anonymised LEGAL SERVICES DEPARTMENT CLOSED CLAIMS COMPLIANCE 2010/2011 Analysis & Conclusion Response Yes Yes Not needed (SUI) Yes Not needed (SUI) Not needed (SUI) Not applicable Non-clinical Not applicable Yes Non clinical Non-clinical Not applicable Yes Non-clinical Not applicable Non-clinical Summary Not applicable Non-clinical Not applicable Not applicable 10

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