HC 499 Annual report and accounts 2019/20 1 NHS Resolution Annual report and accounts 2019/20 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 16 July 2020. HC 499 NHS Resolution Annual report and accounts 2019/20 © Crown copyright 2020 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: 978-1-5286-1997-4 CCS: CCS0620708408 07/20 Printed on paper containing 75% recycled fibre content minimum. 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Contents Contents Performance report 7 Overview 7 Performance summary 15 Understanding our indemnity schemes 17 The year in numbers 18 The environment we work in 29 – Law reform and the legal environment 29 – The health landscape 30 Key risks and issues 32 Going concern 35 Performance analysis 37 Our strategic aims to 2022 38 Performance measures 40 Service updates 47 – Claims Management 47 – Learning from harm 72 – Practitioner Performance Advice 83 – Primary Care Appeals 90 A fit-for-purpose organisation 97 Finance report 103 Accountability report 113 Corporate Governance Report 114 – Directors’ report 114 – Statement of Accounting Officer’s responsibilities 115 – Governance Statement 116 Remuneration and staff report 134 Parliamentary accountability and audit report 154 The certificate and report of the Comptroller and 155 Auditor General to the Houses of Parliament Financial statements 159 Statement of comprehensive net expenditure for the year 160 ended 31 March 2020 Statement of financial position as at 31 March 2020 161 Statement of cash flows for the year ended 31 March 2020 163 Statement of changes in taxpayers’ equity for the year 164 ended 31 March 2020 Notes to the accounts 166 Glossary 214 5 NHS Resolution Annual report and accounts 2019/20 6 Performance report 7 NHS Resolution Annual report and accounts 2019/20 Chair’s welcome Ian Dilks / Chair This is my seventh and final Chair’s welcome and increasingly in recent years I have talked of change. This year is no different and there are more changes to come, both in pursuit of our strategy and as a consequence of the recent and dramatic impacts of Covid-19. Some of these will be temporary but others will be practice in England for incidents after 1 April 2019, with us for years and are difficult to assess at this was launched successfully a year ago and we have also time so I have commented separately at the end of implemented oversight arrangements of claims for this welcome. This is the right place to note, though, earlier periods for two of the main medical defence that we have taken a number of steps to support organisations. Progressively this requires us to increase providers at this difficult time including pausing our workforce to take on this extra work which we reporting requirements, as well as releasing a have done by increasing our foothold in Leeds, ahead number of our clinically qualified staff to return to of a planned move of our London office to a new frontline duties. site in Canary Wharf, now expected to take place in the second half of 2021. This is already creating some We launched our new NHS Resolution five-year useful efficiencies to us and the wider system but in strategy three years ago which heralded some the next two years we wish to use this increased scale significant changes in our role and ambition to as an opportunity to make changes to the way we are improve outcomes for patients and the NHS. organised to handle claims and to align more closely During the last year we took the opportunity to with our client base and other parts of the NHS. review progress and refresh the strategy in the light of both experience and changes in the NHS Our Early Notification scheme, for brain injuries since it was launched. The over-arching conclusion at birth, also launched in 2017, is now delivering to the review, including feedback from a range real benefits to patients and the system as we start of sources, was that it was absolutely the right to learn from incidents some years earlier than was approach and was delivering improvements. possible previously. Our use of mediation to resolve Inevitably, though, with the benefit of experience disputes has continued to increase and evolve and we we have decided some resetting of the sails is have recently published a report on our experience appropriate and of course we have now to reflect of the last two years which both shows the benefits both the challenges of incorporating our new already achieved and gives pointers for increased indemnity cover for general practice and the future benefits. opportunities this provides for some more radical Our Safety and Learning team continues to expand changes. Our refreshed strategy is now available its activities. We now issue a range of publications on on our website. learnings from claims experience and run a number The Clinical Negligence Scheme for General Practice of well-attended events to discuss, on the basis of (CNSGP), the indemnity scheme which covers the that experience, what can be done to further reduce NHS work of GPs and those working in general harm. One area where we would like to do more 8 Performance report is the better use of analytics to provide useful scheme members will continue to increase. After information from the data we hold, particularly two years of small increases or reductions in scheme where this can be looked at in combination with charges it has unfortunately been necessary to data held by other parts of the system. Recent increase our overall charges for 2020/21 by 15%. developments in technology, notably enhanced One third of this increase, 5%, results from the need artificial intelligence, give exciting opportunities to collect from our scheme members £100 million which we are keen to explore, although data privacy of the impact of the change in the personal injury legislation can currently be a constraint. We of course discount rate (PIDR) made in 2017 that is no longer support the use of data in an appropriate way and all funded centrally. For maternity, which bears the within the current legal framework but we also majority of this additional cost, this means an increase encourage the continued review of the framework of 24% once the combined impact of underlying to ensure the right balance is achieved between inflationary pressures on maternity claims and the the rights of individuals and system learning so continuing rise in cash outflows resulting from the that the benefits of these new technologies can increased number of prior year claims settled on an be fully exploited. annual payment basis is taken into account. Charges for all other specialties have increased by less than Of course the elephant in the room, even if in this 10% in total over three years. Approximately £230 case it is now being talked about, remains the cost million of the increased costs resulting from the PIDR of clinical negligence. For the first time in many years change will still be borne centrally. our provisions for claims against the secondary care system in England have reduced, to £82.8 billion, The number of new claims has risen this year by largely due to reductions in expected future claims 6% in secondary care. Further details as to why inflation. Our accounts also this year include an are contained on page 47 but even though this is estimate of the claims arising in the primary care the largest increase in some years, compared to system from the CNSGP scheme that we operate the significant increase in activity in the NHS in and the claims from past events that we oversee of the last few years this represents a significant £1.3 billion. This is not yet the full cost of claims in reduction in the proportion of hospital episodes general practice because we don’t administer all resulting in claims. claims but it is now possible to see a better estimate We continue to play our part in reducing the cost of the full cost of claims against the NHS, something of claims through actions to improve both patient that has not previously been visible. safety and the way incidents and complaints are The cost of harm for CNST in 2019/20 is estimated handled but, as the National Audit Office (NAO) to be £8.3 billion, which for the first time is clearly report published in 2017 concluded, any strategy to shown in our accounts. This is slightly lower than the tackle the drivers of cost will need to include legal c£9 billion we reported last year, again largely due reform. We continue to await the Government’s to lower inflation expectations. The pay-as-you-go response to the November 2017 Public Accounts nature of our schemes, however, means that our cash Committee request for a cross-government strategy outflows and hence the contributions required from and further progress on the Department of Health 9 NHS Resolution Annual report and accounts 2019/20 and Social Care’s (DHSC’s) proposals for fixed complaints against the NHS.