Plans to scrap discounts on clinical negligence premiums will not lead to “big swings in price”, the chief executive of the NHS Litigation Authority has told HSJ.
The authority is in the process of winding up its programme of risk assessments in which each trust’s result determines whether it is eligible for a discount of up to 30 per cent on its premium.
Instead, under the revised clinical negligence scheme for trusts, the price paid by each organisation will be determined by the number and value of successful claims made against it and the type of activity it carries out. The assessment process will be replaced with more support for trusts designed to reduce the number of claims.
Existing discounts will continue to apply until the end of 2014-15 when they will begin to be phased out.
Chief executive Catherine Dixon said: “We’ll look to move away from discounts but not in a way that there will be big swings in price.
“The message on price is if you have fewer claims you will be paying less.”
Litigation authority director of safety, learning and people Suzette Woodward said the authority may “over time” introduce a system of discounts for trusts that followed best practice in high risk areas such as maternity or surgery. This could include incentivising the use of foetal heart monitoring, known to help prevent babies being born with brain damage.
Ms Dixon, who took up her post in April 2012, wrote to trusts in June to inform them of the new approach. This followed meetings with more than 250 chief executives and a survey of members, both of which raised concern existing assessments were bureaucratic and duplicated other agencies’ work.
The change also fits with the Francis report recommendation that the NHSLA set “more demanding” standards in order for trusts to receive discounts.
The new approach includes providing trusts with access to real time information about their claims through a secure safety and learning service which launched at the beginning of this month.
In response to a recommendation from the recent Berwick review that trusts should form networks to learn from one another, the authority also plans to encourage trusts with low numbers of claims to share expertise with counterparts with high claims.
Nottingham University Hospitals Trust chief executive Peter Homa backed the direction of travel. “The claims history does provide a reasonable indication of the nature of the risk that the organisation carries. The important dimension will come in the details of the proposals. What would not be acceptable would be if we just moved to a new system without consultation,” he said.
However, one district general hospital finance director said the changes could lead some trusts to opt out of the scheme altogether.
“In effect the new system simply spreads the cost of a claim over the following years, which means that cash rich FTs will be considering carefully whether it is worth being in the scheme,” he said.
Last year HSJ revealed up to a quarter of trusts had considered leaving the scheme and seeking cover elsewhere. Lancashire Care Foundation Trust gave the authority the required year’s notice it intended to quit, arguing it was subsidising trusts with high numbers of claims. A trust spokeswoman this week said it had agreed to remain in the scheme for 2013-14 but was keeping its position under review.
Ms Dixon said the fact that all NHS organisations had remained in the scheme was an “endorsement” of the changes. Asked whether the authority would be consulting on the details of its proposals she said the work done already represented a “pretty extensive consultation”.