Doctors: Negligence Claims Insurance (Hansard, 1 February 1989)

§ The Parliamentary Under-Secretary of State, Department of the Environment (Lord Hesketh)
My Lords, the rising cost of medical defence subscriptions has been of concern to doctors and to the Government for some years. In 1988 and 1989 the Government are reimbursing two-thirds of the cost of defence subscriptions to hospital doctors on whole-time contracts and to doctors on part-time contracts who work wholly for the NHS. This is an interim arrangement following the recommendation of the Doctors' and Dentists' Review Body in its report in 1988; we are considering what arrangements should be made in the longer term.

The Earl of Halsbury
My Lords, in thanking the Minister for that helpful reply to my Question, perhaps I may congratulate him on the advancement by one stage of his parliamentary career and give him my good wishes.
Could not the pay review body give special attention—because it must be in existence for at least another round—to the fact that GMPs under contract to the National Health Service collect their expenses in full subject to a three year delay in reimbursement, which seems very excessive; and that whole-timers in the National Health Service receive only two-thirds, whereas part-timers, including the nine-elevenths maximum part-time consultants, to date do not receive anything at all? Does that not give an incentive to them to drop the nine-elevenths maximum part-time arrangements and go over to eight-elevenths and take on further private practice, with the loss to the National Health Service of three sessions a week?

§ Lord Hesketh
My Lords, first, perhaps I may sincerely thank the noble Earl, Lord Halsbury, for his very kind words.
1082 GPs are reimbursed on their subscriptions through the expenses system and the Doctors' and Dentists' Review Body each year receives the results of the survey of GPs and their expenses. I accept that that information is inevitably historical but the review body takes account of that in the evidence from the BMA and the health departments when estimating average practice expenses for the year ahead.

§ Lord Harmar-Nicholls
My Lords. before we think of spending any more of the taxpayers' money on covering up a weakness, should we not concentrate on trying to remove or minimise what the question calls: "the erratic character of damages awarded"? Is that not where our attention should be directed rather than spending more money to cover it up?

§ Lord Hesketh
My Lords, I know that my noble friend Lord Harmar-Nicholls will be disappointed but I fear it is not proper for me to comment on the decisions which judges have made in individual cases.

§ Lord Molloy
My Lords, as discussions are already under way within the department and in other departments of the Government which may be affected, can the Minister say whether, before any final decision is made, discussions will also take place with the BMA and the related professions?

§ Lord Hesketh
My Lords, all interested parties are concerned in the discussions which are taking place.

Lord Winstanley
My Lords, perhaps I also may congratulate the noble Lord on his new appointment. I hope that this will not be the last occasion on which he will answer health Questions in your Lordships' House. He has acquired an expertise in that sphere and it would be regrettable if he were snatched from us.
The noble Lord said that the Government were concerned about the increasing costs of these insurance premiums. It is clear that the more the Government have to pay, the more likely they are to be concerned and then perhaps do something about them. In answering the supplementary question, the noble Lord referred to the situation historically regarding general practitioners and how in the past the cost of these premiums was included in the expenses factor. Will the new arrangements under which general practitioners have a budget include amounts for these insurance premiums or will they not?

§ Lord Hesketh
My Lords, first, I thank the noble Lord, Lord Winstanley, for his kind remarks. In answer to the last part of his question, the discussion document will be published in the next one or two weeks. Part of the problem of the very fast rise in cost of the insurance premiums is that they reflect not the claims which are taking place today but the claims which might take place in future years. That is why the percentage rise, which has been very severe, does not reflect a disastrous state of affairs which has occurred or is occurring but the possibility that one may occur.

§ Lord Ennals
My Lords, perhaps I may endorse the congratulations and tribute to the noble Lord. Accepting that there is always a possibility, however small, that a doctor may make an error of judgment which causes damage to a patient and that insurance is an absolute necessity, would it not be far more equitable to introduce a system of no-fault liability? I should have thought that that would be fairer both to patients and to the medical profession. Knowing that the Government have their doubts about that, perhaps it could be an issue for discussion on the White Paper which was published yesterday prior to legislation.

§ Lord Hesketh
My Lords, the subject of no-fault insurance has been discussed before in your Lordships' House and one often hears of the examples of Sweden and New Zealand. However, I must draw your Lordships' attention to the fact that Sweden has a very different social security system, which provides a different starting point. If one looks at the case of Sweden one sees that the average payout on the no-fault liability is only £3,000, but that is because of their social security system, which is very different from that in the United Kingdom.

§ Lord Nugent of Guildford
My Lords, is my noble friend aware that the other aspect of this problem is the increasingly large sums which are being awarded? Is my noble friend and his right honourable friend considering whether there should be a legal limit to the damages awarded in these cases? Is he aware that in America, as I understand it, no less than one-third of surgeons' annual fees are now devoted to insurance premiums because of the astronomical amounts which have been awarded there? Is he aware that we do not wish to follow that path here?

§ Lord Hesketh
My Lords, I fully appreciate the point made by my noble friend Lord Nugent, and I shall certainly draw it to the attention of my right honourable friend the Secretary of State.

Lord Paget of Northampton
My Lords, have we not reached the point in which actions in tort for personal injuries are obsolete? Should we not have a system in which people who are injured or crippled through no fault of their own can claim upon the state, with the state being responsible for that? In view of the increases which we are seeing, I believe that that may be a good deal cheaper for the taxpayer and for everybody else.

§ Lord Hesketh
My Lords, as always I am most interested in questions from the noble Lord, Lord Paget. However, it is fair to say that his question is slightly wide of the Question on the Order Paper.

Lord Morris
My Lords, does not my noble friend agree that, before deciding whether or not judgments are erratic, it is of critical importance to consider the whole of the judicial decision and not consider only the necessarily brief accounts that occasionally appear in the press?

§ Lord Hesketh
My Lords, I am sure that there is a grain of truth in the point made by my noble friend Lord Morris.