THE PAPER IS ALIGNED TO THE DELIVERY OF THE FOLLOWING STRATEGIC OBJECTIVE(S) AND HEALTH AND CARE STANDARD(S):

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1 Agenda Item: 3.1 AUDIT & ASSURANCE COMMITTEE Subject : Approved and Presented by: Prepared by: Other Committees and meetings considered at: Considered by Executive Team on: Date of Meeting: LOSSES AND SPECIAL PAYMENTS REPORT FOR 1 APRIL 2015 to 30 SEPTEMBER 2016 Eifion Williams, Director of Finance Sarah Pritchard, Head of Financial Services This has not been considered at any other Committees or meetings. PURPOSE: To provide the Committee with a Report of Losses and Special for the period 1 April 2015 to 30. Approval/ Ratification/ Decision Discussion Information THE PAPER IS ALIGNED TO THE DELIVERY OF THE FOLLOWING STRATEGIC OBJECTIVE(S) AND HEALTH AND CARE STANDARD(S): Strategic Objectives: Health and Care Standards: Page 1 of 6 Implement effective financial management to ensure statutory breakeven and best value for money. Our Staff and Resources

2 EXECUTIVE SUMMARY: Losses and special payments are items that the Welsh Government would not have contemplated when they passed legislation or agreed funds for the NHS; such payments would also include any ex gratia payments made by the health board. By their nature they are items which should be avoidable and should not arise. They are subject therefore to special control procedures and are included within a separate note in the health board s annual accounts. The following relate to payments made on behalf of cases for which Powys THB have responsibility. Claims relating to the Residual Clinical Negligence (relating to former Health Authorities) cases are scrutinised by the Welsh Risk Pool advisory panel and therefore are not required to be included below. The responsibility for managing Powys clinical negligence and personal injury claims transferred back to the health board in June This action brought together Concerns (incidents, complaints and claims [both < 25k and > 25k]) within the remit of the Concerns Team. The Senior Manager Putting Things Right who has responsibility for this area of work, manages the claims on a day-to-day basis supported by the Assistant Director Quality & Safety. Where indicated, advice and support is provided by the Welsh Risk Pool Services and Legal & Risk Services on the processes and on the management of individual cases. Systems and processes have been established and databases documenting all claims activity alongside the individual claims files exist. Decision making on payments are approved in a number of ways: On a day-to-day basis, advice received from Legal & Risk solicitors regarding payments are discussed with the Executive Director of Nursing. All discussions are documented in file notes to provide an audit trail for all decisions re: approved/ declined advice and subsequent transactions. Information and decision about compensation claims > 25k have been channelled through the Putting Things Right panel since March This allows the panel to have an overview of all claims activity. The terms of reference of the panel were updated end of 2012 to take account of compensation claims activity. This will serve to provide a Page 2 of 6

3 formal record of discussions on these claims and provide the committee with greater knowledge and experience when applying the Tariff for claims < 25k. Reports on the management and status of compensation claims are provided to the Executive Team on a 6-monthly basis in accordance with the PTHB Policy on the Management of Compensation Claims Clinical Negligence & Personal Injury, in the format specified by Section 8 of the Putting Things Right Guidance. It is advised the minutes of the Executive Management Team are provided to the Board for information purposes. Clinical negligence and personal injury In the period from the 1 April 2016 to 30, the health board made payments in respect of 12 cases totalling 85, summarised below. It should be noted that the THB is responsible for the first 25,000 of any claim with the residual balance being covered by Welsh Risk Pool Services. Only two claims have exceeded this 25,000 limit. Details of the payments are included in Appendix Ai. No. of payments/receipts No. of cases Clinical /Personal (Payment) Negligence Injury , Total , Further detail on Cases over 25k : CASE 1 - Pressure Ulcer A redress case pursued as a civil case case recently settled for 275,000 apportioned between ABMU HB and PTHB (smaller amount for PTHB as only relates to pressure areas) Damages 32, Claimant s costs 20, Defence costs awaited CASE 2 - Mismanaged disciplinary Page 3 of 6

4 Damages 10, Claimant s costs 18, Defence Costs 8, (inclusive of 2, discount being paid by L&RS re an error in processing claim) Lessons learnt: Ensuring staff are aware of and complaint with the expectations and requirements of a bank contract Staff are not employed on bank contracts to work regular shifts Ensure managers awareness when conducting an initial assessment of a case, being clear on terminology used, it is not a disciplinary hearing at that stage. Other Special Details of the payments are included in Appendix Aii. No. of payments/receipts No. of cases Other Special 6 6 3, Total 6 6 3, One of the above payments relates to the HMRC Interest payment in respect of a compliance visit. This was notified to the Committee at its May 2016 meeting and has now concluded. A summary of the final agreed position between the health board and HMRC is attached at Appendix Aiii. The Audit & assurance Committee is asked to note the above losses and special payments. The will continue to receive an update every 6 months on losses and special payments as well as an Annual Report consolidating all cases previously reported during the financial year. Trends At the July 2016 Audit Committee meeting a request was made that for all reports will include a section on prior year amounts and trends. Some initial trends are included below and this is to be further enhanced in future reports. Page 4 of 6

5 The new Senior Manager Putting Things Right started in post 3 October, and the health board are supporting her practice certificate for the next year, the intention being that the health board will manage its own personal injury cases anticipating a reduction in defence payments for personal injury cases, as we manage the cases in-house as opposed to seeking legal & risk services to support. Details of Defence made by financial year Defence Clinical Negligence Defence Personal Injury Year 2011/12-11,849 1, /13 2, / /15-2, /16 2,588 7, /17 (6 months) 1,259 12,561 Detail of Damages made by financial year Damages Clinical Negligence Damages Personal Injury Year 2011/12 226,665 32, /13 18,714 14, / , / /16 32,500 11, /17 (6 months) 21,150 50,800 Page 5 of 6

6 RECOMMENDATION(S): The Committee is asked to NOTE this Report on Losses and Special payments covering the period 1 April 2016 to 30 September2016. NEXT STEPS: Page 6 of 6