Gino Kenny on Clinical Negligence Costs Surging to €530m
Gino Kenny warned that clinical negligence payouts have risen from €81 million in 2010 to an estimated €530 million this year and called for a fundamentally new approach to patient safety and compensation. He criticised delays in HSE payments to private providers, described a self-assessment compromise to speed payments, and raised questions about the pandemic recognition payments and resource-driven patient harm.
Rising clinical negligence costs
The estimated jump from 81 million in 2010 to an estimated 530 million this year prompted calls for a strategic response. He said clinicians are practising defensive medicine, that recruitment is affected where staff spend time preparing for court, and he stressed prevention of patient harm should come before payouts handled by the state's claims agency.
HSE payment delays and compromise
He described the HSE as legitimately nervous about sending public money to private, for-profit providers and said that concern over safeguards caused payment delays. He said he intervened to allow a self-assessment process for Section 39 organisations so monies could be paid and audited afterwards as a compromise to speed payments.
Pandemic recognition payments
He noted that 126 000 staff have been paid pandemic recognition payments. He estimated that of the €189 million fund roughly €100 million may have been spent, based on an assumed average payment of about €1,000 each.
Calls for data and alternative compensation models
He argued there are many possible reasons for the increase and that cold hard data and research are needed to identify the drivers in different areas. He proposed looking at no-fault compensation schemes used in other countries and referenced the judge meaning's report, saying progress on its recommendations is being made but more work is required.
Consequences for patients and services
He warned that rising settlement costs divert resources from frontline health services and, more importantly, reflect real patient harm. He urged a ruthless focus on identifying and eliminating patient harm and on assembling a plan to address the problem.
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just in relation to clinical negligence you're saying that in 2010 the figure was 81 million I think you said earlier on that's right yeah so the projected figure this year or even next year could be six times that amount if I'm reading this right yeah nearly nearly six times this year half a billion euros it'll be over half a billion euro that's absolutely incredible yeah what's what's kind of I suppose pushing this what's uh you know why is it incrementally going up by that amount it's an amazing amount of money in relation to just negligence and I know things happen in health services but this is an incredible figure really uh it is deputy to your first point 126 000 staff uh have been paid 126 000 staff have been paid and if I may just respectfully disagree with you on the the wording that you used I mean would we all would I like to it would everyone all of us prefer that it had all been paid within the first week of the government decision of course we would right um the HSE has been dealing with a lot in fairness um and the other thing is that the financial management systems it goes back to the the chair's point in terms of you know the the the the the e-infrastructure they are being improved um the HSE was was was nervous and I think legitimately nervous of whilst it paid its own staff and it paid a lot of its own staff reasonably quickly again we all would have preferred it to be quicker but reasonably quickly um they were genuinely nervous that if they started sending out monies to private for-profit companies right so the the homesick home support the carers going out their private for-profit the nursing homes their private for-profit companies the agency was genuinely concerned that if they sent out the wrong amounts if they sent out too much that they'd be hauled in here into um uh um before pack for example potentially here and they'd be criticized for you know not taking care of public money enough and I have some sympathy with that however because it was taking so long to put what they believed the the sufficient safeguards in place for the public monies were as I was saying earlier on I intervened and said I want a different process which is send out a self-assessment let the private companies in the section 39's do a self-assessment and then pay the money and audit it afterwards um and that was a compromise essentially to get to get the monies paid but I think it is relevant that 126 000 staff have you know have been paid of course we want them all paid but I but I but I do think that is um that that is relevant as well when it comes to the state's claims agency and medical negligence this is a real issue um it's an issue for many reasons I'm sure members of the committee I'm sure yourself you've spoken to clinicians who now talk of practicing defensive medicine you know over referring over you know overuse of diagnostics um because in certain specialties they're they're they are scared of spending all of their time in court in some areas I know they're finding it hard to hire people in because so much of their time ends up getting spent in the high court or preparing for the high court and that's not why they became healthcare professionals it is an issue um and as you quite rightly say a jump from 80 million or 81 million in 2010 to an estimated 530 million this year an estimated higher next year is something that I believe we have to take in a fundamentally new approach to and be very strategic about identifying where the patient safety issues are occurring first and foremost stopping them because that matters far more than any payouts from the SEA is is patience is minimizing and eliminating harm to patients and then we need to have I believe we need to have mechanisms available to patients that that are not in the courts now it turns out that 98 of clinical negligence cases handled by the state's claims agency uh are resolved without a court hearing so 98 do get resolved um but nonetheless I believe there are mechanisms like no fault compensation schemes which are used in other countries which which we need to look at uh you'll be familiar with the judge meaning's report a lot of recommendations in there and the latest advice I have is that good progress is being made on those recommendations I believe there's more to be done just minister just in relation to the clinical negligence I mean one could draw from that either people are taking more kind of um litigation against the you know the health service or there's an issue with um you know these the figures are unbelievable really but obviously is it it's a situation where doctors and medical professionals are so under pressure in relation to resources they are kind of um making more mistakes I mean we understand this happen like mistakes happen in health services but there has to be a reason why all this is happening that's incrementally over the last decade it's gone shot from 80 million to 530 million there has to be a reason my my view is there are there are there are many reasons what we need is we need uh we need the data we need the research we need the cold hard information to say what exactly is driving all of these things uh in uh in in different ways and then we need we need a plan which we'll be looking to put together to deal with this obviously it's a lot of money that could be spent elsewhere in the health service obviously it's a lot of money deputy and and it's a lot of patient harm yeah that's my biggest concern of course we have to be cognizant of the money but ultimately all of this money is simply reflecting harm to patients and that's what we've got to be ruthless in identifying and eliminating yeah just uh just in relation to the the pandemic recognition payment so you're saying 126 000 people have been paid the payment um so how much of the 189 million has been spent well i'm gonna hazard it'll be about 100 if we assume it's broadly a thousand each some people are getting a bit less than that yeah but it would then it would be broadly around 126 million right so the 60 million left um do you know what percentage of section 39 and those that are working in the private sector still haven't got received the pandemic payment i'll get you those figures i certainly we're getting updates on a weekly basis now from the hsc and i'll send the committee around a note afterwards um but there is there is a large volume of the private organizations in the section 39 are now returning these forms and what i've asked the hsc to do and my understanding is they are doing it is very very quickly turning that around yeah uh into the payments i i want and what i said that hsc is anyone who has submitted within a reasonable time before christmas they need to be paid for all the reasons but you can understand why people that were working in the height of the pandemic in the private sector or in nursing home could be really paid off in relation to this like the kind of the goodwill that was you know as i said welcomed last january they still haven't been paid of course and none of us want to be here but can i just though i i think can we just take a step back for a moment right so first of all let's acknowledge that these payments should have happened earlier this year let's let's absolutely acknowledge that and let's acknowledge um that there are still unfortunately whilst you know 126 000 and you know it'll be more by the end of the week have been paid there are tens of thousands who haven't been so let's just start by acknowledging that but also let's just reflect this is you know one of the things that i was determined and government was determined that this would be a genuine recognition and that it would be good um by international comparisons and it is and would i prefer that they had the thousand euro in june than in december yes but it is still good that it's a thousand euro being paid and critically and credit to paschal donahue i asked the minister if we could make it tax free and very very little gets made tax free let me tell you and and to minister dunahoo's credit uh he agreed i said we cannot give people a thousand euro and then take 500 back or more than 500 back in tax right but but normally that's what it would happen so whilst can i accept that we would have all liked it to be earlier there's still about 190 million euro in tax-free money being paid out to about 190 000 men and women in our system and i like ultimately i think that is a good thing no no it's a very good thing it's a very it's just it's just the way it was kind of yeah delivered yeah quite i mean we all i i think agree that it was just you know people not getting it for a period of two years it just it just takes the kind of goodwill out of it well it won't be up to a year though to be clear the decision was only made earlier this year and the vast majority of these should be paid before christmas so it's still within the same year yeah hopefully it's obviously yes i wish it all happened in the first number of months as do we all okay thanks
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