CLAIMS HANDLING POLICY
Policy Number: Status: Edition: Originating Date: Last Review/Ratification Date: Next Review Date: Accountable Director: Policy Author:
RiskMge/R/004 Ratified 3 September 2003 November 2008 November 2011 Chief Executive Claims Manager
CONTENTS 1.0. INTRODUCTION 1.1.0. Rationale 1.2.0. Duties/Scope 1.3.0. Principles 1.4.0. Monitoring 1.5.0 Clinical Negligence Claims 1.6.0. Non Clinical Claims 1.7.0. Reports to the Board 2.0. 3.0. 4.0. 5.0. 6.0. IMPLEMENTAION AND COMPLIANCE CORPORATE OVERSIGHT DISTRIBUTION REVIEW DATE REFERENCE DOCUMENTS
1.0.
INTRODUCTION
1.1.0. Rationale 1.1.1 The Claims Handling policy and associated procedures outline the process by which claims will be handled by the 5 Boroughs Partnership NHS Trust, referred to hereafter as the Trust. 1.1.2. Clinical negligence claims and personal injury claims represent some potentially avoidable sources of harm for service users, members of staff and others. The Trust has governance arrangements to minimise these adverse events. In addition, the Trust Board recognises that clinical negligence and personal injury litigation is a rapidly growing cost. A single large settlement against the Trust may place it at risk of avoidable costs and adverse publicity, as well as taking up a large portion of senior management and clinical time. However, claims, if handled well, will address healthcare governance issues which may emerge and minimise the cost to the Trust, ensuring best professional practice at local level. 1.1.3. The 5 Boroughs Partnership NHS Trust is a member of the Clinical negligence Scheme for Trusts (CNST) and also the Risk Pooling Scheme for Trusts (RPST). Both schemes administered by a separate NHS body called the National Health Service Litigation Authority (NHSLA). 1.1.4. The Clinical Negligence Scheme for Trusts handles all clinical negligence claims against member NHS bodies where the incident in question took place on or after 1 April 1995. The CNST scheme provides a means for trusts to fund the costs of clinical negligence litigation and to encourage support effective management of claims and risk. 1.1.5. Two separate schemes for non clinical claims are covered under the Risk Pooling for Trusts schemes, the Liabilities to Third Parties Scheme (LTPS) and the Property Expenses Scheme (PES), known collectively as the Risk Pooling Schemes for Trusts (RPST). 1.1.6. The Trust aims to reduce the incidence and adverse impact of clinical negligence and personal injury claims by: a) adopting risk management strategies b) the implementation of a robust complaints procedure. c) adopting a systemic approach to claims handling in line with National Health Service Litigation Authority requirements.
1.2.0. Scope 1.2.0 The claims handling policy will apply to all Trust Employees and to Non Executive directors. 1.2.1 DUTIES Trust Board – the Trust Board ensures it is informed about the management and improvements made from incidents, complaints and claims by receiving regular reports on these subjects. More detailed information is obtained by the Integrated Governance Committee on behalf of the Trust Board. Integrated Governance Committee - this committee has responsibility to ensure the Trust investigates, monitors and formally reviews all serious incidents, all complaints and claims and all other incidents are appropriately followed up. The Integrated Governance Committee receives reports on the activity of the Director led Incidents, Complaints and Claims Accountability (ICCA) Group and also the relevant annual reports on specialist subjects (such as Incidents, serious Untoward Incidents, security and Health and Safety). Incidents, Complaints and Claims Accountability (ICCA) Group – To routinely monitor progress of claims. Chief Executive • the Chief Executive is ultimately responsible for ensuring that all claims are dealt with effectively and appropriately. Director of Nursing, Governance ad Performance • this is the nominated Executive Director with the lead for ensuring compliance with this policy Head of Service this post has the responsibility to: • Ensure offer and provision of support to staff where required. • Share the final outcome of claims with all the relevant staff involved. • Share the findings and actions agreed with all staff in the service that they are responsible for. • Provide the Risk Management Department with lessons learned and or improvements made from all claims in order to publicise the learning. • Apply changes required where applicable from actions agreed in other service areas across the Trust.
Claims Manager this role will: • Ensure that the required information is provided to the NHS Litigation Authority or Trust solicitors. • To complete pre-action reports containing investigation findings. All Staff • All employees of the Trust are responsible for acting with due diligence and in accordance with best practice in order to ensure that individuals in our care receive high quality care and treatment and that the surrounding environment is safe and free from hazards. • All letters from legal advisers or patients, which may be the subject of a potential claim against the Trust, must be forwarded to the Claims and Freedom of Information Manager immediately upon receipt. Letters from legal representatives may not initially reveal the intent to initiate legal proceedings. A request for medical records often proceeds a letter of claim. For further information please see the Complaints Handling Policy and Access to Health Records Policy. 1.3.0. Principles 3.1.0. Reduction in the amount of claims either clinical or liabilities to third party schemes can be achieved by effective and integrated risk management processes. 3.1.1 The Trust will endeavour to learn lessons from all reported clams at the outset. From identified breaches of duty and action plans will be implemented to rectify poor practice and to develop and maintain standards of care. 1.5.0 Clinical Negligence Claims 1.5.0. A clinical negligence claim is defined as: “Allegations of clinical negligence and/or a demand for compensation made following an adverse clinical incident resulting in personal injury, or any clinical incident that carries a significant litigation risk for the Trust”. 1.5.1. The Claims and Freedom of Information Manager will: • Where a significant litigation risk has been established through for example a complaints investigation, report the incident to the NHSLA in line NHSLA requirements.
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On receipt of a potential claim against the Trust, manage the claim in conjunction with the NHS Litigation Authority as set out in Circular No. 02/03. Acknowledge the letter of claim to the claimant’s solicitors within 21 working days. Inform and continue to liaise with the relevant Director, Head of Service and other appropriate staff as necessary to gather further information. Inform and continue to liaise with the NHSLA on receipt of a letter of claim. Complete a claim form Request copies of patient records/incidents forms and other relevant documentation for legal advisers. Complete preliminary analysis in accordance with NHSLA requirements. Enter the claim on the DATIX Risk Management System Following the investigation review the claim and consider any lessons learned/actions taken
1.6.0. Non Clinical Claims (Risk Pooling Scheme and Property Expenses Scheme Claims) 1.6.0. A non clinical claim is defined as: “a demand for compensation made following an adverse incident resulting in damage to property and/or personal injury”. 1.6.1. The Claims and Freedom of Information Manager will: • • • • • • • • On receipt of a potential claim against will manage the claim in conjunction with the NHS Litigation Authority requirements. Acknowledge the letter of claim to the claimant’s solicitors within 21 working days of receipt. Inform and continue to liaise with the relevant Director, Head of Service and other appropriate staff as necessary to gather further information. Inform and continue to liaise with the NHSLA on receipt of a letter of claim. Complete a claim form Enter the claim on the DATIX Risk Management System Inform Finance department to ensure appropriate reserves Commence the investigation by requesting the following information, if applicable, from relevant manager for personal injury claims: o Accident book entry o First aider report
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Surgery record Supervisor accident report Safety representatives accident report RIDDOR report to HSE Pre and post accident earnings information Pre and Post accident Risk Assessment required by Regulation 3 of the Management of Health and Safety t work regulations The above is not intended as a comprehensive list of documents required and will vary dependent on the nature of the claim Liaise with Director Nursing, Governance and Performance with regards outcomes/settlement. Following the investigation review the claim and consider any lessons learned/actions taken
1.4.0. Monitoring 1.4.0. The Director of Nursing, Governance and Performance and the Claims and Freedom of Information Manager will prepare quarterly reports for the Trust Board on: a) the number and aggregate value of claims, and details of any high value individual claims; b) the progress and likely outcome of these claims, including the expected settlement date; c) the final outcome of the claim and; d) any proposed remedial action arising out of particular claims 1.4.1. Lessons learned following the investigation/outcome of adverse incidents leading to claims on a quarterly basis 1.4.2. A report will also be presented to and considered at the weekly Incidents, Complaints and Claims Accountability meeting. This report will contain details of the support provided to staff. 2.0. IMPLEMENTATION AND COMPLIANCE 2.1.0. Duties of all staff and Non-Executive Directors All staff and Non-Executive Directors are obliged to adhere to this policy. Managers at all levels are responsible for ensuring that the staff for whom they are responsible are aware and adhere to this policy. They are also responsible for ensuring staff are updated in regard any changes to this policy. 3.0.0 TRAINING All managers must be aware of their responsibilities in forwarding all solicitors correspondence to the Claims Manager on receipt by familiarising themselves with this policy
All staff need to be made of aware of this policy by their managers 4.0. DISTRIBUTION Distribution of this policy shall be to all the Trust’s designated locations. The Policy Unit will hold an up to date list of designated locations and Location Managers. REVIEW DATE This policy will be reviewed in three years. REFERENCE DOCUMENTS NHSLA - CNST Reporting Guidelines NHSLA - RPST Reporting Guidelines
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