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Wednesday, June 26, 2019

How much has medical negligence cost Nottinghamshire hospitals?


Medical mistakes from the last 20 years are still costing hospitals thousands of pounds every year in damages payouts. See how Nottinghamshire NHS Trusts fare in comparison to other trusts in England.

Analysis shows that NHS medical blunders dating back more than two decades are still costing tens of millions of pounds a year in damages.

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In the past five years, the Department of Health has paid out £152 million, including legal fees, to victims of mistakes made before April 1995 in England.

Hospital failings during childbirth account for more than two-thirds of this cost.

And experts have warned that these same mistakes are still being repeated in labour wards today.

A video case study in the article shows the consequences of medical errors on an eight-years-old boy with cerebral palsy affecting all four limbs. He is unable to speak or walk.

This graphic (below) shows the payouts for medical negligence made in the past five years – for medical errors – further clarifications are in the article too.

Nottingham University Hospitals NHS Trust:

Dr Keith Girling, medical director at NUH, said: “We are very sorry when care at NUH falls short of the standards to which we aspire and we seek to learn all that we can from these experiences.

“NHS Resolution manages such legal claims on behalf of our trust. NUH is one of the largest providers of acute health care in the country and includes some highly specialised services delivering care to frail, very unwell, or severely injured patients. We recognise we must do all we can to further improve our systems and checks, and to increase our patients’ safety and confidence whilst in our care.

QMC Nottingham

“At NUH we promote a culture of openness between patients and staff, encouraging staff to inform patients and relatives when things do go wrong, and patients and relatives to let us know when we could have done better. This is an important part of our trust-wide programme of work to further enhance  patient safety, which is informed by a number of sources including claims data.”  


Data has been produced for:

Payouts for mistakes made before 1995

  • University Hospitals Nottingham NHS Trust – £845,957


Total payouts for all mistakes made both before and since 1995

  • University Hospitals Nottingham NHS Trust – £99,568,149
  • Sherwood Forest Hospitals NHS Trust         – £35,620,258
  • Nottinghamshire Healthcare NHS (Foundation) Trust – £3,307,655


If NHS Trusts were to be ranked on the cost of mistakes, then NUH comes out 3rd worst from the sample 258 Trusts in England: below.

Larger trusts like NUH Trust will often have bigger damages bills, because of the volume of patients they see. So we have also normalised the data by looking at the size of the hospital trusts.

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One way to get a sense of the size of a trust is to look at the number of services provided in any given year.

*If the measure is taken using the amount of compensation paid per finished consultant episode – then context is applied.

In this case NUH Trust ranks;

*73rd from 258 Trusts

  • finished consultant episode is one period of care for one patient from one consultant at one hospital

 How does NHS litigation work?

In England, the body NHS Resolution (formerly the NHS Litigation Authority) provides NHS trusts with medical negligence indemnity cover, through two schemes:

  • The Existing Liabilities Scheme (ELS) covers any incidents which happened before April 1995. It is funded by the Department of Health
  • The Clinical Negligence Scheme for Trusts (CNST), covers incidents after April 1995. It is funded by NHS Resolution, by charging NHS trusts a premium based on their expected payouts
Why are payouts still being made for historical cases?
  • Legal battles can take many years
  • New claims are still being received for decades-old incidents
  • It can be years before patients or families realise they may have a claim for compensation
  • Sometimes, assessments about a child’s life-long care needs can only be made when they are older
  • Historically, cerebral palsy claims were often paid as a lump sum but families are now more likely to receive annual payments throughout the child’s life


Medical mistakes left youngster Thomas Hord, now eight years old, with cerebral palsy affecting all four limbs. He is unable to speak or walk.

Thomas was starved of oxygen at birth after midwives failed to place a foetal heart-rate monitor in the right position.

But although Surrey and Sussex Healthcare NHS Trust quickly admitted mistakes had been made shortly after his birth in 2009, the family had to wait a further seven years for compensation.

They secured a £2.5 million lump sum and will also get annual payments for Thomas’s care.

Thomas’s father Chris, 44, of Crawley, West Sussex, said it can take lawyers years to work out the extent of the damage to a child.

“A lot of it is to do with the fact you can’t tell how affected they are going to be until a child starts going through their development,” he said.

Why are the costs so large?
  • Mistakes during or shortly after childbirth can leave the infant with brain damage and lifelong dependency on care, for which NHS trusts become liable
  • In 2016/17, maternity and neonatal care represented around 10% of all overall (historical and non-historical) claims in England but 50% of their monetary value
  • Claims for avoidable cerebral palsy are “undoubtedly the most expensive” of maternity claims and can even exceed £20 million per claim, according to a recent report by NHS Resolution. The number of cerebral palsy claims has remained relatively static over the past ten years
  • Critics say too often the NHS does not admit liability and then faces larger legal fees when it has to pay both its own and the claimants’ costs upon losing cases
  • The life expectancy of children with cerebral palsy is increasing and care costs are also going up
What action is the Government taking?

The Department of Health and NHS Resolution have put forward several measures to cut medical negligence costs in England.This includes:

  • A plan to cap the fees that legal firms can recoup from the taxpayer when they win low-value cases, which critics say does not tackle the root causes of the claims
  • A plan to resolve more medical negligence cases before they go to court
  • A proposal to introduce a voluntary alternative compensation scheme for infants who have suffered avoidable brain injury at birth
  • Cash incentives for trusts which take steps to make maternity services safer

Q&A: Peter Walsh, chief executive, Action Against Medical Accidents (AvMA)

Note: AvMA is a UK charity that provides advice and support to people affected by medical accidents and lobbies the Government for improvements to patient safety

Compensation claims are still being made today for mistakes at maternity wards more than 20 years ago – why is this?

“There may be a number of factors in play.

“Sometimes it takes a very long time to settle these complex and very serious claims.

“It could be also that there are claims relating to very old incidents that are still being made as people become aware they could be entitled to claim.

“We have dealt with at least one case I became involved in where the parents always had suspicions that shortcomings at their son’s birth were responsible for his disability and his mental incapacity.

“They could never put their finger on why, and they were so preoccupied with giving him the best quality of life it took many years before they started making enquiries as to whether they might be entitled to compensation.

“Eventually, they spoke to a specialist solicitor who told them they had a case.”

Why do claims against maternity wards make up such a high proportion of historical (pre-1995) claims against the NHS?

“One of the reasons why obstetrics are over-represented in the historic claims is that the consequences of these things going wrong are so dangerous and serious.

“People will pursue them, the effects are life-changing.

“Compensation is so crucial for their child’s quality of life.

“The claims are high value because of the seriousness of the damage caused.

“Many families just can’t afford not to seek compensation for these injuries – they have no choice unless they are incredibly wealthy.”

Why do the cases take such a long time to resolve?

“One complication is we don’t know the extent of the damage that has been caused until many years after the incident takes place.  It is impossible to make a prognosis straight after the birth to know the full extent of the injuries.

“We have seen claims that have taken over 10 years to resolve.

“Things have improved, but not enough has been done to speed up the process.”

Is enough being done to improve maternity standards now?

“We as a charity have been going for 35 years and we still see the same mistakes, the same avoidable errors causing injury now as we did 35 years ago.

“One common thing in terms of mistakes made during childbirth are failures to read CTG [cardiotocography] traces correctly and respond to them.

“It is a very important tool that helps professionals realise when the baby is under too much stress and there are problems with their heart rate.

“It requires speciality training in terms of interpreting the signs during childbirth. Time is of the essence. A small delay in intervention can make the difference between a child being unaffected, having a brain injury or dying.

“We see these problems occurring again and again. It is time the NHS had consistent high-quality training for midwives and for doctors to ensure they are able to recognise the complications.”

Mr Walsh said training offered by the PROMPT Maternity Foundation – a multi-professional group of obstetricians, midwives and anaesthetists based in the South West – has recently had dramatic results at trusts it has worked with.

The Department for Health-funded training scheme reduced neonatal “hypoxic” injuries  by half at North Bristol NHS Trust.

“It beggars belief that this sort of evidence-based training has not been rolled out across the NHS,” added Mr Walsh.

NOTE: Cardiotocography (CTG) is a technical means of recording the foetal heartbeat and the uterine contractions during pregnancy

The Government is trying to bring in measures to limit the amount of legal fees that can be recovered by claimants, in awards of between £1,000 and £25,000 – what do you think of the proposed reforms?

“The Department of Health is facing huge financial problems but this policy would harm patient safety as well as access to justice.

“By introducing an arbitrary cap on the legal costs that a solicitor can recover it will make it impossible for some would-be claimants to find a solicitor prepared to take on the case.

“Sometimes it is only because there has been a legal challenge that mistakes are recognised and lessons learnt. If the mistakes themselves were cut down on, we would save an awful lot of money and an awful lot of human tragedy.”


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