£55m cost of Lancashire medical mistakes

Medical blunders in Lancashire are costing millions of pounds a year in damages, it can today be revealed.

Monday, 15th January 2018, 8:35 pm
Updated Tuesday, 16th January 2018, 1:20 pm
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Mistakes at Lancashire Teaching Hospitals NHS Foundation Trust, which runs Royal Preston Hospital and Chorley and South Ribble Hospital, cost £55.68m between 2012 and last year.Out of 258 trusts, it ranked at 27 – though it was 83rd once the number of patients it treats was taken into account, an investigation has shown.It paid out a total of £9,330,859.97 in 2012/13, £7,211,587.25 in ‘13/14, £10,013,747.39 in ‘14/15, £13,624,801.54 in ‘15/16, and £15,499,863.75 last year.Errors at Lancashire Care, which is responsible for mental health care across the county, cost £4.2m between 2012 and 17.A spokesperson for Lancashire Care NHS Foundation Trust said: “Lancashire Care pays into 3 schemes; public liability, employers liability and clinical negligence which is when a patient is harmed from clinical care, ranging from the death of a patient known to our services to minor injury during dental work.“As a general rule the Trust has been subject to very few high value claims, the money paid out is as a result of a high volume of low value claims over a period of years for things like slips and trips or violent incidents.”A spokesman for the Department of Health said: “Our relentless drive to improve patient safety, including an ambition to halve the rates of neonatal deaths, stillbirths, maternal deaths and brain injuries caused during or shortly after labour by 2025, will help to reduce traumatic and costly safety failings in the NHS and ensure better protection for patients.“We’re ensuring taxpayers’ money is spent effectively by taking action against law firms creaming off excessive legal costs that dwarf the damages recovered – but we’re also clear we want to ensure patients continue to access justice at a reasonable cost.”Mistakes dating back more than two decades are still costing tens of millions of pounds a year nationally – the majority of which were hospital failings during childbirth – but totalled just £8,965.76 at Lancashire Teaching Hospitals.The sum was paid out last year and did not relate to maternity, figures showed.A spokeswoman for Blackpool Teaching Hospitals NHS Foundation Trust, which paid out a total of £42m over five years, said: “Clinical errors are very rare and many of the incidents referred to in these litigation costs are historic.“We take each case very seriously and each one offers an opportunity for lessons learned to prevent the same thing from happening again.”But Peter Walsh, chief executive of Action Against Medical Accidents, a UK charity that provides support and advice and lobbies the government to improve safety, said the figures nationally show improvement is still needed to maternity care.He said: “We as a charity have been going for 35 years and we still see the same mistakes, the same avoidable errors causing injury now as we did 35 years ago.“One common thing in terms of mistakes made during childbirth are failures to read CTG [cardiotocography] traces correctly and respond to them.“It is a very important tool that helps professionals realise when the baby is under too much stress and there are problems with their heart rate.“It requires speciality training in terms of interpreting the signs during childbirth. “Time is of the essence. A small delay in intervention can make the difference between a child being unaffected, having a brain injury or dying.“We see these problems occurring again and again. “It is time the NHS had consistent high-quality training for midwives and for doctors to ensure they are able to recognise the complications.”

What’s the picture nationally?In the past five years, the Department of Health has paid out £152 million, including legal fees, to victims of blunders made before April 1995 in England.Hospitals failings during childbirth account for more than two-thirds of this cost.Experts warned that these same mistakes are being repeated in labour wards today.Scotland and Northern Ireland also face multi-million pound bills each year for historical medical errors.

Why is medical negilence topical?The bill for all types of medical negligence claims in England - including damages and legal fees - has risen four-fold in 10 years to £1.6 billion in 2016-17, the National Audit Office has warned.Last year, the Government decided that lump-sum damages payments should be larger from March 2017 onwards, to compensate victims for low interest rates.An inquiry by the Public Accounts Committee in November 2017 warned that pressures on the NHS could see the litigation bill ‘spiralling out of control without effective action’.

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Who actually pays?In England, the body NHS Resolution (formerly the NHS Litigation Authority) provides NHS trusts with medical negligence indemnity cover, through two schemes:- The Existing Liabilities Scheme (ELS) covers any incidents which happened before April 1995. It is funded by the Department of Health; and- The Clinical Negligence Scheme for Trusts (CNST), covers incidents after April 1995. It is funded by NHS Resolution, by charging NHS trusts a premium based on their expected payouts.

Why is money still being paid for historical cases?Legal battles can take many years, and new claims are still being received for decades-old incidents.It can be years before patients or families realise they may have a claim for compensations while, sometimes, assessments about a child’s life-long care needs can only be made when they are older.Historically, cerebral palsy claims were often paid as a lump sum but families are now more likely to receive annual payments throughout the child’s life.

Why are the costs so large?Mistakes during or shortly after childbirth can leave the infant with brain damage and lifelong dependency on care, for which NHS trusts become liable.In 2016/17, maternity and neonatal care represented around 10 per cent of all overall (historical and non-historical) claims in England but 50 per cent of their monetary value.Claims for avoidable cerebral palsy are ‘undoubtedly the most expensive’ of maternity claims and can even exceed £20 million per claim, according to a recent report by NHS Resolution. The number of cerebral palsy claims has remained relatively static over the past ten years.Critics say too often the NHS does not admit liability and then faces larger legal fees when it has to pay both its own and the claimants’ costs upon losing cases.The life expectancy of children with cerebral palsy is increasing and care costs are also going up.

What action is the government taking?The Department of Health and NHS Resolution have put forward several measures to cut medical negligence costs in England.This includes a plan to cap the fees legal firms can recoup from the taxpayer when they win low-value cases of up to £25,000, which critics say does not tackle the root causes of the claims; a plan to resolve more medical negligence cases before they go to court, and a proposal to introduce a voluntary alternative compensation scheme for infants who have suffered avoidable brain injury at birth.Cash incentives for trusts which take steps to make maternity services safer have also been proposed.

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What has NHS Resolution said?“Incidents in maternity account for 10 per cent of the number of claims we receive each year but 50 per cent of the expected cost of the claims. This is because of the very high cost of cases which tragically involve brain damage at birth.”