The Doctor, the Patient….and her Lawyer Clinical Negligence and the NHS Celia Newton Legal Affairs Manager 13 October 2015.

The Doctor, the Patient….and her Lawyer

Clinical Negligence and the NHS Celia Newton

Legal Affairs Manager 13 October 2015

Set the Scene…..

The Doctor….A Claims Culture?

2009/10 2010/11 2011/12 2012/13 2013/14

6,652

8,655 9,14310,129

11,945

CNST Claims across the NHS

TRFT against theNational Benchmark

Medium Acute Trusts with Maternity FY2013/14

Stockp

ort

North Cumbria

Univ

Sherw

ood Fore

st

Hampsh

ire

South

end Univ

Buckingh

amsh

ire Healt

hcare

Basildon an

d Thurro

ck Univ

Croyd

on

The Roth

erham

Wals

all Healt

hcare

Bolton

Mid Esse

x

North Te

es & Hart

lepool

South

Devon

Surre

y and Su

ssex

Northam

pton

Ashford

& St

Peter's

Great

Weste

rn

Gatesh

ead

Medway

Prince

ss Alexa

ndra

Warr

ington an

d Halton

Colcheste

r

Dudley Gro

up of Hosp

itals

Luto

n & Dunsta

ble

Frimley P

ark

Heatherw

ood & W

exham

Park

Whitti

ngton

James P

aget U

niversi

ty

Kingston

Ipswich

Countess

of Cheste

r

Taunto

n and So

merset

Peterb

orough

& St

amford

South

port an

d Orm

skirk

Chesterfi

eld Royal

Poole

Royal U

nited Hosp

ital B

ath

North M

iddlesex U

niv

Royal S

urrey C

ounty

Hillingd

on

Royal B

ournemouth

and Chris

tchurch

69 6762 59 58 57 55 55 52 50 50 48 47 44 43 40 38 37 36

31 28

Regional FY 2013/14

Sheffield Teaching

Mid York

shire

Nottingham U

niv

York Teach

ing

Doncaste

r and Basse

tlaw

Barnsle

y

Sherwood Fo

rest

The Rotherh

am

Derby H

ospita

ls

Chesterfi

eld Royal

Sheffield Childre

n's

153

133121 121

102

72 6758

5036

9

TRFT Data

UROL

ORTHOM

SB POD

OPHTHOM

FS ENT

GEN SURG

ANAESTHCYPAS

OBS

GYNAE ED

COMM

NUR

GEN MED

HCOP

STROKE

RADIOL

THERAPY

2

10

4

1 1

3

1

7

12

8

3

7

1 12 2

1 1

Claims Brought FY 2013/14 by Discipline

TRFT Data

UROL

ORTHOM

SB POD

OPHTHOM

FS ENT

GEN SURG

COMM

DENTCYPS

OBS

GYNAE ED

GEN MED

HCOP

LAB M

ED

3

10

1 1

4

12

9

12 2

3

7 7

23

Claims Brought by FY 2014/15 by Discipline

National Data FY 2013/14

15%

12%

11%

11%6%

6%

3%2%2%

2%

30%

OrthoEDGen SurgObsGynaeGen MedRadiolUrolPaedsMental HlthOther

Outcomes

54.50%45.50%

TRFT Claims Outcome FY 2014/15

Closed without DamagesClosed with Damages

Outcomes- Financial

D&S FH

Int MD

Unsch M

edENT

Oral

GenSurg

MSK

OphthUro

l

1.6

10.9

0.62.1 1.8

0.8

3.94.9

0.5 0.8

Est. Costs by Discipline £ million

Estimated Costs by Division

2.15% 5.73%

7.52%

39.00%

45.50%

INT MEDDIAG SUPPUNSCHED MEDFHSURG

Keep in context…

The Patient…..

Possibly an incident : 47%Possibly an unreported/ ‘downgraded’ incident that should have triggered the Duty of Candour Likely a complaint: 77%

AHR: Missing records?

The Patient…..

Snapshot of new Claims brought High -Med Risk FY 2013/14

50% associated with fatality +/ - cardiac arrest +/- significant avoidable injuryFailure to Respond to Deterioration 55%

Missed Diagnosis 32%Delayed Diagnosis 13%

Patient Outcome by Discipline

46%

27%

27%

Fatality / Significant Avoidable Injury

SURGMEDFH

The Patient……The Process……

What the patient recalls…What the lawyer averred……

VS

What the contemporaneous records reveal

The Doctor…..The Process…..

What the patient recalls…What the lawyer averred……

VSWhat the contemporaneous records reveal

The risks….

• Factual Evidence: Record keeping-notes!!• Your Opinion Evidence: Context • Your Opinion: Organisational issues-

fragmented care / referral pathways etc• Independent Expert Evidence: Your peers

The risks…..

• Individual’s perceptions / support • Professional conflict

• Organisational processes- data- accurate• Organisational processes- how do we learn

Her Lawyer….

Thank you for your attention

[email protected]