20th August 2015

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Health Chat

29th October King's Fund 5.30pm

Samantha Jones NHSE Director of New Models of Care and Vanguards.

Tickets selling fast here.

A fair few quid
News and Comment from Roy Lilley
D'ya remember Donald Rumsfeld? He's the 'We don't know what unknowns we don't know...' guy. An American politician and businessman. US secretary of state for defence; served under Gerald Ford and George Dubble-ya. He is the oldest and the youngest person to have filled the role.
He is also the person who gave us Asoartame, an artificial, non-saccharide sweetener; the safety of which I am still not sure about?.
There are some great quotes attributed to Rumsfeld; 'Death has a tendency to encourage a depressing view of war.'
Here's another one I bet you'll use today; 'Don't blame the boss. He has enough problems.'
Here's a good one:
'Your performance depends on your people. Select the best, train them and back them. When errors occur, give sharper guidance. If errors persist or if the fit feels wrong, help them move on. The country cannot afford amateur hour in the White House.'
Feel free to substitute 'White House'!
Here's one more; 'Reduce the number of lawyers. They are like beavers - they get in the middle of the stream and dam it up.'
Boy, is that true!
The NHS Litigation Authority have just produced their annual report. They tell us a third of the 1.1bn paid out by the NHS, in compensation last year, was handed to lawyers.
Can you believe it? And, it gets worse. One firm submitted a 121,700 bill following a 5,000 claim.
In the report, the NHSLA claim the behaviour of several law firms was causing concern, with large bills being submitted and a large number of unjustified claims being made. They added; '...the costs of litigation are placing a burden on NHS finances of a magnitude that was never imagined when the NHS LA was established...'
One firm of thieving, filching lawyers claimed a rate of 400 an hour, although a significant amount of the work was carried out by unqualified staff. They then claimed a 100% success fee on top of this, raising the hourly rate to 800.
In another case, in a row with a firm of hucksters, the NHS agreed to pay 2,000 to settle a claim. The claimant's solicitors then presented a bill for 53,529.60. After a row the NHS managed to get the final amount reduced.
Where patients receive damages of up to 100,000, the average claimant's legal costs are now more than 50% of the total payments.
It's not just the lawyers who are the crooks. Some of the public don't have a lot to be proud of. The NHSLA receives unjustified claims, making no payments at all for more than 46% of clinical claims; more than 1.2bn was saved by rejecting claims that had no merit.
It looks like the boss of the NHSLA, Helen Vernon, is drowning. After the introduction of the legal aid legislation, the NHSLA expected to see a fall in the number of cases. Instead, solicitors are finding other ways to increase costs.
Vernon says;
"We are seeing an increasing number of plainly excessive and disproportionate costs bills, the presentation of which coincides with the banning of success fees and the reduction of the recoverability of the full cost of after-the-event (ATE) insurance against the defendant."  
In other words; changes to government policy have driven up the bills.
This interesting study shows us other countries have the same problems and have come to a variety of solutions. No fault schemes are worth a second look. Once 'causation' is established there is no need to go on and prove negligence in order to be eligible for compensation.
Proponents claim; it is quicker, faster access to justice, the opportunity to collect data (under this 'open procedure' the facts are on the table and not obfuscated in defensive responses to litigation), and rehabilitation can be quicker.
The obverse: compensation is lower but in large populations, in the round, might be unaffordable; fails to promote institutional and professional accountability; no incentive to avoid unsafe practices; no learning through error; no apology.
Not easy, is it. At the heart of this are accidents, bad practice, honest mistakes and pain and suffering.
If we had an atmosphere of openness, learning and apology, instead of regulation, sanction and 'failing'... perhaps we might save ourselves a fair few quid.
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