NHS Resolution Annual Report and Accounts 2018/19
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HC 2371 Annual report and accounts 2018/19 Advise / Resolve / Learn NHS Resolution Annual report and accounts 2018/19 Presented to Parliament pursuant to Paragraph 6 of Schedule 15 of the National Health Service Act 2006. Ordered by the House of Commons to be printed 11 July 2019. HC 2371 Contents © Crown copyright 2019 This publication is licensed under the terms of the Open Government Licence v3.0 except where otherwise stated. To view this licence, visit nationalarchives.gov.uk/doc/open-government-licence/version/3. Where we have identified any third-party copyright information you will need to obtain permission from the copyright holders concerned. This publication is available at www.gov.uk/official-documents Any enquiries regarding this publication should be sent to 151 Buckingham Palace Road, London, SW1W 9SZ. ISBN: 978-1-5286-1248-7 CCS: CCS0419036360 07/19 Printed on paper containing 75% recycled fibre content minimum. Printed in the UK by the APS Group on behalf of the Controller of Her Majesty’s Stationery Office. Advise / Resolve / Learn Contents Contents Performance report 6 Overview 8 Chair’s welcome 8 Chief Executive’s report 11 Performance summary 15 Understanding our indemnity schemes 16 The year in numbers 17 The environment we work in 22 Key risks and issues 24 Going concern 27 Performance analysis 28 Our strategic aims 28 Performance measures 30 Service updates 35 Claims Management 35 Working with our members, beneficiaries and the wider NHS to learn and improve safety 64 Practitioner Performance Advice 66 Primary Care Appeals 72 A fit-for-purpose organisation 78 Finance report 83 Accountability report 94 Corporate governance report 96 Remuneration and staff report 114 Parliamentary accountability and audit report 131 The certificate and report of the Comptroller and Auditor General to the Houses of Parliament 132 Financial statements 136 Statement of comprehensive net expenditure for the year ended 31 March 2019 138 Statement of financial position as at 31 March 2019 139 Statement of cash flows for the year ended 31 March 2019 140 Statement of changes in taxpayers’ equity for the year ended 31 March 2019 141 Notes to the accounts 142 Glossary 178 5 Performance report Performance report 7 NHS Resolution Annual report and accounts 2018/19 Overview Chair’s welcome Ian Dilks / Chair We are now entering the changed is the government’s claims and what can be done third year of the new decision to ask us to operate in a consistent way to reduce strategy we laid out in (on behalf of the Secretary claims and improve patient April 2017. More detail of of State for Health and Social safety. Internally, we will assess progress is contained in Care) what is now known in the months ahead how, by the following pages, but in as the Clinical Negligence bringing the two main clinical Scheme for General Practice negligence schemes together, summary we are very much (CNSGP), similar to the Clinical we can deliver more than the on track and more convinced Negligence Scheme for Trusts sum of the parts. An early than we were before that (CNST) that we have operated example of benefits is that this this is the right strategy to for over 20 years. Preparing for has given us the scale to justify pursue. As Chair, I have the this has been a major task for opening an office in Leeds to pleasure and privilege of the senior management team, service both CNST and CNSGP meeting with a wide range but a scheme for liabilities schemes from a lower-cost of stakeholders and I receive arising from incidents after site, in a location that is more frequent feedback on how 1 April 2019 was successfully attractive to some of our staff. launched on that date and much NHS Resolution has There are a number of early has met with widespread changed in the last few signs that our strategy is support from GPs and other years and how much more having an impact. Customer key stakeholders. The current connected, visible and satisfaction levels continue position on claims arising from relevant we have become to rise, our Early Notification incidents occurring prior to 1 in the wider NHS family. scheme is beginning to deliver April 2019 is explained in the faster support and resolution There is also increasing financial statements (see Note to those impacted by serious international interest in 12 on page 177). some of our initiatives. incidents at childbirth, our Although the decision to maternity incentive scheme We have inevitably progressed introduce CNSGP and to is improving adherence to faster in some elements of appoint NHS Resolution as recognised best practice in strategy implementation than scheme administrator and maternity safety and we are others but progress is being operator was not ours, we are resolving record numbers made in all areas. We are in the delighted to take it on and of claims though alternative process of reviewing progress see real benefits for the NHS means such as mediation – in more detail in the light of in bringing clinical indemnity again more detail is in the other developments in the cover for all NHS activities in following pages. At the same healthcare system but with one England under one roof. For time, we are taking more exception are not expecting the first time, one organisation robust action against those, major changes. The one will have access to the learning thankfully rare, patients who major thing that has of course from all NHS clinical negligence exaggerate claims for personal 8 Performance report gain at the expense of finite decreasing discount rates. to be presented to the Civil NHS funds and also against The difference between Justice Council in summer 2019 excessive legal fees. For the current payment levels in and what the response of the first time, this year we have respect of clinical claims of Department of Health and seen exaggerated claims result £2.4 billion – of which £0.4 Social Care (DHSC) to it will in custodial sentences and billion relates to the impact of be in the public consultation a solicitor struck off by the the personal injury discount we expect to follow. As the Solicitors Regulation Authority. rate (PIDR) change in March National Audit Office study 2017 – and the cost of harm Our Practitioner Performance published in September 2017 is the main reason that our Advice and Primary Care concluded, in order to tackle Appeals services also continue total claims provisions have the drivers of cost, any strategy to develop successfully. increased by a further will need to include legal £6 billion to £83 billion, a Claim levels have remained sum which represents the reform. However, any changes largely stable for the last two value at current prices of claim are now unlikely to take effect years which, combined with payments to be made years or before 2020. the benefit of other measures, in some cases decades into the has meant that we have been We continue to develop ways future. In November 2017, of learning from claims and able to follow a modest 2% the Public Accounts Committee feeding this information into increase in charges to our (PAC) recommended the the system to help improve members in 2018/19 with a need for a cross-government patient safety and we were 2% reduction for 2019/20, the strategy to tackle the pleased to contribute to first reduction in 10 years. increasing costs of clinical However, as I flagged last year, negligence and as we said last the new patient safety we cannot be complacent and year the initial response was strategy being developed by it is sadly inevitable that the expected last September. We NHS Improvement. pay-as-you-go nature of our continue to contribute our We have also made progress in schemes means that charges knowledge and expertise to looking at other factors that will rise in future years unless the discussion, but ultimately it impact claims, in particular the there is reform of the legal is a political decision as to the research conducted for us last environment in which we basis on which patients who year by the Behavioural Insights operate. I said last year that have suffered harm are to be Team which illustrated the at current prices the annual compensated and their legal ‘cost of harm’ was about representatives remunerated. dissatisfaction with procedures £7-8 billion in recent years. We await with interest the for handling incidents and In 2018/19 the cost of harm initial response to the PAC complaints experienced by was approximately £9 billion, which is now expected later those who have brought of which approximately 60% this year. We also await the claims, as well as the role of relates to maternity claims, report on fixed recoverable NHS staff in recommending the increase being largely costs (for clinical negligence claims on occasion as a way of attributable to the impact of claimant lawyers) which is due getting redress. 9 NHS Resolution Annual report and accounts 2018/19 Working with others in the of the UK government, is in completed external board system to address the issues the very positive independent effectiveness review confirmed raised by this research will assessment of the quality of the many positive aspects of be a priority for us in the the executive team of NHS the way our unitary board year ahead. Resolution and its leadership in operates and also made some repositioning the organisation helpful recommendations for We continue to seek external as one focused on ‘resolution’ further development to reflect validation of the quality of across all our activities.