Rapid redress and resolution scheme: where next?
The Department of Health has published a summary of responses, having sought views last year on the proposed investigations into severe avoidable birth injury. Those responses confirm that reducing incidents of avoidable harm during birth must remain one of the priorities for the NHS.
A desire for patient safety unites all stakeholders in the proposed voluntary administrative compensation scheme (the Scheme). If this can be achieved, then an additional measure of its success should be a reduction in the currently unsustainable level of costs associated with clinical negligence claims.
The main elements that can be derived from the summary into the potential parameters of the Scheme include:
- The need to improve the current system for providing redress to those who suffer negligently caused birth injuries.
- Achieving compensation by way of lengthy, and often adversarial, litigation is not appropriate.
- Time is required to assess the injured party’s condition and prognosis and determine the appropriate level of compensation. The importance of an early apology and explanation to families why events occurred and what has been done to prevent such occurrences in the future.
- The need for early relatively low value upfront payments when avoidable injury established, so as to assist with accommodation costs and buying of essential equipment.
- Thereafter more significant payment to be made at the four year, post-event, mark with periodical payments eventually being made (which would need to be appropriate to the needs of injured party and regularly reviewed).
- The importance of ongoing needs assessment to ensure appropriate funding throughout life.
- The opportunity for improvement in the overall quality and consistency of investigations.
- The need to investigate early and achieve learning from avoidable events is not being fully exploited. Early investigation should be undertaken but not replace those internal investigations instigated under the Serious Incident framework.
- The Scheme should complement, not overlap, with the work of the Healthcare Safety Investigation Branch.
- The need for a structured hierarchy to avoid duplication and additional stress on families and clinicians from multiple investigations running in parallel
- The potential for a central learning database to collate findings and be made available to trusts.
- A combination of web based e-learning, remote and face to face learning.
The opportunity for financial incentives to ensure learning is embedded into NHS culture.
- Respondents to the consultation included midwives, the legal profession, families with personal experience of obstetric negligence, obstetricians and other healthcare professionals.
The findings confirm the overall objective of reducing future incidents of avoidable harm, which is to be welcomed.
What is helpful is that the timing of Scheme and the themes identified from the consultation process accord with the aims of NHS Resolution and its five year strategy in delivering fair resolution and learning from harm.
It also accords with the hard work of the Action against Medical Accidents in seeking to advise and support patients who are attempting to obtain redress.
The scheme, if implemented, will support improved investigation at the time of incident, prior to a complaint even having to be made and will result in a better opportunity to learn. It will also help maintain trust between family and the healthcare provider. The assistance of the family will aid a thorough investigation and set the tone for a collaborative approach being taken both in preventing future harm and in seeking to resolve at an early stage.
This accords with the belief that individual patients should be compensated fairly where harm has been caused by negligent care.
Further research and modelling is now being undertaken so as to guide the Department of Health on how to proceed.
If the Scheme is to be successful then there needs to be engagement from all relevant stakeholder. To help achieve engagement, further work will be needed to reassure those who might proceed down the Scheme route that the damages to be obtained would be at an appropriate level, when compared with the litigation route. Such efforts should begin as soon as possible.
If confidence in the assessment of damages can be achieved with the benefits of an earlier resolution by way of prompt investigation, an apology and the opportunity to share learning, then we anticipate the Scheme will be a positive step forward.