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NHS legal costs

including wills and probate
Clitheroekid
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NHS legal costs

#125258

Postby Clitheroekid » March 16th, 2018, 1:20 am

There has been a lot of press coverage of how much the NHS has to pay out in legal costs, and the lawyers who act for claimants in clinical negligence cases are extremely vocal in defending their charges.

But what's hardly ever mentioned is how grossly disproportionate the costs often are to the actual case. I assume the lack of press coverage is because the amount of the costs is never mentioned in the published judgment. It's usually negotiated between the two firms of lawyers, so very few people outside the trade would get to know.

However, occasionally there is a reported case about costs, and one such from the Court of Appeal is Springer v University Hospitals of Leicester NHS Trust [2018] EWCA Civ. However, before looking at it please read the rest of the post.

Reading the whole judgment is for enthusiasts only, but it's the details of the costs claimed that I'm concentrating on.

It was a fatal accident claim, where someone died of heart failure whilst undergoing treatment for a bowel disorder, allegedly as a result of negligence on the part of the NHS.

The claimant's solicitors, a firm called Kirwans from - no surprise here - Liverpool, dealt with the claim. When the solicitor dealing with it set up her own one woman firm, DHF Solicitors, she took the case with her.

The case never got anywhere near a trial. In fact, all that happened in procedural terms was that DHF sent the Claim Form (the formal court document that starts the claim running) to the NHS solicitors, and the NHS solicitors sent DHF their Defence. Two weeks later the claim was settled for £20k.

So bearing in mind the fairly modest amount of the settlement and the fact that all that had been done in court terms was for DHF to send the claim papers to the NHS and for the NHS to send their Defence what sort of figure would you expect DHF to have claimed as their bill?

I was tempted to do a poll, but I couldn’t work out how to integrate it into the post, and in any case I don't suppose anyone outside the trade would have much idea. But I would be interested to know what sort of figures people would have expected.

Trying to wear a layman's hat I'd probably have expected maybe £10,000 or so, maybe a bit more.

But the actual figure was ...













£115,880.74! :shock:

The breakdown is set out in paragraph 27 of the judgment. The basic charges for the time spent were £37,700 + VAT, which is pretty extraordinary in itself. But the real killer is the `success fee'.

Under the type of Conditional Fee Agreements in force at the time (now thankfully ended) if a solicitor `won' a case (i.e. recovered any money at all for their client) they were entitled to charge a success fee of up to 100% of their basic charges. So in this case the success fee meant that DHF were seeking not `just' £37,700 but an additional £37,700 success fee - a total of £75,400 + VAT!

Under that CFA regime the solicitors were also allowed to take out insurance against losing and their client being ordered to pay the other side's costs. This was an additional killer from the NHS point of view, as if the claimant `won' the premium had to be paid by the NHS plus the basic costs plus the success fee.

And because the insurers knew this the premiums were massive - in this case no less than £15,900.

So astonishing as it may seem, a basic bill of about £42,000 was quite legally inflated to well over £100,000.

And, of course, the NHS would also have had to pay their own solicitors.

In reality these CFA’s were legalised extortion. Faced with this sort of costs liability any defendant to a claim – not just the NHS – would settle even a very weak case just to stop the legal bill escalating into hyperspace.

This system used to be in place for all personal injury claims, and explains why so many spivs and shysters rushed into what had once been a fairly dull but respectable area of practice, and why there was so much TV advertising and attempts to get people to make claims, even if they were invented.

But the reason this case got to the Court of Appeal quite made my day. The solicitor dealing with the claim had forgotten (oops!) to tell the NHS that she was running the case on a CFA. This was an absolute requirement because of the financial threat that a CFA carried.

So when the bill went to court to be assessed the NHS picked up on the point, and the judge agreed with them that DHF couldn't claim either the success fee or the insurance premium, between them amounting to about £61,000!

She was, of course, not very happy, so appealed to the County Court judge. He dismissed her appeal, hence her trip to the Court of Appeal in London.

Who also dismissed her appeal :lol:

But this is not an isolated incident. Legal bills that are several times the amount of the settlement are commonplace, and the entire system is a disgrace. I used to practise in personal injury before these absurd CFA's were introduced, and in those days bills like this were completely unheard of.

It's ironic that CFA's were only introduced because the Government, in one of the most short-sighted and stupid decisions ever, abolished legal aid for personal injury claims. By doing so they turned personal injury litigation into a legalised extortion racket.

In 2016/17 the amount the NHS paid out to solicitors like DHF and their ilk amounted to £500 million. Perhaps it’s therefore time to take lawyers out of the system altogether and have compensation decided by an independent tribunal. Or maybe introduce a `no fault’ scheme, where injured patients receive compensation without having to prove negligence.

Almost any alternative has to be better than this.

Lootman
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Re: NHS legal costs

#125259

Postby Lootman » March 16th, 2018, 1:29 am

I cannot comment on the way the number you cited breaks down, but if the NHS killed somebody who should have lived, due to their negligence, then 115K doesn't sound like a lot of compensation to me (even though I understand that much of this goes to the lawyers).

In fact I would have thought that the NHS killing someone should probably be worth at least a million, maybe two, especially if the poor victim was in a good job and supporting a family. How else can we hold these alleged "professionals" to account if not monetarily?

bonrepos
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Re: NHS legal costs

#125287

Postby bonrepos » March 16th, 2018, 8:51 am

Clitheroekid ,thanks for highlighting this legal area of extortion.

Having read Lootman's reply, perhaps you would clarify what I think the outcome of this is,
a modest amount for the claimant and an huge amount for the claimant's solicitor.

How does this sort of system evolve without the NHS quickly asking the government to counter
this abuse with legislation.

didds
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Re: NHS legal costs

#125292

Postby didds » March 16th, 2018, 9:00 am

I don;t disgree with lootman, but the level of compensation is probably for a different thread.

As it is rather than millions the wife in this case got less than 40K, less that one year's salary for a very low tier professional, two years salary for a "blue collar worker" (for the want of a better description).

The rest ended up in the hands of the solicitor. Nice work if you can get it.

didds

newlyretired
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Re: NHS legal costs

#125326

Postby newlyretired » March 16th, 2018, 11:09 am

didds wrote:As it is rather than millions the wife in this case got less than 40K, less that one year's salary for a very low tier professional, two years salary for a "blue collar worker" (for the want of a better description).
didds


According to the OP the case was settled for £20K

newlyretired

didds
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Re: NHS legal costs

#125327

Postby didds » March 16th, 2018, 11:12 am

newlyretired wrote:According to the OP the case was settled for £20K

newlyretired




apologies - indeed.

so a year's salary for (say) a blue collar worker.

didds

DrBunsenHoneydew
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Re: NHS legal costs

#125337

Postby DrBunsenHoneydew » March 16th, 2018, 11:52 am

The hospital offered £10k, the family requested £36k and settled for £20k. So for whatever reason, they didn't believe it was a claim worth millions.
I suspect that the amount of negligence involved was very small and contributed little to the death.
No one was pursued for gross negligence manslaughter, which is what happens when there is serious delinquency in the duty of care.

Lootman
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Re: NHS legal costs

#125344

Postby Lootman » March 16th, 2018, 12:18 pm

newlyretired wrote:
didds wrote:As it is rather than millions the wife in this case got less than 40K, less that one year's salary for a very low tier professional, two years salary for a "blue collar worker" (for the want of a better description).
didds

According to the OP the case was settled for £20K

To put that in some context, my youngest son was awarded 20K for a car accident in which he was knocked off his bike. He broke his hip but made a full recovery. It seems lamentable if getting killed by doctors isn't deemed to be worth a lot more.

DrBunsenHoneydew wrote:The hospital offered £10k, the family requested £36k and settled for £20k. So for whatever reason, they didn't believe it was a claim worth millions. I suspect that the amount of negligence involved was very small and contributed little to the death.

According to CK the patient went in for a bowel treatment and ended up dying of heart failure. It wasn't even the same organ. Assuming the patient was young and otherwise healthy, then that looks pretty damn negligent to me.

Another question is why doctors and hospitals don't carry malpractice insurance, rather than just paying out awards from NHS funds?

Maybe we need to move towards the US model where a jury decides the award, and where punitive damages can be awarded as well. I'd be willing to bet such a case would settle for millions in the US. The lawyer typically takes between 25% and 40% of the award there.

Maybe the problem here is that the UK system has adopted the bad parts of the US contingency system but not the good parts.

DrBunsenHoneydew
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Re: NHS legal costs

#125350

Postby DrBunsenHoneydew » March 16th, 2018, 12:37 pm

Lootman wrote:Another question is why doctors and hospitals don't carry malpractice insurance, rather than just paying out awards from NHS funds?

They do have insurance. For hospitals it's called "NHS Resolution" (previously called Clinical Negligence Scheme for Trusts), and it paid out £2billion last year (including legal fees). The hospitals pay millions in premiums and still have a large 'excess' to give the an incentive. Hospital employees are covered by their employer's vicarious liability. Doctors get their own independent insurance for private practice as they are self-employed there. GPs have their own insurance and it is paid for by the practice for employed practice staff. There are moves afoot to have the GPs covered by the Dept of Health centrally, as the total cost (which the taxpayer ultimately bears for NHS work) would be lower than the current several hundred thousand individual policies for each GP etc.

Kantwebefriends
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Re: NHS legal costs

#126228

Postby Kantwebefriends » March 20th, 2018, 12:32 am

Lootman wrote:I would have thought that the NHS killing someone should probably be worth at least a million, maybe two


How many of your friends have taken out a couple of million in life insurance?

Kantwebefriends
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Re: NHS legal costs

#126229

Postby Kantwebefriends » March 20th, 2018, 12:34 am

Lootman wrote:the patient went in for a bowel treatment and ended up dying of heart failure. It wasn't even the same organ. Assuming the patient was young and otherwise healthy, then that looks pretty damn negligent to me.


What makes you suppose he was young and otherwise healthy?

Lootman
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Re: NHS legal costs

#126361

Postby Lootman » March 20th, 2018, 12:12 pm

Kantwebefriends wrote:
Lootman wrote:I would have thought that the NHS killing someone should probably be worth at least a million, maybe two

How many of your friends have taken out a couple of million in life insurance?

My wife and I certainly have. Can't speak for others.
Kantwebefriends wrote:
Lootman wrote:the patient went in for a bowel treatment and ended up dying of heart failure. It wasn't even the same organ. Assuming the patient was young and otherwise healthy, then that looks pretty damn negligent to me.

What makes you suppose he was young and otherwise healthy?

What makes you suppose that he wasn't?

staffordian
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Re: NHS legal costs

#126674

Postby staffordian » March 21st, 2018, 11:00 am

Lootman wrote:
Kantwebefriends wrote:
Lootman wrote:I would have thought that the NHS killing someone should probably be worth at least a million, maybe two

How many of your friends have taken out a couple of million in life insurance?

My wife and I certainly have. Can't speak for others.
Kantwebefriends wrote:
Lootman wrote:the patient went in for a bowel treatment and ended up dying of heart failure. It wasn't even the same organ. Assuming the patient was young and otherwise healthy, then that looks pretty damn negligent to me.

What makes you suppose he was young and otherwise healthy?

What makes you suppose that he wasn't?

The fact that the award was only £20k implies that his death was only in very small measure due to any NHS neglgence, or possibly that the patient was aged. Were the NHS entirely responsible for the death of a younger person, then the future earnings of that person would probably be a large part of the compensation and it would run into six or seven figures, whereas for an older person, that element would be negligible.

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Re: NHS legal costs

#126697

Postby Lootman » March 21st, 2018, 12:15 pm

staffordian wrote:The fact that the award was only £20k implies that his death was only in very small measure due to any NHS neglgence, or possibly that the patient was aged. Were the NHS entirely responsible for the death of a younger person, then the future earnings of that person would probably be a large part of the compensation and it would run into six or seven figures, whereas for an older person, that element would be negligible.

I agree that it is implied. I just don't know if it's true. The assumption there is that the award is fair and reasonable, and that is what was being questioned.

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Re: NHS legal costs

#126710

Postby swill453 » March 21st, 2018, 12:43 pm

Lootman wrote:I agree that it is implied. I just don't know if it's true. The assumption there is that the award is fair and reasonable, and that is what was being questioned.

Well it was the deceased's father making the claim, so perhaps the deceased wasn't elderly. As far as the claim amount is concerned, the initial damages claim was assessed to be in the range £50,000-£100,000 by the claimant's solicitor. The NHS offered £10,000. £36,000 was counter-claimed, then £20,000 was agreed upon.

Obviously we've no information on why the initial claim wasn't for "millions".

Scott.


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