Dear
I am writing to respond to your request
December 2016. Oxford
University Hospitals NHS Foundation Trust can confirm that it holds the data that you
requested.
1. How many members of staff are directly employed at the Trust at present as of 15
December 2015?
The Trust employees over 12352 staff
2. What was your external legal advice expenditure from 01/04/2014
to 31/03/2015?
£90,679 for external legal fees in 2014-2015
3. What is your budget for external legal advice for the current
financial year?
Budget for Legal Fees in 2015-2016 is £214,000
4. Please provide the list of the solicitors instructed for external
Legal advice from 01/04/2014 to 31/03/2015 - DAC Beachcroft LLP, Weightmans LLP,
Trethowans,
5. Please provide the full structure of your legal services team
Refer to attached below.
6. Please provide qualifications of the members of the legal
department.
Solicitor x 1, Non-practicing solicitor x 2, Legal Executive x 1,
All Advisors are graduates and have additional professional qualifications
7. How many active Coroner's Inquest cases are you managing at your
Trust as of 15 December 2015?
220
8. Please provide numbers of:
a) Active clinical negligence claims against your Trust as of 15
December 2015 (claims reported to the NHSLA)?
See (b)
b) Active clinical negligence claims against your Trust as of 15
December 2015 (claims not reported to the NHSLA)?
634 open clinical negligence claims (claims data not recorded in format to readily identify
reported and non-reported)
c) Active Employer's Liability claims against your Trust as of 15
December 2015 (claims reported to the NHSLA)?
See (d)
d)active Employer's Liability claims against your Trust as of 15December 2015 (claims
not reported to the NHSLA)?
47 open employers liability claims (claims data not recorded in format to readily identify
reported and non-reported)
e)active Public Liability claims against your Trust as of 15
December 2015 (claims reported to the NHSLA)?
See (f)
f)active Public Liability claims against your Trust as of 15 December 2015 (claims not
reported to the NHSLA)?
10 open public liability claims (claims data not recorded in format to readily identify
reported and non-reported)
9.Please attach a relevant policy and a flowchart which describes the process of how your
legal services department communicates the lessons learned from the claims and
coroner's inquests to the relevant teams across the Trust, to ensure the effective risk
management and prevention of similar incidents and to improve care provided.
Refer to Claims Management Policy below.
10. Please provide two, most recent, claims management/ legal services reports.
Refer to Legal report
Please note that on 1 November 2011 the Oxford Radcliffe Hospitals NHS Trust (ORH)
merged with the Nuffield Orthopaedic Hospital NHS Trust (NOC) to form the Oxford
University Hospitals NHS Trust (OUH). Our response reflects these changes. Therefore,
we consider that Oxford University Hospitals Trust has released to you all of the
information that it holds in relation to your request.
Internal review
If you are dissatisfied with the service or response to your request you can ask for an
internal review by writing to:
Director of Assurance, John Radcliffe Hospital, Headley Way, Headington,
Oxford OX3 9DU.
If you remain dissatisfied with the handling of your request or complaint, you have a right
to appeal to the Information Commissioner at:
The Information Commissioner's Office,
Wycliffe House, Water Lane,
Wilmslow,
Cheshire,
SK9 5AF.
Telephone: 0303 123 1113 Website: www.ico.gov.uk
Provision of this information does not constitute permission for its commercial re-use in
terms of the Re-Use of Public Sector Information Regulations 2005. You are free to use
the information for your own use, including for non-commercial research purposes. The
information may also be used for the purposes of news reporting. However, any other
type of re-use will require permission from the Oxford University Hospitals NHS Trust.
Patient safety & Clinical Risk Committee
Claims and Inquests Summary Q1 of 2015/16
New Claims - April - June - 2015
1. There were 61 new claims reported.
Type of Claims
1. 55 new claims were clinical negligence
2. <5new claims were occupier liability (where there is 1 reported to avoid reidentification of the patient <> are used)
3. <5 new claims were employer liability (where there is 1 reported to avoid re-
identification of the patient <> are used)
Grade of New Claims
The CNST grading tool is used for the following claims:
1. There were 11 red claims
2. There were 37 orange claims
3. There were 13 green claims
Closed Claims in Q1 of 2015/16
1.
2.
3.
4.
There were 37 claims closed in 01 2016/16
Of the closed claims 22 were withdrawn and 15 settled by NHSLA
The total claims settled was £1,016,573.80
The total ex gratia payments by the Trust with no admission liability was £0.
Closed Red Graded Claims April- June- 2015
They were <5 closed red graded claims in 01 were standard care resulted in patient
death or permanent damage (where there is 1 reported to avoid re-identification of
the patient <> are used).
New Inquests- April- June- 2015
1. There were 48 new inquests opened in 01
Grade of New inquests- April- June- 2015
1. Inquests are graded on probability according to the key factual root of the
harm.
2. There were <5 red inquests (where there is 1 reported to avoid reIdentification of the patient <> are used)
3. There were 11 orange inquests
4. There were 34 green inquests
Inquest Conclusion- April- June 2015
1.
2.
3.
4.
There were 19 inquests closed by Her Majesty's Coroner
Her Majesty's coroner returned 8 accidental death conclusions
Her Majesty's Coroner returned <5 narrative conclusions
There were <5 drug related deaths returned and <5 industrial disease related
deaths (where there is 1 reported to avoid re-identification of the patient <>
are used)
Prevention of future Deaths Reports (Schedule 5 Regulation 28) -April -June
-2015
1. There was < 5 prevention of future deaths (where there is 1 reported to avoid
re-identification of the patient <> are used)
2. Training initiatives were undertaken and in place to train all junior doctors on
new initiatives as per Trust policies
Organisational Learning and Actions from Inquest Conclusions
From the 19 heard inquests, learning and actions were identified and shared with the
various divisions and tabled at the PS & CRC. There no outstanding action plans for
claims or inquests feedback forms requiring assistance from divisions.
Patient safety & Clinical Risk Committee
Claims and Inquests Summary Q2 of 2015/16
New Claims- July, August, September 2015
1.
There were 66 new claims opened in Quarter 2
Type of New Claims
2.
3.
4.
There were 57 new claims - clinical negligence
<5 new claims were Occupier's Liability (OL) claims relating to alleged
personal injury to visitors on Trust premises (where there is 1 death reported
to avoid re-identification of the patient <> are used)
5 new claims were Employer's Liability (EL) claims relating to alleged
personal injury to Trust staff.
Grade of New Claims
5.
6.
There were 11 red graded claims
There were 37 orange graded claims
7.
8.
There were 18 green graded claims
Claims are graded using the CNST grading tool required by the NHSLA.
New Red Graded Claims- July, August, September 2015
9.
There were 13 new red graded claims
Closed Claims in Quarter 2 of 2015-2016
10.
11.
12.
13.
14.
There were 30 claims closed in Quarter 2 of 2015-2016
Of the closed claims 25 were withdrawn
5 were settled by the NHSLA
The total amount of damages for settled claims was £249,771.96.
The total ex gratia payments made by the Trust with no admission of liability
in Quarter 2 was £0.
Closed Red Graded Claims- July, August, September 2015
15.
There were 0 closed red graded claims in Quarter 2 of 2015-2016 where
substandard care resulted in patient death or permanent damage.
New Inquests -July, August, September 2015
16.
There were 52 new inquests opened in Quarter 2 of 2015- 2016.
Grades of new inquests- July, August, September 2015
17.
18.
19.
20.
Inquests are graded, on the balance of probability, according to the key
factual root cause of harm relating to the Trust's patient care
There were <5 red graded inquests (where there is 1 reported to avoid reIdentification of the patient <> are used)
There were 16 orange graded new inquests
There were 34 green graded new inquests
New Red-Graded Inquests -July, August, September 2015
21.
There were <5 new red graded inquests in Quarter 2 (where there is 1
reported to avoid re-identification of the patient <> are used)
Inquest conclusions- July, August, September 2015
22.
23.
24.
25.
26.
In Quarter 2 of 2015 - 2016 Her Majesty's Coroner for Oxfordshire heard and
closed 24 inquests
Her Majesty's Coroner for Oxfordshire returned 5 accidental death
Conclusions
Her Majesty's Coroner returned 6 narrative conclusions
Her Majesty's Coroner returned 5 deaths by natural causes
Her Majesty's Coroner returned <5 suicides, <5 drug related death and <5
Industrial disease ((where there is 1 reported to avoid re-identification of the
patient <> is used)
Oxford University Hospitals
Prevention of Future Death Reports (Schedule 5 Regulation 28) -July, August,
September 2015
27.
There was <5 Prevention of Future Death (PFD) Report under Schedule 5
Regulation 28 issued by Her Majesty's Senior Coroner for Oxfordshire in
Quarter 2 (where there is 1 reported to avoid re-identification of the patient <> are
used).
Organisational Learning and Actions from Inquest Conclusions
28.
From the 24 heard inquests in Quarter 2 organisational learning and actions
were identified in <5 closed inquests ((where there is 1 reported to avoid reidentification of the patient <> is used)
Outstanding Action Plans in Claim and Inquest Feedback Forms
There are no outstanding action plans for Claims or Inquests Feedback Forms requiring
assistance from the Divisions
Claims Management Policy
Category:
Summary:
Policy
Policy governing the management of all clinical
negligence, personal injury (staff and third party)
and property expenses claims that arise on
Trust premises or involve Trust staff elsewhere
while on official NHS Trust business.
Equality Impact
Assessment Undertaken:
August 2011
Valid From:
21 June 2012
Date of Next Review:
30 June 2015
Approval Date/ Via:
Distribution:
20th June 2012 via Clinical Governance
Committee
Via Legal Services Department to:
 Divisional Directors, General Managers and
Divisional Nurses
 Safety Quality & Risk Intranet Site
Oxford University Hospitals
Related Documents:
Being Open Policy
Conduct-Disciplinary Action Procedure
External Reviews Policy
Health Records Management Policy
Incident Reporting and Investigation Policy
Information Governance Policy
Management of Patient Comments, Concerns
and Complaints Policy and Procedure
Record Retention Policy
Author(s):
Head of Legal Services
Further Information:
Head of Legal Services
Safety, Quality & Risk Intranet Site
This Document replaces:
Claims Policy, v 7.0 August 2011
Claims Management Policy
Version 8.0 – June 2012
Lead Director:
Chief Nurse
Issue Date:
21st June 2012
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Oxford University Hospitals
Contents
Page
Introduction…………………………………………………………………………….......
3
Policy Statement……………………………………………………………………..........
3
Scope…………………………………………………………………………………..........
3
Aim…………………………………………………………………………………………...
4
Definitions…………………………………………………………………………………..
5
Responsibilities…………………………………………….……………………………...
5
Chief Executive ………………………………………………………………………
5
Chief Nurse and Medical Director………………………………………………….
5
Director of Assurance………………………………………………………………..
5
Head of Clinical Governance ………………………………………………….......
5
Divisional Directors…………………………………………………………………..
5
General Managers and Divisional Nurses………………………………………...
5
Head of Legal Services ……………………………………………………….........
5
Legal Advisors………………………………………………………………….........
6
Head of Financial Accounting ……………………………………………………...
7
Matrons/ Clinical Leads/ Heads of Department/ Operational Managers/
General Managers…………………………………………………………………..
7
Individual Staff………………………………………………………………………..
7
Organisational Arrangements……………………………………………………..........
7
Principles and Objectives of Claims Management…………………………….…
9
Aggregation & Analysis……………………………………………………………..
11
Learning Lessons from Claims and Inquests………………………………….…
11
Training……………………………………………………………………………………...
14
Monitoring Compliance……………………………….……………………………….…
14
Review…………………………………………………………………………………….…
16
References……….…………………………………………………………………….......
16
Equality Impact Assessment………………………………………………………….…
16
Document history……………………………………………………………………….…
Appendix 1: Clinical Negligence Claims Pre Action Protocol…………………………
16
Appendix 2: Personal Injury Claims Pre Action Protocol………………………………
18
Appendix 3: Civil Procedure Action Steps………………………………………………
19
Appendix 4: Claim/Inquest Feedback Form…………………………………………….
20
Appendix 5: Protocol for Delegated Authority CNST Claims Purpose……………....
21
Appendix 6: Potential Litigation Communication Group (Women’s Centre)………...
28
Appendix 7: Procedure for Supporting Staff Following an Adverse Incident, Claim or Complaint….
29
Appendix 8: Procedure for learning from incidents, complaints and claims…………
33
Claims Management Policy
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17
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Oxford University Hospitals
Introduction
1.
This policy covers all clinical negligence, personal injury (staff and third party) and
property expenses claims that arise against the Trust on Trust premises or involve
Trust staff elsewhere while on official NHS Trust business.
2.
NHS organisations are indemnified against different types of claims through
membership of various risk pooling schemes. The Trust is a member of the
Schemes as set out below. These are managed by the NHS Litigation Authority
(NHSLA) and include:
3.
2.1.
The Existing Liabilities Scheme (ELS) for all clinical negligence claims
arising before 1 April 1995;
2.2.
The Clinical Negligence Scheme for Trusts (CNST) for all clinical
negligence claims arising since 1 April 1995;
2.3.
The Risk Pooling Schemes for Trusts (RPST) for all non-clinical claims
arising since 1 April 1999. RPST is the collective term for two schemes:
2.4.
Liabilities to Third Parties Scheme (LTPS) for all public and employers’
liability claims
2.5.
Property Expenses Scheme (PES) for loss or damage to Trust property.
The Trust is liable for claims that arise from events since its establishment on 1
April 1994. South Central Strategic Health Authority is liable for claims that arise
from events prior to 31 March 1994.
Policy statement
4.
The Trust is committed to ensuring that legal claims are managed in a proactive,
timely and effective manner.
5.
The Trust will handle claims in accordance with protocols and reporting guidelines as
set down by the NHS Litigation Authority (NHSLA), the Pre-Action Protocol for the
Resolution of Clinical Disputes, the Pre-Action Protocol for Personal Injury Claims;
the Civil Procedure Rules as updated and amended and linked Trust Policies.
6.
The Legal Services Department has Delegated Authority from the NHSLA to
manage and settle clinical negligence claims up to £25,000 (excluding defendant
and claimant costs), although the Trust may choose not to exercise this Delegated
Authority, depending upon constraints on available resources. For clinical
negligence claims out with Delegated Authority, the Trust’s Legal Services
Department reports as required to the NHSLA in accordance with the CNST and ELS
schemes.
7.
The Trust recognises that such effective and timely claims management is a
fundamental tool of risk management, the aim of which is to collect information
about claims and to use NHSLA Solicitors’ Risk Management Reports on Claims
which will help to facilitate wider organisational learning. See Appendix 8
Procedure for learning from incidents, complaints and claims.
8.
All claims will be thoroughly investigated regardless of the claimant’s age,
disability, ethnicity, gender, religion, beliefs or sexual orientation.
9.
No claimant will be discriminated against.
Scope
This document applies to all areas of the Trust, and all employees of the Trust,
including individuals employed by a third party, by external contractors, as voluntary
workers, as students, as locums or as agency staff.
Claims Management Policy
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Version 8.0 – June 2012
10.
Oxford University Hospitals
11.
This policy and the procedures and protocols contained herein apply to requests for
the disclosure of records, made in contemplation of legal action against the Trust;
clinical negligence claims; personal injury claims, incorporating employer’s liability
and public liability matters, property expenses claims; and inquests.
Aim
12.
This policy sets out a framework of the principles of good claims management to
ensure consistently high standards across all professional groups.
13.
The aims of the policy are to ensure that:
13.1.
The Trust complies with legislation, Civil Procedure Rules, Pre-Action
Protocols and NHSLA Reporting Guidelines as set down under the
Clinical Negligence Scheme for Trusts (CNST) and the Risk Pooling Scheme
for Trusts (RPST).
13.2.
Where appropriate a Root Cause Analysis of an incident is undertaken in
order to identify what happened, how and why it happened, and thereafter, to
analyse the issues and problems, and develop recommendations to help
prevent or reduce the likelihood of another incident or recurrence
13.3.
Lessons are learnt from claims to improve overall practice, patient care, and
the safety of staff and patients.
13.4.
Claims are managed in a proactive, timely and effective manner with due
regard to legislation, Civil Procedure Rules; Pre-Action Protocols; and the
NHSLA Member Rules and Reporting Guidelines under the CNST and RPST.
13.5.
Thorough investigations are conducted in line with the principles set out in
the Incident Reporting and Investigation Policy. This is in a methodical
and consistent manner to ensure justified actions are settled efficiently,
and unjustified claims are defended robustly. This approach to claims
follows the recommendations of the NHSLA and Department of Health to
achieve best possible practice and to act in the interest of both the patient and
the NHS.
13.6.
Trust Staff responsible for the management of claims are given training in
investigation and root cause analysis, in line with the Trust training needs
analysis.
13.7.
Trust Staff are aware of their responsibilities as Trust employees, and of
the inquest procedure, claims procedure and claims management process
as they may be required to be involved in investigations and provide witness
evidence.
13.8.
Sufficient advice, guidance and support are provided to Trust Staff
involved in investigations and providing witness evidence. See Appendix 7
for Supporting Staff guidance.
13.9.
Trust Staff are supported throughout the claims process, particularly if the
investigation is linked to a traumatic or stressful incident.
13.10. External organisations are appropriately involved in claims in accordance
with the External Accreditation and Inspection Policy.
13.11. During the course of a claim, risk management issues are identified,
monitored and managed in accordance with the Risk Management Strategy.
Claims Management Policy
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Oxford University Hospitals
Definitions
14.
The terms in use in this document are defined as follows:
14.1.
A claim is defined as an allegation of negligence and/or a demand for
compensation made following a complaint, an adverse clinical incident or
an accident resulting in personal injury, or incident involving
property/buildings. It includes any clinical incident that carries a significant
litigation risk to the Trust.
14.2.
A claim can include a complaint leading to a claim, notification of a
Serious Adverse Event or Incident Report generated by Risk Management
processes which represent a significant litigation risk, and request for the
disclosure of health care records.
14.3.
All potential clinical negligence cases must be reported to the NHSLA. The
identification of a potential case may follow an inquest, complaint
investigation, clinical incident/internal investigation or receipt of a Disclosure
Request or Letter of Claim.
Responsibilities
15.
The Chief Executive has overall responsibility for quality and safety, including the
proper management and resolution of claims.
16.
The Chief Nurse and Medical Director have delegated overall responsibility for
ensuring that the Trust has appropriate systems in place for assessing, reporting
and managing risk. There is a joint executive responsibility, with the Medical
Director, for Clinical Governance and to implement and manage systems for Risk
Management (see Risk Management Strategy). As such, they should be briefed
of any incident, risk management issues, serious untoward incident, never event,
complaint, claim (clinical or non-clinical) or inquest that is likely to significantly impact
on the Trust.
17.
The Director of Assurance has delegated authority for the assurance of
systems to ensure effective risk management within the Trust.
18.
The Head of Clinical Governance has responsibility for developing all aspects of
clinical governance including appropriate strategies, policies and systems.
19.
Divisional Directors are responsible for ensuring that the Claims Management
Policy is implemented throughout their Division.
20.
General Managers and Divisional Nurses are responsible for notifying the
Head of Legal Services of adverse incidents and complaints which are likely to be
the subject of a claim. They are responsible for giving due consideration to the
need for appropriate professional support of staff involved in a claim; and for
providing or facilitating such professional support as may appropriately be required,
wherever possible.
21.
The Head of Legal Services is responsible for:
21.1.
Ensuring that risk is reduced through the effective management of claims in
line with this policy and the dissemination of information arising from
claims and investigations. S/he will monitor the application of this policy and
provide monthly reports for the Clinical Risk Management Committee
(CRMC); q u a r t e r l y integrated report with Risk and Complaints on
Organisational Learning and Trends to Clinical Governance Committee;
Claims Management Policy
Version 8.0 – June 2012
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Oxford University Hospitals
annual report on claims and inquests to the Clinical Governance Committee
and annual report on Coroners’ Rule 43 Letters to Clinical Governance
Committee.
Claims Management Policy
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Oxford University Hospitals
21.2.
Ensuring that any present or former Trust staff member who may be
adversely affected by either an adverse incident linked to a claim, the claims
process itself, or an inquest receives support during the claim or inquest and
in the long term, if necessary.
21.3.
Providing advice to the Chief Executive and Directors in relation to claims
management and reducing the risk of litigation.
21.4.
Ensuring a coordinated case management approach is achieved between
the Risk Management Department, the Complaints Department and the
Legal Services Department in the investigation and reporting of cases,
liaison with service delivery areas of the Trust; aggregated analysis and the
implementation and monitoring of action plans.
21.5.
Ensuring that claims management is integrated within clinical governance
processes within the Trust so that action plans arising from claims
investigations and NHSLA Solicitors’ Risk Management Reports are created
and monitored in line with Trust standards.
21.6.
The day to day running of the Legal Services Department.
21.7.
Ensuring a proactive, timely and effective investigation of all claims in
accordance with the Civil Procedure Rules, Pre-Action Protocols and
NHSLA Reporting Guidelines.
21.8.
Providing authority for admissions, responses, defences, settlement terms
and offers for claims.
21.9.
Maintaining the Safeguard Claims Database, ensuring integrity of data
stored and used, in accordance with the Data Protection Act 1998 and the
Information Governance Policy.
21.10. Signing routine legal documents relating to claims including List of
Documents, Consent Orders and Defences.
21.11. Conducting periodical audits of case files to ensure compliance with this
policy, the Civil Procedure Rules, the Pre-Action Protocols and the NHSLA
Reporting Guidelines; and taking necessary action to address any
deficiencies, and monitoring the effectiveness of those actions.
21.12. Supervising the investigation of claims and providing advice and
recommendations to the Legal Advisors and Trust Staff as required or
necessary.
21.13. Providing advice and support to staff in the Legal Services Department and
Trust Staff involved in claims or inquests.
22.
Legal Advisors are responsible for:
22.1.
Conducting proactive, timely and effective investigations into clinical and
non- clinical claims in accordance with this Policy, Civil Procedure Rules,
Pre-Action Protocols and NHS Reporting Guidelines.
22.2.
Reporting the findings of investigations, liability and quantum to the Head
of Legal Services and undertaking appropriate referrals for admissions,
responses, defences, settlement terms and offers for claims and signing
of official documents relating to claims.
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Oxford University Hospitals
22.3.
Co-ordinating and collating statements and requests for information by the
Coroner in respect of Inquests in a timely and effective manner.
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Oxford University Hospitals
22.4.
Maintaining the Safeguard Claims Database and ensuring the integrity of
data stored and used, in accordance with the Data Protection Act 1998 and
the Information Governance Policy.
22.5.
Informing the Head of Legal Services of any present or former Trust staff
member who may have been adversely affected by either any adverse
incident linked to a claim, or by the claims process itself, or inquest.
23.
The Head of Financial Accounting is responsible for the reporting and handling of
any property claims to the NHSLA under the Property Expenses Scheme.
24.
Matrons/ Clinical Leads/ Heads of Department/ Operational Managers/ General
Managers should ensure an investigation is undertaken as and when an incident occurs
which requires referral to the Risk Management Department, or which may give rise to a
complaint or claim against the Trust.
25.
Individual staff are responsible for:
26.
25.1.
Adhering to the procedures set down in this policy.
25.2.
Referring
to
appropriate
Matron/Clinical
Lead/Heads
of
Department/Operational Manager/General Manager as soon as they are
aware of any incident which may give rise to a complaint or claim against the
Trust.
25.3.
Assisting with the claims investigations and provide a response to requests
for statements, comments and opinion within the time frame specified in
correspondence from the Legal Services Department, so as to endure the
Trust’s compliance with time scales set down by legislation, Civil Procedure
Rules, Pre- Action Protocols and NHS Reporting Guidelines.
Staff should refrain from providing opinion and comment to patients or their
families regarding any legal liabilities of the Trust or indicate that compensation
should be paid.
Organisational Arrangements
Trust Position on Records Management
27.
Effective health care records management is integral to effective risk management,
primarily since effective systems to ensure clinical staff have access to patients’
health care records, have been shown to reduce clinical risk. Health care
records are also critical evidence in defending claims.
28.
All health care records, x-rays, imaging, scans, and cardiotocography (CTGs) traces
should be retained in accordance with the Health Records Management Policy.
29.
Health care records should be clear and legible. Detailed notes are of significant
importance to the claims investigation and can provide the basis for a robust defence.
30.
Disclosable documents should be factual in content and avoid opinion or criticism.
The documents can include complete health care records prepared a parts of a
patient’s care and treatment; incident reports, root cause analysis reports and
complaints responses.
31.
Claims, complaints and incident investigation documents should not be stored in
the patient’s health care records so as to ensure that clinical treatment is recorded
separately and kept discrete from the claim, incident or complaint investigation
Claims Management Policy
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Oxford University Hospitals
processes.
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Letters of Apology
32.
Trust Policy is to encourage openness and honesty with patients and families
where there has been an adverse outcome and when appropriate to offer
apologies, explanations and expressions of sympathy (see NHSLA Circular
Number 02/02 Apologies and Explanations and the Being Open Policy).
33.
Letters of Apology from the Medical Director are addressed to the Claimant or
their family. Whilst every effort must be made to convey the apology to the
Claimant or their family the letter should remain distinct from the legal claim. See the
Being Open Policy.
Statement/Report Writing
34.
When Trust Staff are asked by the Legal Services Department to provide their
written comments or report for a potential or actual claim, such documents are not
disclosable to the claimant or their representatives, as their primary purpose is to
assist the claims investigation.
35.
Any response to a request from the Legal Services Department should specifically
state that it has been prepared in response to an actual or contemplated/potential
claim.
36.
It is advisable that staff preparing comments or reports should retain a copy of their
final document for their records.
37.
Written comments or reports for a potential or actual claim should not be filed in
the patient’s health care records and must be stored separately and securely in
accordance with the Information Governance Policy.
38.
Trust Staff should refer to the Legal Services Department directly for advice or
the Safety Quality & Risk intranet site for guidance on How to Write a Statement.
39.
If, during the course of a claim, a formal statement is required, Trust Staff will be
assisted by the Legal Services Department and/or the NHSLA Panel Solicitors for
the Trust.
Documentation: Legal Privilege
40.
Any documents created specifically for use in a potential or actual claim, or
specifically for the purpose of seeking or obtaining legal advice, are protected by
litigation and legal professional privilege. Such documents will be used by the Legal
Services Department and/or the Trust's legal advisors but will not necessarily be
disclosed to third parties.
41.
Any correspondence or documents produced specifically for the purposes of
litigation must not be filed in patient's health care records.
42.
Due regard will be paid to the confidentiality of claims data relating to patients, Trust
staff and third parties.
The NHS Litigation Authority (NHSLA)
43.
The NHS Litigation Authority is a Special Health Authority, responsible for
handling negligence claims made against NHS bodies. The main functions of the
NHSLA include administering schemes under which NHS bodies pool their clinical
and non-clinical negligence liabilities, promoting high standards of risk
management in the NHS, administering the risk management standards for non-
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Oxford University Hospitals
clinical liabilities, the provision of an information service for the NHS on Human
Rights case law and advice and assistance to NHS bodies when handling equal pay
litigation.
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Oxford University Hospitals
44.
In addition to managing clinical and non-clinical claims against NHS organisations,
the NHSLA has a responsibility to promote good risk management in the NHS.
45.
The costs of the NHSLA schemes are met by membership contributions. The
projected claim costs are assessed in advance each year by a professional actuary.
Membership contributions are then calculated to meet the total forecast of
expenditure for that year. Individual member contribution levels are influenced by a
range of factors, including the type of Trust, the clinical specialties, the relevant
NHSLA Risk Management Standards and those with a good claims history.
46.
The NHSLA retains a panel of solicitors to represent the interests of the Trust and
the NHSLA.
47.
When a claim is issued against the Trust, it remains the named legal
defendant.
However, the NHSLA assumes responsibility for handling the claim and meets the
associated costs.
48.
Timescales for reporting to the NHSLA are to be found in Appendices 2, 3, 4 and 5.
Principles and Objectives of Claims Management
49.
Trust Staff need to be supported during the investigation process and to be
advised of the developments and the progress of a claim. For further guidance
see Appendix 7, Procedure for supporting staff following an adverse incident, claim
or complaint.
50.
Trust Staff undertake best endeavours to carry out their work in a safe and
effective manner with due regard to patients and others and the avoidance of risks or
hazards.
51.
In the event of an adverse outcome or incident, and in line with the Being Open
Policy, it is imperative that communication with the patient and others is consistent
and honest.
52.
An investigation following an adverse outcome or incident will address system
failures as well as individual accountability, if applicable, and the results of these
investigations will ensure lessons are learnt and safer practice is implemented locally,
organisationally, and if appropriate within the local health community.
Investigation
53.
The Head of Legal Services, and all Legal Advisors, shall undertake timely and
thorough investigation of allegations of clinical negligence, or staff and third party
personal injury. The level of investigation undertaken will be determined by the
severity of the event, and by reference to the CNST, RPST and PES Reporting
Guidelines. In every case, a prompt Preliminary Assessment will be prepared
detailing the merits of the claim; including recommendations for risk management
implications and reference to action plans to reduce future risks, monitoring and
lessons that can be learnt for the future given structured analysis of the events in
question.
54.
When undertaking their investigation, members of the Legal Services Department
shall consult fully and with all due sensitivity with clinical, managerial and
executive staff directly involved in the claim, and provide support to staff as
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appropriate.
55.
When undertaking investigation, members of the Legal Services Department shall
endeavour to identify what have been the principal causal factors in accordance with
the principles of root cause analysis for a red incident as defined in the Trust’s
Incident Reporting and Investigation Policy, with a view to facilitating wider
organisational learning.
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56.
The Head of Clinical Risk will liaise with the Legal Advisors on any
investigations of claims that have previously been reported as incidents in
accordance with the Trust’s Incident Reporting and Investigation Policy
57.
The Complaints Operational Manager will liaise with the Legal Advisors for the
investigation of any claims that have previously been reported as complaints, in
accordance with the Trust’s Complaints Policy.
Management, settlement and disposal of claims
58.
59.
The Head of Legal Services, and all Legal Advisors, shall manage all claims in
accordance with the CNST and RPST Guidelines, the Clinical Negligence Claims
Pre- Action Protocol (Appendix 1), the Personal Injury Pre-Action Protocol
(Appendix 2) and in compliance with the Civil Procedure Rules (Appendix 3). The
Safeguard Claims Management System will be utilised by the Legal Services
Department to ensure compliance and to ensure that claims are reviewed so as to
effect proactive, timely and effective case management. In particular, they shall
ensure:
58.1.
prompt settlement of claims where an admission of liability is indicated;
58.2.
repudiation of claims where there is no indication of negligence as
currently defined in English law;
58.3.
working in co-operation with the NHSLA and its appointed CNST and
RPST panel solicitors under the Protocol For Delegated Authority;
58.4.
working in co-operation with the NHSLA and its appointed CNST and
RPST Panel Solicitors to obtain approval as required in respect of the
management of claims falling out with Delegated Authority;
58.5.
working in co-operation with the Trust’s Head of Financial Accounting and
the NHSLA to refer at the earliest indication of a Property Expenses Scheme
(PES) claim regarding theft or damage to Trust Property to the Head of
Financial Accounting, who will report the claim if it exceeds the excess of
£20,000 to the NHSLA together with relevant documentation and
communicate with stakeholders as necessary to ensure the claim is
concluded any claim below this level would be the Trusts liability.
Key actions for PES claims are opening a file, instigating an investigation within 5
days of notifications of the loss or damage; once the report is compiled, notifying the
Head of Financial Accounting (for claims that fall below excess level) or Director
of Finance within 5 working days and once the decision has been made (by the
Head of Financial Accounting) to pursue a claim, informing the NHSLA of this
decision within 5 working days.
59.1.
considering alternative means of dispute resolution (other than litigation) as
appropriate; and learning from claims by making changes in clinical and
organisational practice and procedure and facilitating education of staff as
appropriate.
Delegated Authority
60.
Delegated Authority will only be granted by the NHSLA to named individuals,
following compliance with its protocol. The exercise of Delegated Authority is
subject to audit by the NHSLA, and the Trust may choose not to exercise same,
depending upon constraints on resources.
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Aggregation & Analysis
61.
The Legal Services Database Administrator will provide data for the regular claims
reports and quarterly overviews for the Trust Board as required.
62.
Other reports can be provided on request submitted to the Head of Legal Services.
63.
The Clinical Risk Management Committee [“CRMC”] helps executives, managers
and clinicians review and manage incidents, complaints and claims.
64.
Analysis of aggregated data on all claims and inquests will be submitted to CRMC,
for aggregated analysis along with data on all serious incidents, complaints, and
referrals to the Parliamentary Ombudsman or to the Care Quality Commission.
65.
The aggregated data considered and reviewed by CRMC on a monthly basis will
include the following breakdown:
66.
67.
65.1.
total number of serious incidents reported within each division, including a
summarised action plan in respect of those incidents graded ‘red’;
65.2.
total number of serious complaints received within each division, including
a summarised action plan in respect of those complaints graded ‘red’;
65.3.
total number of claims and inquests received within each division,
including a summary of the allegations received, and investigation undertaken
to date;
65.4.
A summary of any referrals to the Parliamentary Health Service Ombudsman.
The CRMC meets on a monthly basis. In reviewing the aggregated data as
stipulated above, it will:
66.1.
monitor whether serious incidents, complaints, claims and inquests are
being managed effectively; specifically, monitoring the development and
delivery of action plans as appropriate;
66.2.
identify any apparent trends, or clusters; and
66.3.
Determine whether there are any underlying issues which may need to be
addressed, relating to the delivery of care/staff safety and welfare.
Given the particularly high level of potential financial liability in the area of obstetric
care, the functions of the CRMC in relation to obstetric incidents, complaints and
claims will be supplemented by the operation of a dedicated sub-group, the
Women’s Centre Potential Litigation Communications Group, see Appendix 6.
Learning Lessons from Claims and Inquests
68.
The Trust is committed to ensuring that Risk Management issues are identified
and lessons arising from clinical negligence and personal injury claims and
inquests are identified, and necessary remedial action is taken to prevent or
minimise the recurrence of the risk and to improve practice.
69.
Action Plans based on Risk Management issues and lessons arising from claims will
be developed, implemented and monitored in the Claim/Inquest Feedback Form
(Appendix
4) By the Divisions and by CRMC, to effectively improve practice.
70.
Any recommendations or actions issued by HM Coroners under Rule 43 of the
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Coroners Rules will be handled in accordance with the Trust Policy on External
Accreditation and Investigation.
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71.
An aggregate analysis of outcomes will be reported in the monthly report to
CRMC; quarterly reports to the Clinical Governance Committee on behalf of the
Board of Directors and in the annual audit return to the NHSLA of Panel Solicitor’s
Risk Management Reports.
72.
Claim/Inquest Feedback Forms will be completed by Legal Advisors at the
conclusion of each claim and copied to the Lead Consultant, the appropriate
Divisional Manager(s), the Head of Clinical Risk, the Safety Risk Manager and
Divisional Risk and Governance Coordinators, to identify the outcome of the
claim/inquest and any organisational, clinical or other risk management lessons to be
learned.
73.
At the settlement or closure of a claim, the Claim/Inquest Feedback Form together
with the associated NHSLA Solicitor’s Risk Management Report, will be tabled at
CRMC for its consideration, and any wider dissemination as appropriate, and
recommendations actioned.
74.
The Claim/Inquest Feedback Form be tabled at CRMC until there is written
assurance that the Action Plan has been completed by the Division.
75.
The Head of Legal Services and all Legal Advisors, with the support of the CRMC,
shall identify lessons to be learned; both specific to the area in which the claim
has arisen, and across the organisation. If there are any lessons which may be
relevant to other health care organisations, the Head of Legal Services shall notify
the NHSLA as appropriate, and may liaise with the Head of Clinical Governance to
determine whether notification to an external agency is appropriate.
76.
Dissemination of the lessons learned throughout the organisation shall be through
feedback from the Divisional Risk and Governance Coordinators to the lead
clinicians, matrons, divisional managers or via the Trust Clinical Risk Management
Committee or Health and Safety Committee, where appropriate.
77.
The Head of Legal Services and Legal Advisors will support Divisions in the
development of an action plan for the delivery of any appropriate risk reduction
measures identified. The development and delivery of such action plans will be
monitored by CRMC. Where possible and appropriate, in accordance with the
Trust’s Risk Management
Strategy, local
management should initiate
implementation of appropriate risk reduction measures identified. In all cases,
consideration should be given to whether a risk has been identified which should
be referred for inclusion in the relevant risk register.
78.
Aggregation, analysis and learning from incidents, complaints, claims and inquests
will also occur in accordance with Appendix 8.
How the organisation communicates with relevant stakeholders
79.
At the outset of a claim, Legal Advisors will notify the appropriate Trust Staff and
Divisional Managers of any allegations received, and will keep them informed of
any significant developments as the investigation proceeds.
80.
Legal Advisors will identify any other individuals with whom it may be appropriate
that they communicate during the conduct of their investigation, within or out with
the Trust, and shall ensure that they are kept informed as appropriate.
81.
Reference to external organisations may be necessary following an adverse
incident, complaint or claim. The following list of external organisations is not
exhaustive:
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•
NHSLA Panel Solicitors
•
HM Coroner
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•
GP/GP Surgeries
•
Health and Safety Executive
•
National Patient Safety Agency
•
NHSLA
•
Primary Care Trusts, NHS Trusts
•
Police
•
Medicines and Healthcare Products Regulatory Authority
•
Social Services (including Child Protection Services)
•
Supervisory Authority for Deprivation Of Liberty (DOLs)
Liaison with Risk Management
82.
When a serious incident is under investigation and a claim or inquest is received
relating to the same event, then the Head of Legal Services will liaise with the
Head of Clinical Risk or the Safety Risk Manager as appropriate, to ensure that
the issues will be handled in accordance with both the Incident Reporting and
Investigation Policy, and the Claims Management Policy.
83.
If during the management of a claim, it becomes clear that the issues raised
require investigation in accordance with the Trust's Serious Incident Procedure,
then the Head of Legal Services will inform the Head of Clinical Risk or the Safety
Risk Manager as appropriate. They will decide whether to investigate under the
Serious Incident Procedure, in liaison with the Medical Director, Chief Nurse or
the Head of Clinical Governance. The Head of Clinical Governance will decide if
an appropriate external agency needs to be informed.
84.
If health and safety issues are identified through management of a claim, and the
matter has not previously been reported, the Safety Risk Manager will investigate
the matter and if necessary report it to the Health and Safety Executive.
Interface with Complaints Policy and Procedure
85.
In accordance with the Parliamentary and Health Service Ombudsman’s Principles
for remedy1, there is a range of appropriate responses to a complaint that is
upheld, and these may include financial as well as non-financial remedies.
Appropriate consideration will be given to the full range of remedies that may be
offered to compensate for injustice and hardship where a complaint of poor service or
maladministration is upheld.
86.
In particular, if a complaint includes an allegation of clinical negligence or a request
for compensation, or if it is identified as a significant litigation risk, then the Head of
Legal Services, in liaison with the Complaints Operational Manager and relevant
Divisional Managers, will consider how best to address the issues raised, and will
determine the most appropriate means of delivering any redress due.
Publicity and Liaison with Media & Communications Team
87.
At the earliest indication of any media interest a brief synopsis of the
circumstances of the case and present position should be provided to the Head
of Media & Communications by email. The Media & Communications Team may
request further information or specifics regarding the case, which will be provided by
the Legal Advisor.
88.
A pre-inquest and post-inquest brief will be circulated by Legal Advisors to the
Executive Team, Divisional Managers and Media & Communications which will
contain information
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1
Ref http://www.ombudsman.org.uk/improving services/principles/remedy/index.html
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about the inquest, post mortem, issues raised by the family and likely media
attention. Where required a media statement will be prepared for press release.
89.
Where claims are likely to generate media interest, the NHSLA will liaise with the
Trust to agree the content of a press release.
Performance and Conduct Policy and Procedures
90.
If a decision is taken to instigate the Conduct-Disciplinary Action Procedure following
the receipt of a claim, the investigation of the civil claim will continue irrespective of
the disciplinary action. Divisional Managers should seek advice from Human
Resources regarding disciplinary procedures.
91.
The Medical Director and Chief Nurse will report to the General Medical Council
(GMC) and Nursing and Midwifery Council (NMC) in suspected cases of gross
professional negligence where appropriate.
92.
In cases of criminal misconduct the police will be informed.
Training
93.
Claims are only investigated by the Trust’s Head of Legal Services and Legal
Advisors, for which they have specialist training. This is role specific training (not
part of statutory, mandatory and essential training).
Monitoring Compliance
94.
The Trust Board has overall responsibility for ensuring that the claims
management system is working effectively.
95.
The Clinical Risk Management Committee (CRMC) will have operational
responsibility for monitoring the effectiveness of claims management.
96.
The Head of Legal Services will conduct regular file reviews with the Legal
Advisors, to monitor the effectiveness of each Legal Advisor’s individual
performance.
97.
Information about claims, stored on the Legal Services Safeguard Claims Database,
will be subject to regular interrogation and review by the Head of Legal Services
98.
The Trust is subject to audit by the NHSLA generally, to check compliance with
the protocols and reporting guidelines as set down by the NHS Litigation Authority
(NHSLA) and the Civil Procedure Rules (see Appendices 1, 2 and 3). Any NHSLA
audit will take place in accordance with the Trust’s Policy on External Accreditation
and Inspection.
99.
The Trust is further subject to audit by the NHSLA specifically to monitor the
exercise of Delegated Authority.
100.
Key monitoring arrangements are outlined in the table overleaf.
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Measurable Policy
Objective
Monitoring/Audit
Method
Duties
To be addressed by the monitoring activities below.
Claims will be
managed and
recorded in Trust
Safeguard Litigation
Database System
Retrospective
random audit of
claims files and
Safeguard
Database System
Annually
Head of Legal
Services
Clinical Risk
Management
Committee
Risk Issues arising
from litigation
recorded in local,
Divisional Corporate
Risk Registers
Retrospective
review of Risk
Registers
Annually
Divisions or
Head of Clinical
Governance
Clinical Risk
Management
Committee
Compliance with time
scales for
investigation and
Preliminary Analysis
Report
Retrospective
random audit of
time scales
Annually
Head of Legal
Services
Clinical Risk
Management
Committee
NHSLA schemes
relevant to the
organisation (i.e.
CNST, LTPS and
PES)
Review of policy
and membership
Annually
Head of Legal
Services
Clinical Risk
Management
Committee
The action to be
taken, including
timescales
Audit of cases
Annually
Head of Legal
Services
Clinical Risk
Management
Committee
Communication with
relevant
stakeholders
Audit of cases
Annually
Head of Legal
Services
Clinical Risk
Management
Committee
Investigation and
analysis of incidents,
complaints, claims
and inquests
(including
aggregation).
Monitoring of this process will occur in line with the Incident Reporting and
Investigation Policy.
Learning from and
implementing
changes as a result
of incidents,
complaints, claims
and inquests
including
implementation of
risk reduction
measures.
Monitoring of this process will occur in line with the Incident Reporting and
Investigation Policy.
Supporting staff
involved in an
incident, complaint,
claim or inquest.
Monitoring of this process will occur in line with the Incident Reporting and
Investigation Policy.
Claims Investigation
Training
This is not applicable for Claims since investigations are only undertaken by
the Head of Legal Services and Legal Advisors.
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Frequency of
Monitoring
Responsibility
for performing
the monitoring
Responsibility for
review of
monitoring report
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Appendix 3: Civil Procedure Action Steps
CLAIMANT
ISSUES CLAIM FORM
Within 4 months
SERVE CLAIM FORM AND
PARTICULARS OF CLAIM
SERVE CLAIM FORM
OR
Within 14 days
(and no later than
4 months after
issue of claim
form)
SERVE
PARTICULARS OF
CLAIM
Within 7 days
FILE AT COURT
DEFENDANT
Within 14 days of
service
FILE AND SERVE
DEFENCE
OR
FILE
ACKNOW LEDGEMENT OF
SERVICE
Within 14 days,
extension by
agreement
limited to 28 days
otherwise
Application to
Court
FILE AND SERVE DEFENCE
COURT OFFICE
SEND OUT ALLOCATION QUESTIONNAIRE TO BOTH PARTIES ON
FILING OF DEFENCE
CLAIM ANT AND DEFENDANT
Within time specified by Court
COURT OFFICE
Small Track (up to
£5,000)
Otherwise according to
Standard Civil Procedure
Rules
*Standard Directions
*Service of documents 14
days before hearing
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REPLY TO ALLOCATION QUESTIONNAIRE (AND CLAIMANT FILE
REPLY TO STATEMENT OF DEFENCE IF DESIRED)
TRACK ALLOCATION
Fast Track (£5,000 - £15,000
Multi Track (above £15,000)
* Standard directions
* Standard disclosure, exchange
witness statements, joint expert
* Listing questionnaire
*One day trial within 30 weeks of
allocation to track
*Case management
conference pro-active
management by Judge
*Special Directions
*Listing questionnaire
*Pre-trial review
*Trial
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Appendix 4: Claim/Inquest Feedback Form
Legal Services, Oxford University Hospitals NHS Trust
Claim Reference:
NHSLA Reference:
Trust:
Division:
Clinical Area:
Claim Summary:
Outcome
Incident Date:
Complaint made:
Incident Report Form:
SIRI:
Settlement/Closed Date:
Cost of Claim
Damages
Claimant costs
Defendant Costs
CRU
Amount Paid by Trust:
Reason for Outcome
Risk Management Lessons
Division Action
Action:
Responsibility:
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Appendix 5: Protocol for Delegated Authority CNST Claims
Purpose
1.
This document sets out the process by which delegated authority can be requested
from
the NHS Litigation Authority (NHSLA). Trusts are not obliged to seek a
delegated authority, although many may, particularly those with experienced claims
managers in
post.
2.
For the avoidance of doubt, a delegated authority will only be granted following
compliance with the pre-audit procedure and audit visit and only then to
nominated individuals within the Trust.
3.
In the event of a delegated authority being granted, the Trust will need to utilise
the services of their own internal auditors to provide verification that acceptable
practice continues to exist or alternatively submit to further audit visits by the
NHSLA. An audit checklist for use by internal auditors appears as Annex 4.
General Principles
4.
The audit process breaks down into two stages.
Pre-audit requirements
5.
Annex 1 sets out the areas within which the NHSLA will need to be satisfied prior
to a visit to the Trust.
6.
The pre-audit requirements break down into two distinct areas:
6.1.
The personnel involved in the claims unit within the Trust, their experience
and qualifications.
6.2.
The protocols for the investigation of cases and handling interest from
exterior parties (local or national media for example) and the
administrative support systems (information technology and liaison with other
administrative areas within the Trust).
7.
The letter of support required from the Trust Chief Executive or Director of Finance
is a free format letter wherein a positive recommendation must be made and
attention can be drawn to any features of the unit by way of systems or
personnel which the Trust consider to be of particular value to the NHSLA.
8.
Upon satisfactory compliance with the pre-audit documentation, the NHSLA will
audit a selection of ten cases referred to the Authority by the Trust against the
criteria set out in annex 2.
9.
The criteria concentrate on proactive claims handling and seek reassurance on
the quality and timeliness of investigation, decision making on breach of duty and
causation and active quantum assessment and resolution (if appropriate).
Audit Visit
10.
Annex 3 shows a sample NHSLA audit form which will be completed in respect of
files reviewed during a visit to the Trust claims unit.
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11.
Each category is scored on a scale of 1 to 5 as
follows: 5 = Excellent
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4 = Good
3 = Satisfactory
2 = Poor
1 = Very Poor
12.
The minimum acceptable score is 21 out of a possible 35 for each file audited.
Decision/Appeal
13.
The NHSLA will produce an analysis of the audit exercise with a recommendation for
the granting of a delegated authority. In the event of a request for delegated
authority being denied, reasons for the denial will be provided.
14.
Should the Trust wish to appeal the decision of the audit exercise, appeals will be to
the Chief Executive of the NHSLA whose decision as Accountable Officer for all
clinical negligence claims within the NHS in England will be final.
Reporting
15.
In the event of a delegated authority being granted, Trusts must continue to notify
the NHSLA of circumstances and claims as detailed in the CNST Reporting
Guidelines. Those Trusts granted delegated authority will also be required to
prepare a quarterly update of all claims subject to the delegation.
Exclusions
16.
The NHSLA will continue to handle all claims (regardless of value) where there
is involvement:
•
Of a Member of Parliament
•
Allegations or pleadings alleging breaches of the Human Rights Act
•
The case is one of a number of similar cases or part of a Group Litigation Order.
•
For Provisional Damages
•
Any claim which could be constituted as novel, contentious or repercussive.
Defence Solicitors
17.
Authority will be required from the Litigation Authority before solicitors are instructed
on behalf of the Defendants.
18.
If a claim should become subject of legal proceedings, the file must immediately
be forwarded to the Litigation Authority to assume conduct of the matter.
Payments
19.
All payments, irrespective of type or value will be made by the Litigation Authority.
20.
The form found at Annex 5 should be used for this purpose.
Follow-up Audits
21.
The NHSLA reserves the right to audit any Trust with a delegated authority at any time.
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22.
Trusts are expected to seek independent verification of the pre-audit
requirements annually and Annex 4 provides a local auditors checklist.
23.
Should you have any queries or wish to discuss an application for delegated
authority with the NHSLA please refer all queries to the NHS Litigation Authority.
Annex 1: Documentary Evidence Required to Meet Pre-Audit Criteria
24.
This documentation should be forwarded to the CNST Scheme Manager, when the
Trust feels it is ready to apply for Delegated Authority.
•
Evidence of achievement of Level 1 CNST Risk Management Standards. This
would assure the NHSLA of clinical reporting systems etc.
•
Time Claims Manager in post (minimum requirement - 6 months)
•
CV for individual(s) proposed
•
Job description
•
Evidence of new claims process i.e. post system within Trust, registration
system, allocation of new claims (where applicable), response times, system for
disclosure of records etc.
•
Investigation protocol
•
Diary system
•
Internal Claims Committee
•
Evidence of relationship with local Claimant Solicitors/community
•
Use of information technology, particularly claims management system
•
Evidence of support team i.e. medical records, admin etc.
•
Policy for dealing with serial offenders/multi-party actions
•
Trust media policy
•
Evidence of keeping up to date with changes in law, training etc.
•
Evidence of proactive local claims handling over past 6 months, to include
sample successful settlements/repudiations
•
Evidence of liaison between claims and risk management
•
Letter of support from Chief Executive/Director of Finance
Annex 2: Pre-Audit Sample Criteria
25.
Upon satisfactory compliance of pre-audit documentation, an audit of 10 files,
selected at random referred to the Authority, will be undertaken. Criteria to be
considered:
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•
Notification of new claims. Timely, in line with CNST Reporting
Guidelines, enclosures etc.
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•
Preliminary analysis. Quality, investigations, quantum assessment etc.
•
Ongoing input into claims management with the NHSLA Case
Manager, communication etc.
•
Proactivity
•
Factual/expert witness management
•
CRU
•
FRS12 data
•
Quantum assessment/settlement negotiation
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Annex 3: NHSLA Claim Audit Form (for use when visiting Trust Claims offices)
NHSLA Claim Number
_
Defence Solicitors (if appointed)
_
Office (if more than one)
Trust Case Manager
1.
_
Please score the following factors from nil to five:
Communication
Score
Includes prompt and systematic reporting to NHSLA; use of the telephone where
necessary; sensible tone.
2.
Investigation
Identification of key issues and prompt/thorough pursuit of them; appropriate and timely
liaison with CRU; avoidance of unnecessary minor points.
3.
W itness Management
Proper management of both expert and lay witnesses.
4.
Proactivity
Is the case being managed “hard and fast”? Effective use of diary and negotiation> Shelflife of file.
5.
FRS12 Data
Accuracy. Prompt reassessment as required.
6.
Administration/File Management
Is file handled at the right level? Evidence of supervision and review; file presentation;
Management of costs.
7.
Quantum Negotiation/Settlement
Early quantification and negotiation
TOTAL SCORE:
(out of 35)
_
Comments (especially regarding very high or low scores)
Audited By
Date
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_
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Annex 4: Auditors’ Checklist
Evidence of the following procedures/practices is required:
•
Cases logged within IT system.
•
Cases reviewed not less than quarterly.
•
Establishment and maintenance of FRS12 data.
•
System for reporting to NHSLA.
•
System for payment requests from NHSLA.
•
Risk management feedback within the Trust.
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Annex 5: Payment form
TO:
NHSLA – FAX NO:
FROM:
PAYMENT REQUEST DELEGATED AUTHORITY
CLAIM NO:
We have agreed an interim/settlement of Claimant’s
damages/costs. We have received a Disbursement Invoice for
………………………….. Attached is correspondence confirming the
position
Please forward a cheque to:
PAYEE
Addressee:
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Version 8.0 – June 2012
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Oxford University Hospitals
Appendix
Centre)
6:
Potential
Litigation
Communication
Group
(Women’s
Terms of Reference
Membership
Chairman: Legal Advisor for Children’s & W omen’s Division
Members: Perinatal Risk Co-ordinator
Frequency of Meetings:
Monthly
Role and Purpose
To highlight any incidents taken place in the Women’s Centre, which may result in
future litigation.
To enable Legal Services Department to take steps in preparing evidence as close in time to
the incident as possible to maximise accuracy.
To highlight information of interest to other parties i.e. health and safety and non-clinical
risk where appropriate, in the prevention of future litigation.
Any notes taken of these meetings will attract legal/professional privilege.
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Appendix 7: Procedure for Supporting Staff Following an Adverse Incident, Claim or
Complaint
Introduction
1.
Research shows that healthcare staff who are involved in incidents, complaints,
inquests or claims have an increased probability of being traumatised by the event
both professionally and on a personal level. Incidents for the purpose of this process
are any event or circumstance arising that could have or did lead to unintended or
unexpected harm, loss or damage, fire, theft, violence, abuse, accidents, ill health,
infection, near misses and hazards and may be identified through an incident,
complaint or claim.
2.
Therefore, it is important that the Trust recognises this and has systems in place
that support staff to reduce the effects of these often traumatic events, and in doing
this, it is hoped that it will reduce the incidences of stress related sickness. The
number of incidents, complaints, inquests and claims is unfortunately on the increase
meaning that staff are more likely than ever to encounter an experience that may
cause distress.
3.
The Trust believes in a fair and just culture, one in which staff feel supported and
cared for.
4.
For the purposes of this guidance the term ‘incident’ encompasses incidents,
complaints and claims.
Duties
5.
Depending on the category of investigation to be undertaken, the responsibility of
accessing the effects of an incident on an individual(s) will be different.
6.
The main aim is that an individual asked to investigate an incident, claim, inquest
or complaint ensures that as part of this investigation a review of how staff
involved are coping is undertaken and noted within the records of the investigation
and to advise staff, what support is available or make appropriate arrangements for the
member of staff.
7.
Initial support may be required when the incident occurs or when the claim or
complaint is received however, consideration should also be given to providing
support in the intermediate and long-term. Support may be required on an ad-hoc
basis as events unfold or may need to be continuous depending on the needs of the
staff member.
Managers
8.
After an incident has occurred or a claim or complaint received it may be
necessary to provide support for any of the staff involved. It will be the role of the
line manager to be alert to those factors, and make the necessary arrangements to
support the member of staff in the short and longer term.
Operational Site Managers
9.
Out of normal working hours and at weekends or bank holidays the Operational
Site mangers will assess whether any individual(s) involved in an incident need
support and in what form. The Duty Executive on call should also make sure that this
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has been assessed.
Serious Incident Investigation Team
10.
The welfare of any staff involved in a serious incident must be considered
particularly in relation to psychological trauma or stress.
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11.
The SIRI investigation team as part of their investigation should make sure that all
staff involved in the incident, are aware of the support available within the Trust.
This should form part of the records of the SIRI.
Trust Staff
12.
Stress can have adverse effects on both mental and physical wellbeing leading to
illness anxiety and feelings of inability to cope. An individual’s response to stress is
dependent on various factors, including personal and health problems that may
impact on the work situation. The individual has responsibility to inform their
manager if they feel that following the incident they are no longer able to continue in
their present role this may only be temporary and support should be given for this
request. Individuals must not feel a failure in not being able to continue.
13.
Employees of the Trust have a responsibility to support their colleagues who have
been involved in an incident. Not just at the time of the incident but thereafter. Staff
involved in incidents must not feel that they are victims of the incident and suffer any
harassment or bullying from colleagues.
Immediate support offered to staff (internally and if necessary externally)
14.
Being involved in a serious incident, inquest, claim and complaint can precipitate
stress and anxiety and can lead to a loss of confidence. The trust has a duty to
support staff through this period.
15.
Immediately following a serious incident or inquest or following receipt of a claim or
complaint the lead of the investigation with the support of the line manager will
need to assess whether the individual(s) involved are able to continue in their role. It
is sometimes good practice to offer some time off. Staying in the area where the
incident happened can add to the individuals stress. It may be that by just taking them
off their present duties and doing another task will be sufficient.
16.
Debriefs and line management support can be a very effective way of helping staff
cope with the effects of the incident. The person facilitating this should be an
experienced senior member of staff who has good communication and interpersonal
skills, de-briefs can be one-to-one or for a group of staff.
17.
Following any incident, inquest, claim or complaint the line manager should
provide or ensure that staff are aware of the options available to support them
through the consequences of the incident, this may include all or some of the following:
Debrief discussion with the
manager Pastoral support from the
Trust team
Time to meet their mentor or another colleague for
support Self-referral to GP
Professional body or Union
How to access the confidential support and counselling available to all Trust staff.
Working in an alternative area
Time off/special leave.
18.
For further advice and support the manager can contact the Occupational Health
team, Human Resources or the Trust’s Risk Management Team. Any support
provided to an individual should be documented and a record kept in their personal
folder held by their department manager.
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Intermediate and Ongoing support offered to staff (internally and if necessary externally)
19.
Support is often given immediately after an incident but staff may be affected by
the incident for a long time afterwards and intermediate and ongoing support should
be provided (in the same way as paragraph 17 above). It is important that the
support given is not a one-off and staff can be offered on-going or further ad-hoc
support as required to help them regain their confidence.
20.
It may be appropriate to arrange a period of supervised practice, undertake some
additional training or possible relocation to another area whilst the individual regains
their confidence. Careful monitoring of the situation must be put in place by an
identified member of staff or other that the individual has access to. A record of any
actions taken must be recorded by the line manager in the staff member’s personal file
held locally.
Action for managers or individuals to take if the staff member is experiencing difficulties
associated with the event.
21.
If an individual is not performing as well as prior to the incident, inquest, claim or
complaint managers should first consider revisiting the principles outlined in
paragraphs 13-17. If the situation persists, advice can be sought from the HR
department. Staff can be referred to Occupational Health for an assessment of their
fitness to practice. It will be necessary for there to be evidence within the staff
member’s personal file held by their manager detailing support given/ offered to date
and information concerning the difficulties that the staff member has experienced.
Occupational Health and GP Support
22.
The role of Occupational Health is to provide specialist support to staff who self-refer
or to those who are referred by their line managers due to concerns about their
wellbeing and their fitness to work. Staff members should also be informed that they
can self- refer and obtain support from their GP. Further information and guidance
on stress is available within the “Policy on the Prevention and Management of
Occupational Stress”.
23.
If a member of staff is referred to Occupational Health for support it will be necessary
for a record of and reason for this referral to be kept within the staff member’s file.
Occupational health records are confidential and any support offered by
occupational health will remain confidential.
Advice available to staff in the event of their being called as a witness (internally and if
necessary externally)
24.
Staff may be asked to give their comments or in some cases a written statement on
an incident, inquest, claim or complaint in order for the Trust to undertake a robust
investigation. Guidance on this can be obtained from Legal Services or the Risk
Management Department. Individuals may approach their own professional body or
union for advice and support during this process.
25.
Being a witness in either a Court of law or at an inquest can be a very
frightening experience. The Trust Legal Services Department not only offers advice on
how to prepare witness statements but also supports the member of staff by meeting
with them prior to a Court appearance and attending the Court with them. Advice for
staff being call as witnesses is available from the Legal Department on or on the
intranet under Clinical Governance there is written detailed guidance on the following:
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Checklist for witness statements
Checklist for witness statements for the Coroner
Writing a witness statement
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NPSA Decision Tree
35.
In cases where an employees practice or decision making may be in question the
Incident Decision Tree can be a useful tool to objectively decide on an individual’s
level of involvement (see Incident Reporting and Investigation Policy). The tool
when followed should lead those using it to a conclusion about whether the incident
occurred as a result of individual failure or systems failure. In general there is usually
more than one outcome when using this tool and it is advised that this exercise is
carried out by more than one party.
Other relevant documentation
36.
Policy on the Prevention and Management of Occupational Stress.
37.
Harassment and Bullying Policy
38.
Writing a W itness Statement Legal Services Stable Block JR
Monitoring Compliance
39.
The monitoring arrangements for this procedure are outlined within the Incident Reporting
and Investigation Policy.
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Appendix 8: Procedure for Learning from Incidents, Complaints and Claims
Introduction
1. The Oxford University Hospitals NHS Trust (OUH) is committed to learning from
untoward incidents, claims and complaints and has a robust process in place to
enable the organisation to maximise learning for the future and reduce the likelihood of
recurrence, thus improving the safety for patients, staff, visitors and contractors.
2. This appendix supports the detailed guidance on the investigation of incidents, claims
and complaints outlined within the relevant policies to which this appendix is attached.
Identification and implementation of changes in practice as a result of individual
incidents, complaints and claims
3. All incidents, claims and complaints will be reviewed and action plans agreed locally by
the relevant Clinical Service Unit, Directorate, Division, Clinical Governance/Risk
Forums. Results of investigations into red and orange incidents, claims and
complaints must be reviewed and action plans agreed with the senior Divisional team.
4. The divisions (or equivalent Senior Managers within non-clinical services) are
responsible for the implementation of changes to practice and reviewing action plans
arising from investigations, and for ensuring that Risk Management, Complaints and
Legal Services are informed of all actions implemented.
Process for aggregation and presentation of reports
5. The Head of Clinical Risk, the Head of Legal Services Department and the
Complaints Operational Manager will be responsible for collating the qualitative and
quantitative data required for a combined quarterly report of incidents, complaints and
claims for each of their areas. This is presented to the Clinical Risk Management
Committee on a monthly basis. Details of content is described in paragraphs 65-70 of
the Claims Management Policy.
6. An aggregated report for the Trust is produced by the Safety; Quality and Risk team
for review by the Clinical Governance Committee will be presented by the Head of
Clinical Risk on a quarterly basis to the clinical Governance Committee.
7. The aggregated report will contain both qualitative and quantitative analysis including
numbers of incidents, complaints and claims, key themes and trends, the grading of
incidents and claims, performance relating to response times for complaints, a
Divisional breakdown of where the complaints, claims and incidents occurred together
with examples of actions taken as a result of incidents, complaints and claims.
8. The report will be available to all members of the Clinical Governance Committee and
it is the responsibility of the Divisional representatives to communicate relevant
information back to the Divisions.
9. An annual review of the minutes from the Clinical Governance Committee with regard to
the frequency of the aggregated reports, together with a review of Divisional minutes
will be completed by the Safety, Quality and Risk team.
10. An annual audit of the content of the aggregated report will be completed by the
Safety, Quality and Risk team to ensure the minimum quantitative and qualitative
analysis is incorporated.
11. Divisional quality reports are presented monthly by the Divisions to the Clinical
Governance Committee for review. The reports include reactive risk data and illustrate
incident, complaints, claims and inquest reporting. Particular reference is made in
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the reports to cases graded red and orange which have been investigated using
Root Cause Analysis
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techniques, t o g e t h e r w i t h t r e n d a n a l y s i s h i g h l i g h t i n g e m e r g i n g
t h e m e s . The C l i n i c a l Governance Committee may request further monitoring or
reporting by the Divisions.
12. The reports produced by the Divisions are cascaded further throughout the relevant
Directorates. Local staff managers are then responsible for ensuring that staff are
made aware of required changes to practice shared through these reports.
13. A quarterly report detailing incident, complaints and claims activity across the
organisation will be submitted to the Quality Committee.
Maximising learning
14. The Trust is keen to maximise learning that results in changes in organisational
practice through the sharing of lessons resulting from incidents, claims and
complaints and their subsequent investigation findings and will liaise with partners
such as contacts in commissioning PCTs, partner organisations and other relevant
bodies such as the Strategic Health Authority (SHA), Health and Safety Executive
(HSE), National Patient Safety Committee (NPSA), The Care Quality Commission
(CQC) and the Department of Health (DoH).
15. Representatives from the PCT and the Trust’s Private Finance Initiative (PFI) Carillion
attend monthly and quarterly Clinical Governance Committee and Health and Safety
Meetings. Incidents reported and the outcome and learning from investigations is
presented and discussed to ensure that learning is communicated.
16. The Trust is represented at various regional Patient Safety Forums hosted by the SHA.
Data is shared on work undertaken on projects designed to target specific risk related
issues.
17. Work is undertaken with health and safety forums outside the organisation such as
LOXANG (London, Oxford, Anglian) Regional Risk Managers Forum and the Cherwell
Health and Safety Forum. These groups receive information about incident rates,
sharing best practice from local investigations and local and national initiatives.
18. Serious Health and Safety incidents are reported to and learning shared with the HSE
via the RIDDOR database. This data is aggregated and forms the basis of national
health and safety informing safety initiatives. The same process occurs for all patient
safety incidents occurring with the Trust. These incidents are reported to the NPSA
national Reporting and Learning database. Trends in reporting are then feedback to
the Trust via quarterly reports and recommendations acted upon. This process is
overseen by the PCT.
19. All red incidents requiring investigation are reported on the STEIS database
administered by the SHA. The SHA use the data and learning generated from incidents
that are reported to inform future patient safety work or take immediate action where
an incident poses immediate regional risk.
20. The quarterly report produced by the Safety, Quality and Risk department highlights
both local and organisational learning with regard to incidents, complaints and claims.
The representatives from the Divisions communicate relevant information back to the
Divisions.
21. The Divisional quality papers prepared by the Divisions and presented to the Clinical
Governance Committee incorporate lessons learnt from incidents, complaints and
claims within Divisions. The representatives from the Divisions communicate relevant
information back to the Divisions.
22. The Clinical Risk Management meeting attended by representatives from the safety,
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quality and risk Department and the Divisions identifies key areas for organisational
learning. An ‘at a glance’ summary is produced from this meeting that captures key
areas of organisational learning. The representatives from the Divisions communicate
relevant information back to the Divisions.
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23. Risk issues arising from incidents, claims and complaints will be also recorded
on the appropriate Risk Register. This will normally be the local register. The
management of risks identified on risk registers will occur according to the Trust
risk management processes (see the Trust Risk Management Strategy and
supporting procedures), thus promoting further changes in practice.
24. The process for implementing risk reduction measures as outlined in the
incident reporting policy and the risk management strategy and supporting
documents.
25. An annual audit relating to local and organisational learning of the quarterly
report from the Clinical Governance Committee and the Divisional reports will
be completed by the Safety, Quality and Risk team.
26. An annual audit of the minutes of the Clinical Risk Management meeting
minutes and the at a glance document for organisational learning to be
completed by the Safety, Quality and Risk team.
Monitoring Compliance
27. The monitoring arrangements for this procedure are outlined within the Incident
Reporting and Investigation Policy.
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