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Clinical negligence is a niche area of law.  Cases are more complex than a typical personal injury claim and invariably require expert medical opinion at an early stage. 

The cornerstone of every clinical negligence case is whether the care a patient received fell below the standard expected of a reasonably competent specialist in that area of medicine. This test was established in 1957, in the case of Bolam v Friern Hospital Management Committee (1957) [1] and continues to apply today.  Both parties obtain independent expert reports from the relevant medical discipline(s), to ascertain whether the treatment in question was substandard and if so, what pain, suffering, loss of amenity and other damages it has caused to the patient.

Interestingly, with the advancement of medical science, experts can now contend issues that were once considered simply right or wrong.  It is perfectly possible for two specialist experts to have opposing views of whether a treatment was substandard, making claims not only challenging, but expensive to settle.

Volume of cases

Each year in the UK, the NHS receives more than 10,000 new claims for clinical negligence [2] compensation [3]; although not all will necessarily be merited.  Clinical negligence cases have been on the steady rise since 2006 and have increased by 133% since then [4].  Not surprisingly, the costs of dealing with clinical negligence claims also continues to rise each year. [5]

One possible explanation is the ageing population.  Naturally, medical conditions occur more frequently in old age, creating an ever-increasing demand for treatment.  

Another is the widely recognised issue of understaffing, caused primarily by underfunding of the NHS.  As a result, existing doctors and nurses have taken on longer hours and heavy workloads to cope with growing demand.  Doctors are now at a higher risk of mental health issues, substance abuse and suicide in comparison with the general population.  Over 30% of NHS doctors reported feeling so physically and mentally exhausted that they are clinically considered ‘burnt out’.  This was prior to the Coronavirus outbreak, which for obvious reasons added further insult to injury.  

These pressures inevitably affect the quality of service provided to patients, delay investigation and treatment, all of which result in clinical negligence claims. 

Population figures in Jersey show over 40,000 island residents are aged 50 plus, accounting for approximately 38% of the population.  As of October 2022, it was reported that there are 400 vacancies in the Jersey Health Department [6] which equated to 15% of the total positions, putting resourcing at Jersey General Hospital in a similar position to that of the NHS.  The Chairman of the Royal College of Nursing stated this kind of shortfall in staff puts the Jersey General Hospital “...in the red zone” and part of a larger worldwide staffing crisis faced by healthcare providers.  

As Jersey faces similar challenges as the NHS, it will face an ever-demanding increase in claims unless it sets itself apart from the NHS and tackles those challenges head on.

Compensation & legal costs

In the UK, the BBC reported that in 2020, the outstanding legal costs for unsettled clinical negligence claims amounted to an eye watering £4.9 billion [7].  

Jersey has however limited the compensation rates they will pay out in more serious claims by legislating for a higher discount rate than the UK.  The discount rate is a figure used to calculate compensation payments for high value injury claims, where the claimant will have losses occurring in the future, but which need to be calculated in advance.  It reflects the fact that someone getting a lump sum payment in place of, say, 20 years of their earnings, will typically invest it and expect to get a return on it. The lower the rate, the higher the compensation awarded and the greater the cost to the public purse.

Balancing an individual’s right for compensation for sustaining a preventable injury against society’s ability to pay is no easy task.  This only becomes more difficult giving consideration to the impact that the claim may have on the public care system as a whole and particularly hospital employees, who are simply trying to save people’s lives.

What next?

In the UK, the Department of Health and Social Care is consulting on fixed legal costs for low value clinical negligence cases.  However, the issue of costs on complex cases remains unresolved.  The use of joint medical experts, (where the claimant and defendant instruct one expert to provide an opinion on the case, therefore splitting the costs, as opposed to instructing separate experts) has also been put forward, but unsurprisingly, in a recent focus group there was no support for this approach from claimant and defendant practitioners alike. 

Meanwhile, the Jersey court has shown itself willing to restrict costs for the lower value clinical negligence claims, by setting very limited fixed costs.  The drawback is that such limited costs make such cases difficult to justify pursuing, due to the level of potentially costly investigation required in even relatively low value clinical negligence claims.  Although a higher discount rate does apply in Jersey when compared to the UK, this can be changed periodically, and it remains to be seen if there will be any further legislative intervention to deal with costs in larger clinical negligence claims in Jersey in the future.  Ultimately any legislative changes have to be balanced against a patient’s access to justice, and their right to have legal assistance to bring a claim.

If you believe you have been the victim of negligent medical treatment, we recommend you contact a specialist lawyer in this area. Viberts has a specialist personal injury and clinical negligence team who can guide you through the process and we offer a range of fee structures to suit our client’s different financial circumstances. 

 

[1] Bolam v Friern Hospital Management Committee | Westlaw UK

[2] NHS England: clinical negligence claims by specialty 2021/22 | Statista

[3] NHS faces huge clinical negligence legal fees bill - BBC News

[4] Medical Negligence Statistics UK - Claims against the NHS explored (wrighthassall.co.uk)

[5] Clinical negligence numbers steady, but rising costs remain a concern - NHS Resolution

[6] Health turn to UK and India to fill 400 roles - Jersey Evening Post

[7]Clinical negligence numbers steady, but rising costs remain a concern - NHS Resolution