Plan to end `lottery' of medical negligence

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A NEW scheme to end the lottery of medical negligence awards, in which some patients win millions of pounds in compensation while others get nothing, is being considered by ministers.

Doctors, lawyers and MPs say urgent action is needed to curb the soaring cost of the claims, which are imposing growing financial strain on the NHS. The British Medical Association has written to Alan Milburn, the Secretary of State for Health, proposing measures to deal with the exponential rise in spending that has led to two settlements in the past three months of more than pounds 4.5m each. One option it wants considered is a tariff that would pay fixed amounts for different injuries regardless of blame, similar to the tariffs that already operate for criminal and industrial injuries.

The BMA's move is being backed by medical defence organisations who say the present system, which depends on proving negligence in a court of law, is both hugely expensive and inequitable. Figures published last April show the NHS is facing a bill of pounds 2.8bn for known and expected claims - enough to build 10 new hospitals.

Gerard Panting, of the Medical Protection Society, said: "For every patient that wins a large sum, many times that number go unbenefited and have to struggle. The question is whether we want to ensure everyone is looked after or just those that can prove negligence."

The NHS spent pounds 235m settling claims in 1996-97, twice the total amount spent on drugs for treating cancer. The report last April showed a total medical negligence bill of pounds 1.8bn in known claims plus a further pounds 1bn in expected claims. That figure is said to be rising by pounds 100m a year. Growing consumer power, an increasingly litigious culture and declining confidence in doctors have all contributed to the rise.

In place of the existing court-based system, the BMA is proposing "non- adversarial dispute resolution". Patients claiming they had suffered injury would be assessed against the normal risks for that procedure and compensated where it was accepted something had gone wrong, without an admission of liability. Dr Mac Armstrong, the secretary of the BMA, said: "The average settlement is pounds 10,000 but the average costs are pounds 50,000. It seems to us that a disproportionately large amount is going on the adversarial process."

No-fault compensation schemes have been tried in other countries, notably New Zealand where it was later abandoned because of the high cost. However, the New Zealand scheme applied to all injuries, not just medical injuries. Dr Armstrong said the BMA proposal was not intended to let guilty doctors off the hook but to ensure compensation was paid to injured patients speedily and equitably. "A no-fault scheme is not compatible in a consumer society with accountability," he said.

Dr David Pickersgill, the chairman of the BMA's medico-legal committee, which has produced a discussion document setting out the options, said: "We want to see patients having easy access to a system that compensates them adequately, is cheaper for the NHS and more equitable. It doesn't seem right that one person gets a huge payout and another gets nothing on the basis of which barrister they happen to have."

A spokeswoman for the Department of Health said that the Health minister Gisela Stuartwould be meeting the BMA to discuss the scheme.