As far as I am concerned the best place for a lawyer in the NHS is on the operating table, not sliding around causing trouble for other people, ' health secretary Frank Dobson told the Royal College of Midwives.
It is the sort of language Mr Dobson would not use even in connection with NHS managers, so it comes as little surprise that the government is anxious to cut the health service's legal bill.
These latest comments follow similar remarks early this year when Mr Dobson estimated clinical negligence to have cost the NHS over£200m in 199697. New moves to restrict the number of law firms carrying out negligence work for the health service have been touted as one way of reducing the cost.
But Mr Dobson was not the first to recognise that the processing of medical negligence cases was ripe for an overhaul and an area where potential savings could be made.
Back in 1995 the Tory administration laid down the foundations for change by allowing the NHS Litigation Authority to begin a two-year review. But it is only since 1 April this year that the NHSLA's work has really come into effect.
The NHSLA set up a scheme called Clinical Negligence For Trusts which enables trusts to subscribe to a system similar to a mutual insurance scheme.
Each subscribing trust pays a contribution to the NHSLA, which in turn manages and oversees any clinical negligence claims over an agreed sum.
Some 96 per cent of trusts in England are now subscribers and discounts are offered to trusts demonstrating good risk management standards.
But in February the NHSLA realised its task would be impossible due to the large number of legal firms offering their services for negligence cases.
Chief executive Steve Walker says: 'There were nearly 100 legal firms covering clinical negligence in England alone. It was impossible to manage a group so large.'
More alarming were the variations in quality of service. According to Mr Walker, it ranged from 'good' to 'professionally negligent'. In fact the NHSLA intends to pursue a number of the 'negligent' legal firms.
Mr Walker describes one exceptional case where a firm took 18 years to process a negligence claim involving birth damage to a child, even though liability was admitted. The child was 21 years old before the case was settled.
'We wanted to work with people who were instructed to our protocols and accepted fees. But quality was the overriding consideration when selecting the legal firms for the panel, ' says Mr Walker.
The NHSLA approached 30 law firms to tender for a contract to serve on a provisional panel. A panel of 18 eventually went live on 1 April this year. All new cases will now be assigned, under a three-year contract, to firms on the list. Mr Walker believes trusts and patients will benefit.
'Claimants will notice that claims are paid faster. This is not about reducing the amount of compensation paid out but about reducing the legal costs', he says.
Jill Broadhead, a partner in the NHS litigation department of Bevan Ashford, one of the panel members, believes the streamlined list will bring advantages for patients and tax-payers. 'Through control and efficiency, working within stipulated parameters and through the buying power of the NHSLA, clinical negligence work should become more efficient, ' she says.
The NHS Confederation has welcomed the move. 'The NHSLA has the expertise to manage these cases. It makes sense and should lead to better value for money, ' says policy director Derek Day.
Just how much money the scheme will save remains unclear. According to Mr Walker, the statistical data on NHS clinical negligence cases remains incomplete.
He complains of a 'mishmash' of recorded information on costs and the time taken over claims. Under the new scheme the NHSLA has promised proper auditing, which in turn should lead to better risk assessment.
In addition the NHSLA will instruct its solicitors on local risk assessment and management, learning from best and worst practice in the field.
So far the scheme has attracted few critics. The only voices of dissent come, not surprisingly, from law firms specialising in medical negligence, which did not make it onto the panel.
Lewington Partnership, a Birmingham firm specialising in healthcare law, believes it was left out unfairly. Stuart Knowles, head of medical negligence, is said to be determined to get the firm on the list.
And, ironically, while the NHSLA has been set up to try to reduce the extent and cost of litigation, the authority could itself face a legal challenge from a firm that failed to make it onto the list.
Newcastle-based firm Samuel Phillips and Company, which is experienced in dealing with clinical negligence claims on behalf of health authorities and trusts, was not invited to tender.
Now the firm may seek a judicial review.
In the meantime, firms not on the panel can continue to handle outstanding cases, negligence claims for the 4 per cent of trusts not signed up to the NHSLA scheme, smaller negligence cases and non-clinical matters.
Though some managers may feel they have lost autonomy, many welcome the fact that the expensive litigation process has been largely taken off their hands.
'Generally it seems to make sense, although we will want to see how things operate, ' Mr Day cautiously concludes.
Factfile
Medical negligence costs the NHS£200m a year. and costs rose 17 per cent last year.
Only one case in six succeeds.
19 out of 20 trusts are in the NHS Litigation Authority's negligence scheme.
Until a select list was introduced, some 90 firms competed for the work.
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