NHS Resolution

NHS Resolution has four main services:

• Claims Management: Delivers expertise in handling both clinical and non-clinical claims to members of our indemnity schemes.

• Practitioner Performance Advice: Provides advice, support and interventions in relation to concerns about the individual performance of doctors, dentists and pharmacists.

• Primary Care Appeals: Offers an impartial tribunal service for the fair handling of primary care contracting disputes.

• Safety and Learning: Supports members of our indemnity schemes to better understand their claims risk profiles, to target their safety activity while sharing learning across the system.

The bulk of NHS Resolution's workload is handling negligence claims on behalf of the members of our indemnity schemes: NHS organisations and independent sector providers of NHS care in England. The five clinical negligence schemes managed by NHS Resolution are:

• Clinical Negligence Scheme for Trusts (CNST), which covers clinical negligence claims for incidents occurring on or after 1 April 1995.

• Existing Liabilities Scheme (ELS) is centrally funded by DHSC and covers clinical negligence claims against NHS organisations for incidents occurring before 1 April 1995.

• Ex-Regional Health Authority Scheme (ExRHAS) is a relatively small scheme, centrally funded by DHSC, covering clinical negligence claims against former Regional Health Authorities abolished in 1996.

• DHSC clinical covers clinical negligence liabilities that have transferred to the Secretary of State for Health and Social Care following the abolition of any relevant health bodies.

• Clinical Negligence Scheme for General Practice (CNSGP), is a new scheme which covers clinical negligence claims for incidents occurring in general practice on, or after, 1 April 2019.

NHS Resolution also manages two non-clinical schemes under the heading of the Risk Pooling Schemes for Trusts (RPST):

• Property Expenses Scheme (PES) which covers ‘first party’ losses such as property damage and theft, for incidents on or after 1 April 1999.

• Liabilities to Third Parties Scheme (LTPS) which covers non-clinical claims such as public and employers’ liability for incidents on or after 1 April 1999.

In addition, we manage one other non-clinical scheme:

• DHSC non-clinical – which covers non-clinical negligence liabilities that have transferred to the Secretary of State for Health and Social Care following the abolition of any relevant health bodies.

In addition it:

• monitors human rights case law on behalf of the NHS
• co-ordinates claims for equal pay in the NHS
• In NHS Resolution's Our strategy to 2022: Delivering fair resolution and learning from harm outlined a shift emphasis away from predominantly claim management to proactive, earlier interventions to support families, particularly in maternity cases including an Early Notification scheme focused on supporting families and staff following a brain injuries at birth.

As reported in NHS Resolution's annual report and accounts 2018/19 liabilities arising from claims under all of NHS Resolution's indemnity schemes had increased by £6.4 billion to a total of £83.4 billion, at current prices, at the end of 2018/19. This is the value of liabilities arising from incidents that occurred before 31 March 2019, both in relation to claims received, and NHS Resolution's estimate of claims that they are likely to receive in the future from those incidents which have occurred but have yet to be reported as claims. In 2018/19 the organisation had received 10,678 new clinical negligence claims, compared to 10,673 in 2017/18, a relatively flat profile with an increase of just five claims (0.08%). The number of new non-clinical claims, typically employers’ and public liability claims, rose from 3,570 received in 2017/18 to 3,585 in 2018/19, a modest increase of 0.42%.

In 2018/19 the number of new referrals received in relation to the performance of doctors, dentists and pharmacists within the NHS remained broadly consistent, with 925 new requests for advice compared to 919 in the previous year. In addition, NHS Resolution received 171 appeals in accordance with the Pharmacy Regulations compared to 170 in the last financial year.

The payments made in-year may relate to incidents that occurred many years in the past. This is due to the time lag between when an incident occurs, a claim is lodged and when payments are made – these payments in-year include annual payments (periodical payment orders) to provide on-going care. Periodical payment orders often provide claimants with a lifetime of support to meet complex care needs while spreading the cost to NHS providers into the future. This pay-as-you-go approach to operating NHS Resolution's indemnity schemes allows NHS funds to be spent on delivering the services of immediate need and spread the future costs to be met as and when they are needed.

£2.4 billion was paid out to meet clinical and non-clinical claims in 2018/19, however the incurred cost of harm for incidents in 2018/19 that NHS Resolution estimates will turn into claims was approximately £9 billion.

The cost in respect of all incidents up to 31 March 2019 that either have become claims, or we estimate will become claims in the future (the provision for future liabilities) by £6 billion from £77 billion in 2018 to £83 billion as of 31 March 2019. These costs will be met from annual budgets allocated to the NHS, and as such, NHS Resolution is not required to hold assets to cover the provision.

When considering the provision, it is important to note that:

• this figure currently only relates to the secondary care sector (hospitals) for the NHS in England;
• it is a figure that is correct at the date of issuing NHS Resolution's annual report and accounts, and needs always to be linked to the 'as of' date;
• it is not the total cost of claims (which would need to include the 'hidden' costs of claims – such as lost staff time dealing with incidents, investigating what went wrong and dealing the aftermath of an incident etc.); and
• if there is a value allocated to a future periodical payment order this will by its very nature change in response to changing needs and lifespan of the claimant concerned

It was established in 1995 as a special health authority.[1] Its current duties are established under the National Health Service Act 2006.[2]

Mr Ian Dilks is chair of NHS Resolution, having taken up his appointment on 1 April 2014 for a three-year term of office, which was extended on 1 April 2017 for a further three years till 1 April 2020. He succeeded Dame Joan Higgins who was appointed in 2007.[3]

• Official website