BOARD OF DIRECTORS COVER SHEET. Meeting Date: 25 July 2012

Transcription

1 BOARD OF DIRECTORS COVER SHEET Meeting Date: 25 July 2012 Agenda Item: 1.9 Paper No: F 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 Clinical 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 the policy and the 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 F 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 2012 Presented to: Board of Directors Action Plan: Yes Date of Next Annual Report: July 2013 Author: Legal Services Manager 1

3 CONTENT 1. INTRODUCTION 3 2. MONITORING AND AUDIT AIMS AND OBJECTIVES 3 3 METHODOLOGY 3 4 RESULTS 4 5 CONCLUSIONS 6 6 NEW STANDARDS/LEGISLATION 7 7 GOOD PRACTICE 7 8. RECOMMENDATIONS 7 9. ACTION PLAN APPENDICES

4 1. INTRODUCTION 1.1 This is the fifth annual report relating to the Policy and Procedure for the Management of Clinical Negligence Claims, Employers/Public Liability Claims and Property Expense Scheme Claims. The fourth annual policy review report was submitted and approved by the Board of Directors in July Six monthly reports on claims are provided to the Board of Directors and the Patient Safety and Quality Committee. Aggregated data is reported to the Complaints, Claims, Incidents and PALS Review Group (CCIP) on a quarterly basis. 1.2 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 current version of the policy is Version 4. The next review date is November The updated action plan arising from fourth APRR was submitted and approved by the Board of Directors in January The action points completed are as follows: To achieve an improvement in the ratio of preliminary analyses for clinical claims completed within 40 days in all relevant cases. The fourth APRR reported that 35 out of 54 new clinical claims had had preliminary analyses completed. A review of the second half of the financial year 2011/2012 indicates that 22 out of 25 new claims had the analysis completed. The detailed 2011/2012 APRR updated action plan can be found at Appendix 1 of this report. 2. RESULTS OF MONITORING AND AUDIT 2.1 Aims and Objectives 2.1.1This review is intended to provide the Board of Directors with assurance that the Policy and Procedure for the Management of Clinical Negligence Claims, Employers/Public Liability Claims and Property Expense Scheme Claims continues to be delivered and managed effectively. Where gaps in compliance are identified confirmation that actions have been taken or clear action plans to remedy gaps are in place, thus ensuring that the Trust: Complies with the NHSLA Reporting Guidelines Communicates with relevant stakeholders Aggregated analysis is undertaken Organisational learning is identified and implemented 3 METHODOLOGY 3.1 The audit and monitoring criteria for the policy are listed below. 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 3

5 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:- Clinical 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 2011 to March 2012 by reviewing data held on DATIX and each individual case file. 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, the Patient Safety and Quality Committee and in the quarterly reports to the CCIP 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 CCIP Review Group, with relevant Clinical Leads and Consultant staff. The appropriateness of grading is also reviewed with the Medical Director. Since the previous APRR, Solicitors Risk Management Reports are sent to the relevant Consultant by the Legal Services Manager in order that the actions identified can be considered and implemented. These issues identified and the lessons learned are discussed at the CCIP Review Group to monitor compliance and evidence of actions taken. 4 RESULTS The specific results for each are given below. 4.1Review of NHSLA Reporting Guidelines There have been no Property Expense claims in the period April 2011 to March

6 Clinical Negligence cases Appendix 2 60 cases were notified to the Trust: of these: of these 58 requests for disclosure of healthcare records were received. 56 of these were processed within the 40 day timescale. Disclosure on one claim took 45 days and on the other claim, disclosure took 42 days. In both instances this was due to late availability of the healthcare records. Of the 60 cases, 54 have had a preliminary analysis performed. In 4 cases an analysis was not required as it became apparent the claim was not against the Trust. 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 51 cases had a preliminary analysis completed within 40 days. This represents 94% of claims had a preliminary analysis undertaken within the time-scale and is an improvement from the previous APRR when there was 73% compliance with the time-scale. The causes of delays for the remaining 5% were a combination of notes not being available and the availability of the Legal Services Manager. 6 cases were identified as high probability and all were notified to the NHSLA, with completed preliminary analyses. The Trust received 13 Letters of Claim and 6 Court Proceedings and these were notified to the NHSLA within 24 hours. Liabilities to third parties (employer s liability and public liability cases) 12 new employer s liability and public liability cases were opened. All were acknowledged and within the 21 day time-scale. All 12 cases were notified to the NHSLA with standard disclosure lists completed: 9 were reported within 21 days. This represents 75% of claims reported within the time-scale. For the previous year there was 77% compliance. The average notification was 20 days. 4.2 Communication with relevant stakeholders For the 60 open clinical negligence claims, the relevant consultants have been given details of the claim and asked to provide reports on the standard of clinical care received, an opinion as to whether the care represents a reasonable standard and comments on causation. Comment has also been requested on any allegations received at the time disclosure of healthcare records is requested, on receipt of Letters of Claim, independent expert reports and Particulars of Claim. Following preliminary analyses, 11 claims were graded as amber. All of these have been discussed with the Medical Director, in line with the Trust s policy. These reviews considered the facts, comments from clinicians, the appropriateness of grading, probability of settlement, quantum and actions arising from the analyses. 6 of the 60 new clinical negligence cases were reported to the NHSLA as they carried a high probability of settlement, following preliminary analysis. 4.3 Aggregated analysis Claims themes were provided in the six monthly reports to the Board of Directors and the Patient Safety and Quality Committee. Aggregated analysis was provided on a quarterly basis to the CCIP Review Group, which also 5

7 considered key themes and correlation between complaints, claims and adverse events. 4.4 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. 40 claims were closed for the period April 2011 to March Of these, 30 have been through the process to date. (Appendix 3) Organisational learning is reported on a six monthly basis to the Board of Directors and Patient Safety and Quality Committee. Learning arising from claims is also reported at the CCIP Review group, on a quarterly basis and disseminated to all Divisions. Following the introduction of the NHSLA Solicitors Risk Management Reports, the Trust received 8 reports for the period April 2011 to March Each of these reports has been followed up with the relevant clinician and responses received in all instances with evidence of implementation of action points. These are routinely reported in the aggregated report to the CCIP Review Group on a quarterly basis and lessons disseminated to the Divisions. 5 CONCLUSIONS 5.1 The monitoring and audit of this policy in respect of: NHSLA Reporting Guidelines Communication with relevant stakeholders Aggregated analysis Organisational learning confirms that Preaction Protocol disclosure within 40 days was achieved in all but 2 clinical claims where requests had been received by the Trust 54 clinical claims had preliminary analyses completed and of these 51 (94%) were completed within 40 days, which represents an improvement over the previous APRR All letters of claim and Particulars of Claim were notified to the Trust within 24 hours All 12 LTPS claims were acknowledged within 21 days and all cases were notified to the NHSLA with standard disclosure lists completed. There was, however, a small reduction in percentage terms of claims notified to the NHSLA within the 21 day time-scale (75% as opposed to 77%) 6

8 For all 60 clinical claims, the relevant consultant(s) were contacted and asked to provide reports on the clinical care received 11 amber claims were discussed with the Medical Director in line with Trust policy 6 of the 60 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 Clinical Governance Committee (CCG) and to the Board of Directors and Patient Safety and Quality Committee on a six monthly basis Evidence of organisational learning was demonstrated through the six monthly Claims Report to the Board of Directors, and Patient Safety and Quality Committee, completed Analyses and Conclusions in 30 out of the 40 closed clinical claims and via the quarterly Aggregated Reports for the CCIP and CCG. The NHSLA s Solicitors risk Management Reports were sent to relevant consultant staff in all 8 instances, the actions and learning being disseminated through the CCIP Review Group. 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 reporting requirements for claims received by the Trust. 6 NEW STANDARDS/LEGISLATION 6.1 Learning lessons from claims 2.7. The Trust must evidence that action has been taken to improve safety in response to incidents giving rise to clinical negligence claims. Where solicitors risk management reports on claims have been prepared, the Trust must demonstrate that the risk issues identified have been considered and action taken (if any). If action has not been taken, the reasons why and how this decision was made must be clearly documented. 7 GOOD PRACTICE 7.1 The number of completed Preliminary Analyses within 40 days. The regular review of Amber claims with the Medical Director. 8 RECOMMENDATIONS 8.1 None 9 APPENDICES Appendix 1: Updated Action Plan 2011/2012 Appendix 2: Claims Compliance Open Appendix 3: Claims Compliance - Closed 7

9 Appendix 1 Poole Hospital NHS Foundation Trust 7.1 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 Update January 2012 Code: Red Amber Green Issue Identified Green Ratio of preliminary analyses completed within 40 days Action Lead Target Date Improve the ratio of preliminary analyses completed within 40 days Carrie Stone January 2012 Progress Preliminary analyses completed within 40 days in all relevant cases. Review Date January

10 Appendix 2 LEGAL SERVICES DEPARTMENT CLAIMS COMPLIANCE 1 ST HALF 2011/2012 Claim Claimant - Disclosure/Acknowledgem Preliminary analysis Number anonymised ent L17/2011 Completed Completed L18/2011 Completed Completed L19/2011 Completed Notes not available L20/2011 Completed Completed EL21/2011 Acknowledged (9 days) NHSLA 31 days L22/2011 Not applicable notes not Not applicable as claim not requested. being pursued. EL23/2011 Acknowledged (3 days) NHSLA 24 days L24/2011 Completed Completed 39 days L25/2011 Completed Not applicable claim against GP not Trust L26/2011 Completed NHSLA/Completed 21 days EL27/2011 Acknowledged (16 days) NHSLA 16 days L28/2011 Completed Completed + NHSLA L29/2011 Completed Completed EL30/2011 Acknowledged (14 days) NHSLA 21 days L31/2011 Completed NHSLA referral L32/2011 Completed Completed L33/2011 Completed Completed L34/2011 Completed Completed L35/2011 Completed Completed + NHSLA L36/2011 Completed Completed L37/2011 Not applicable notes not Completed requested. L38/2011 Completed Completed EL39/2011 Acknowledged (14 days) NHSLA 16 days L40/2011 Completed Completed L41/2011 Completed Completed L42/2011 Completed Completed L43/2011 Completed Completed L44/2011 Completed Completed L45/2011 Completed Completed EL46/2011 Acknowledged (14 days) NHSLA L47/2011 Completed Completed out of time L48/2011 Completed Completed L49/2011 Completed Completed L50/2011 Completed Completed L51/2011 Completed Completed L52/2011 Completed Completed EL53/2011 Acknowledged (14 days) NHSLA 30 days L54/2011 Completed Completed L55/2011 Completed Completed L56/2011 Completed Completed EL57/2011 Acknowledged 14 days NHSLA 6 days 9

11 2nd HALF 2011/2012 Claim Claimant - Disclosure/Acknowledg Preliminary Analysis Number anonymised ement L59/2011 Completed Completed L60/2011 Completed Completed L61/2011 Completed Completed L62/2011 Completed Completed L63/ days late No no allegations received Completed on receipt L64/ days late Completed L65/2011 Completed Completed L66/2011 Completed Completed L67/2011 Completed Completed L68/2011 Completed Completed L69/2011 Completed Completed EL70/2011 Completed 14 days NHSLA 15 days L71/2011 Completed Completed EL72/2011 Completed 14 days NHSLA 25 days L73/2011 Completed Completed L74/2011 Completed Completed L75/2011 Not applicable Completed L76/2011 Completed Not required notes review indicate RBH case L77/2011 Completed Completed L78/2011 Completed Completed L1/2012 Completed Completed L2/2012 Completed Completed EL3/2012 Acknowledged 14 days NHSLA 15 days L4/2012 Completed Outside of timescale = a/l L5/2012 Completed Completed EL6/2012 Acknowledged 14 days NHSLA 15 days L7/2012 Completed Completed L8/2012 Completed Completed L9/2012 Not applicable Not required L10/2012 Completed Completed L11/2012 Completed Pending EL12/2012 Acknowledged 14 days NHSLA 13 days Carrie Stone Legal Services Manager July

12 Appendix 3 LEGAL SERVICES DEPARTMENT CLOSED CLAIMS COMPLIANCE 2011/2012 Type Claimant - 1 st half Response anonymised Analysis Non-clinical Completed Received Clinical Not applicable Not applicable Non-Clinical Not applicable Not applicable Clinical Not applicable claim not related to PHT. Not applicable 2 nd half Non-clinical Completed Received Non-clinical Completed Received Clinical Not applicable Not applicable Non-clinical Not required. Not applicable 11