The future of clinical negligence litigation?

doi:10.1136/bmj.328.7437.457

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Brian Capstick, senior partner (jbc@capsticks.co.uk)1

¹Capsticks Solicitors, London SW15 2TT

Accepted 8 January 2004

The UK's proposed reforms of claims for clinical injury risk fuelling a compensation culture

About 7500 clinical negligence claims are brought each year in England.1 The current system has been criticised by some as complex, inequitable, and expensive in terms of time and legal fee. However, the cost of negligence claims in 2001-2 was £446m,2 less than 1% of the budget for the NHS. Last year, the chief medical officer published a consultation document, Making Amends, which set out proposals for a NHS redress scheme that would provide adjudication for certain clinical negligence claims without the need for legal proceedings.2 It draws on experience in the United States, New Zealand, France, and Scandinavia, which have similar problems. So how will the proposals work, and what will they mean for the NHS?

What is the redress scheme?

The proposed NHS redress scheme will provide an administrative rather than a judicial route for claims up to £30 000 (€43 640, $54 420) and claims arising from severe neurological impairment related to birth (box). Initially, these schemes would apply only to the hospital sector but would eventually be extended to primary care.

The redress scheme proposes that hospitals investigate all adverse events, not only in response to a complaint or claim by the patient. Making Amends predicts about 850 000 adverse events a year, many more than the 33 000 complaints concerning hospital care or the 6797 new clinical claims reported to the NHS Litigation Authority in 2002-3. Although prompt investigation of adverse events that lead to serious injury is a sound risk management measure,3 investigating the larger number of adverse events that cause only minor harm will greatly increase the workload.