At £85 billion, the NHS carries an enormous litigation cost liability
Though modern healthcare practices are highly effective, the health system itself is a complex behemoth under immense pressure from relentless growth in demand. Despite significant progress in both the use of technology and the development of drugs, the delivery of healthcare remains vulnerable to the potential for significant harm. Human fallibility increases the probability that mistakes will happen.
When they do, questions are asked, investigations conducted, responsibility apportioned, and accountability determined. If the harm is deemed to have been avoidable, the organisation and the professional or professionals responsible find themselves subject to costly litigation. Each case can cost the organisation millions of pounds.
The NHS paid out over £2bn or approximately 2% of the entire budget of NHS England (£115b) in clinical negligence claims in 2018-2019. In addition, to be prepared for future clinical negligence claims, it has built up a litigation cost liability fund of around £85 billion. Each NHS Trust pays an annual premium into this fund, reaching 4% of annual revenue in 2020.
These are enormous costs taking away crucial health service funding that could be better spent on investing in services and staff.
However, there is a significant opportunity to reduce clinical harm and litigation costs through empowering the professionals, digital innovation and linking the right data.
The real cost of negligence claims
The real cost of each mistake is bigger than just the cost of a claim.
The impact of healthcare mistakes can be catastrophic. Lives damaged, debilitated or lost, lead to a cascade of consequences for the patients’ families and loved ones. For healthcare providers, there is not only a reputational cost but also the opportunity cost of the time spent managing and responding to claims, implications for staffing and services as well as the impact on morale.
A forensic examination of the web of relationships and services that sits behind each patient-service interaction reveals a complex network: large teams of health workers, hierarchical managerial systems often working to unmanageable targets in disconnected silos.
Accountability: assigning responsibility
There is no dearth of initiatives designed to improve the quality of healthcare, to optimise the ‘processes of provision’, to minimize the possibility of harm to the patient, and to reasonably protect those responsible for providing care.
Yet the incidence of ‘mistakes’ and their cost to the NHS and therefore the public exchequer, continues to rise. According to NHS Resolution, the cost of paying out for clinical harm during 2019/2020 was £8.3b.
Despite the employers’, in this case, the NHS’, best efforts to manage resources and responsibilities, in terms of responsibility, there remains a direct line from the patient to the professional responsible for their care. This is a direct line of accountability that can never be broken.
Accountability: measuring professionalism
Clearly, healthcare professionals juggle multiple responsibilities each with its own set of qualifying requirements. Those qualifications must be regularly measured, assessed and approved according to predetermined standards.
Unfortunately, current validating systems are bureaucratic, cumbersome paper trails that are in some cases mere tick boxing exercises. They widen the disconnect between the professional and the organization. As primarily manual data collection exercises, they offer limited potential for data analysis when a vast digitized database of information could be leveraged to deliver crucial analysis driven insight.
Imagining a connected solution
Let us imagine a health service that has the tools and capability to track, monitor and develop its services in a way that supports, empowers and enables the clinicians.
Imagine a digital capability that enables both the professional and the employer to spot, monitor, and address the needs of the professional in real time. A tool that recommends timely mediations, enables immediate quality of care interventions and reduces the need for expensive after the fact management overheads.
Imagine if we could evidence the level of quality, improvements, and professional development, to reduce the incidence of clinical mistakes and therefore the level of clinical negligence premiums.
P3: making imagination reality
P3. Proactive Personal Professionalism Solution.
A solution imagined for the health care professional. A solution designed to support, enable, and empower. A tool that connects both the professional and the employer with their professional development data enabling both to collect, record, view, monitor and assess progress.
P3 is designed to target development, predict and prevent incidences of harm, optimise the quality of care and help reduce the healthcare service’s burden of litigation liabilities.
For the sake of patients, the professionals who take care of them, and the future health of the NHS, a thoroughly modern ‘makeover’ of professional development in health care, is long overdue.
Dr Nadeem Moghal
Chief Medical and Innovation Officer