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The cost of clinical indemnity has doubled for many specialties in recent years, increasing by an average of 40 per cent in 2014 alone. This paper reported late last year how ophthalmologists, among other specialties, were being quoted prices of €80,000-€100,000 annually for cover in some cases, leading to Irish patients being deprived of treatment advancements, as well as putting additional pressure on the public sector.
The State Claims Agency (SCA) confirmed in April that there were 2,840 medical negligence claims for HSE patients pending, with a contingent liability of €1.159 billion provided for. The number of claims under the SCA has increased by more than 45 per cent between 2008 and 2012. In addition, the average cost of personal injury (clinical) claims resolved in 2014 was €140,000, compared to €67,000 in 2009.
At the same time, the Medical Protection Society has confirmed that at the end of 2014, the total number of claims pending against consultants, GPs and dentists was 925, compared to 282 at the end of 2008. The total cost of claims that they provided for has increased from €28.8 million in 2008, to €146.5 million in 2013 for consultants alone, which is a jaw-dropping increase of 408 per cent.
It is clear that major reforms are required to address these unsustainable costs and to reduce the number of medical negligence claims.
After years of pleas for the Government to step in and help, in a very welcome move, the Oireachtas Joint Committee on Health published a report on the issue last week.
The report sets out a number of key proposals for reform, including that affected parties should have to consider mediation, or other alternative dispute mechanisms, at an early stage in medical negligence cases and that a series of protocols prior to any legal action should apply to reduce costs.
The report also recommends the introduction of new legislation, proactive HSE support and the establishment of independent advocacy to help embed a culture of open disclosure into the Irish health system.
The Committee says that a ‘duty of candour’ should be a professional obligation for health professionals; but medical professionals must be supported so that they can be open in highlighting mistakes when they do occur.
Other recommendations include that the medical indemnity lower cap be reduced to €250,000 and the higher cap reduced to €500,000, to help ease the pressure on private consultants, and that consultants with low numbers of claims be rewarded with lower premiums.
Hopefully the report will lead to action sooner rather than later, given the escalating crisis. Implementing these recommendations would have a major impact on costs for both doctors and the State, but doctors should be fully involved in any consultation process on whatever changes will be made.
The under-sixes PR war
There was no escaping the free GP care for under-sixes PR war last week. The launch of the registration process for under-sixes saw over 70 per cent of GPs sign up before the end of last week and thousands of parents register their children each day, notwithstanding the predictable HSE website crashes, signalling a crucial ‘win’ for Minister for Health Leo Varadkar regarding this contentious scheme.
It is clear many GPs felt they had no choice but to sign up and many GPs are still holding out, most notably in South Tipperary and Cork.
The email inboxes of journalists were groaning with daily press releases, and at one stage, thrice-daily updates on sign-up rates and quotes from Hawkins House, alongside carefully-staged photos of smiling babies and health ministers.
Is implementing a major change to our primary care services in such a blunt manner really the way to go? A much-needed new GMS contract is currently being negotiated and railroading GPs, who have genuine concerns about workload implications, into the under-sixes scheme will not bode well in asking them to accept what will no doubt be major changes to their work practices under the new full contract. Nor will it stem the tide of emigration of disillusioned Irish GPs, in the face of a growing medical manpower crisis.