Nurses can lead on reducing NHS litigation claims by avoiding preventable harms
More than 15,000 claims were made against the NHS in England in 2015/16, NHS Litigation Authority’s latest annual report has revealed.
More than 15,000 claims were made against the NHS in England in 2015-16 for incidents involving patient harm, clinical negligence and non-clinical injuries or accidents, according to the NHS Litigation Authority’s (NHS LA) latest annual report.
Of those – 10,965 related to new clinical negligence claims in 2015-16, compared with 11,497 in 2014/15. In the same period, the NHS LA received 4,172 new non-clinical liability claims, typically employers’ and public liability claims, compared with 4,806 in 2014-15.
Although the number of new clinical negligence claims and new non-clinical claims fell by 4.6% and 13.2% respectively on the previous year’s figures, the NHS LA is concerned a total of 15,137 claims is ‘significant’ and should be addressed by the NHS with urgency.
Trial and error
NHS LA chief executive Helen Vernon says: ‘The key to reducing the growing costs of claims is learning from what goes wrong and supporting changes to prevent harm in the first place.’
Paid out to patients and their legal representatives in 2015-16 by the NHS
To help tackle extensive litigation costs, the NHS LA has published a series of leaflets that draw on lessons learned through managing clinical negligence claims to reduce preventable harms such as surgical burns, Cauda equina syndrome and maternity pressure ulcers.
The Did You Know? leaflets highlight costs of compensating patients affected by poor care – money that could otherwise be used in providing frontline services.
The NHS LA has also issued claims scorecards to each NHS trust to outline the cause and cost of harm arising from claims in all clinical and non-clinical areas. Scorecards show the number and value of claims arising from each specialty in their own organisation and highlight safety issues.
What can be done
NHS LA director of safety and learning Denise Chaffer says nurse managers should triangulate their claims data with information on incidents and complaints so they can identify trends in harm caused to staff and patients.
‘It is important nurse managers understand the data and what might be contributing to patient harm,’ she explains.
‘Through reducing harm, more money could be spent on patients and treatment instead. Harm costs money, not just in terms of the cost of the claim but also the human cost through the suffering endured by patients, and the distress it can cause staff.’
She says nurses may be able to see common causes for harm: 'The scorecard is a learning improvement tool and could help nurse managers to ensure staff always recognise a deteriorating patient, know how to escalate concerns to get help or improve their handover processes.’
The NHS LA’s claims data shows that costs also relate to harm caused to staff (see box below).
NHS litigation claims, England
Total non-clinical claims (those not involving injury to patients) cost the NHS £53.4 million in 2014-15.
Non-clinical manual handling claims contribute to that figure. The NHS spent more than £7.2 million to settle non-clinical manual handling incidents – claims covering injury incurred by staff transporting or supporting a load, including a patient – between 1 April 2010 and 31 March 2015.
The NHS LA received 484 successful claims relating to manual handling incidents between 1 April 2010 and 31 March 2015.
Common themes for these costs include:
- Moving and transfer of bariatric patients, for example if slings too small
- Lack of evidence of training, documentation and medical records
- Risk assessments not completed or being inadequately done
- Inadequate nursing care/staff available
- Broken or unavailable hoists
- Incorrect sling sizes and straps
- Staff using inappropriate equipment
The NHS LA received 336 claims for surgery related burns to patients for incident dates between 1 April 2009 and 31 March 2014.
171 of those claims were successful resulting in the NHS paying out £3,968,343.
£3.9 million pounds could fund about 20 band 5 perioperative nurses or operating department practitioners for five years.
RCN senior employment relations adviser Kim Sunley would also like to see claims information gathered for needlestick and sharps injuries. She says that many organisations are failing to comply with current needlestick injury legislation.
In 2008, an RCN survey of 4,407 nurses revealed that 96% of respondents use needles as part of their job. Nearly half of all nurses (48%) had been stuck by a needle that had previously been used on a patient, however, just 55% had received any form of training from their employer on safer needle use.
Cost to the NHS for claims relating to venous thromboembolism
‘A lot of nurses tell us their organisations won’t buy safer sharps equipment because they are too expensive.
'The organisations need to be aware of the costs of failing to invest and comply with health and safety regulation and equipment,’ says Ms Sunley
She adds that nurse managers should enable RCN safety representatives within their organisations time to do the regular three-monthly inspections of their work areas.
‘They are the eyes and ears on the shop floor and they can check aspects such as when hoists were last serviced, examine safety records and assess whether staff have difficulties in speaking out about problems,’ Ms Sunley explains.
Former RCN head of nursing JP Nolan, who recently moved to a new role at the Health and Safety Executive, Northern Ireland, welcomes the guides but says: ‘The priority focus should be on reducing harms.
Cost of claims for pressure ulcer damage to women in maternity units
'We need to be looking at the lower level day-to-day near misses or minor levels of harm to improve safety.
‘We learn a lot from no harm cases and we learn it early so we have more time to implement changes. If a claim has arisen, it is generally too late to do something.’
He wants organisations to create a culture in which staff feel confident in reporting concerns and near misses, knowing they will be acted on. ‘RCN members at times feel they are not able to nurse in the way they aspire to, because although they have information about how safe their surgery, practice or hospital might be, they do not feel actively involved in the patient safety culture of their organisation,’ he says.
‘Unless there is a culture of openness and transparency we will not get open reporting of near misses.’
- Nurse managers should triangulate their data on claims, incidents and complaints to identify correlations and spot trends or common causes for harm
- Patient safety is linked to staff health and well-being at work. There should only be one safety culture across any NHS organisation
- Reduce the need for expensive litigation by using mediation, demonstrating transparency, saying sorry and showing lessons have been learned
- Do not focus solely on cases where care has resulted in harm; near misses and cases of minor harm can give early indications of where problems need addressing
Injury claims made by nurses and healthcare assistants at work are mainly assaults, manual handling and slips and trips (due to wet floors or poorly maintained car parks or other hospital areas)