the doctor, the patient….and her lawyer clinical negligence and the nhs celia newton legal affairs...
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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….
