.Commission for Health Improvement), NHSLA .National Health Service Litiga-
tion Authority), NPSA .National Patient Safety Agency). These organisations can
all affect the care environment through their activities such as litigation case
management, guideline creation and identifying and investigating bad care prac-
tices and adverse incident reporting.
5.2 Focus on health litigation
More patients are suing their health carers than ever before. The NAO .National
Audit Office) in 2001 [2] noted an increase in clinical negligence litigation:
`The rate of new claims per thousand finished consultant episodes rose by 72
per cent between 1990 and 1998 ... The estimated net present value of out-
standingclaims at31 March 2000 was £2.6billion .up from £1.3billion at 31
March1997).Inaddition,thereisanestimatedliabilityofafurther£1.3billion
wherenegligentepisodesarelikelytohaveoccurredbutwhereclaimshavenot
yet been received.'In Finance Directorate Letter .FDL) .96) 39, the Department of Health clearly
acknowledge a rise in clinical negligence litigation [3] as does the Lord Chancel-
lor's Department [4]. The Department of Health estimated in 1996 that the total
costofNHSclinicalnegligencewaslikelytogrowatnearly25percentperannum
for the next five years [5]. The cost of clinical negligence to the Department of
Health in 1996±97 was £300 million [6].
It is now generally accepted by the Department of Health and by all those
concerned with the provision of health services, that health litigation is on the
increaseandthatstrategiestodealwiththisidentifiedtrendneedtobedeveloped.
The Clinical Disputes Forum [7] identify the problem and some corrective
strategies:
`The number of complaints and claims against hospitals, GPs, dentists and
private healthcare providers is growing as patients become more prepared to
question the treatment they are given, to seek explanations of what happened,
and to seek appropriate redress. Patients may require further treatment, an
apology, assurances about future action, or compensation.'Statisticson litigation claims are helpfulbut they can bedistorted.Charles Lewis
[8] argues that `statistics for medical negligence litigation are constantly being
distorted by those with an axe to grind'. The Lord Chancellor's Department
produced a consultation paper on conditional fees [9] which contained some
financial statistics on the cost of clinical negligence litigation to the tax payer:
`However,theGovernmentdoesneedtotackletheproblemofthehighnumber
of cases that recover nothing or next to nothing. The net cost of medical negli-
gencecasestothetaxpayerlastyearwas£27million.Lookingatthecasesclosed
by the Legal Aid Board in 1996/97, 32 cases recovered £500,000 or more.
Leaving these cases aside, the average cost of cases was £4,122 to recover
average damages of £4,107. In only 17 per cent of cases was £50 or more62 Nursing Law an dEthics