NHS National Services Scotland
— Supporting Scotland's Health
Clinical Negligence & Other Risks Indemnity
Scheme
(CNORIS)
Annual Report 2015-16
Scheme Director: Fiona Murphy
NHS National Services Scotland
Date Published: July 2016
Please contact the Scheme Manager, Irene A Hallett ([email protected]) , for all enquiries.
NHS National Services Scotland
— Supporting Scotland's Health
Table of Contents:
Introduction................................................................................................................................... 3
Outturn for 2015-16...................................................................................................................
3
Table 1: CNORIS Payments by Members 2015-16...........................................................
4
Incident Timeline........................................................................................................................... 4
Graph 1: Claims Paid 2015-16 by Year of Incident............................................................
4
Trends in Payments..................................................................................................................... 5
Table 2: Payments made since 2005-06...............................................................................
5
Graph 2: Value of Claims Paid during 2013-14, 2014-15 & 2015-16....................................
6
Graph 3: Number of Claim Payments made during 2013-14, 2014-15 & 2015-16...............
6
Periodic Payment Orders and Structured Settlements 2015-16...........................................
7
Contributions and Claims Paid.................................................................................................... 7
Graph 4: Contributions & Claims Paid – 3 Year Total...........................................................
7
Analysis of Claims by Year of Incident and Year Received...................................................... 8
Graph 5: Breakdown of No. of All Claims..............................................................................
8
Graph 6: Breakdown of CNORIS Payments 2005-06 and 2015-16......................................
9
Graph 7: CNORIS Payments made 2005-06 and 2015-16 by Speciality Group...................
10
Graph 8: CNORIS Payments by Years of Incidents and Claims Received...........................
11
Pipeline Analysis........................................................................................................................... 12
Graph 9a: Pipeline Analysis of Open Claims.........................................................................
12
Graph 9b: Pipeline Analysis of Open claims (adjusted for risk).............................................
12
Appendix 1: Background, Definitions, and Key Delivery Partners………………………......... 13
Appendix 2: Organisations covered by CNORIS........................................................................ 14
Notes ............................................................................................................................................. 15
NHS National Services Scotland
— Supporting Scotland's Health
Introduction
Clinical Negligence and Other Risks Indemnity Scheme (CNORIS) is a risk transfer and financing
scheme for Health and Social Care across Scotland and was first established in 1999 by the
Scottish Government Health Directorates in partnership with Willis Limited. The primary objective
is to provide cost-effective risk pooling and claims management arrangements for members of the
Scheme who include: NHS Health Boards, Special Health Boards and Health & Social Care
Integration Joint Boards from across Scotland1.
With effect from the 1st September 2013 NHS National Services Scotland (NSS) took over
responsibility for managing the Scheme from Willis Limited, with the NHS Central Legal Office
continuing to provide legal advice and guidance to members in relation to negligence claims.
This year’s annual report provides summary details of the number and value of claims made during
the financial year 2015-16, and gives an insight into arrangements for payment of clinical
negligence claims and the impact on NHS Scotland2. The NHS in Scotland treats some 4.5 million
outpatients and 1.5 million inpatients each year in hospitals in Scotland3. There is a very high
standard of care and patient safety. The total number of claims upheld for clinical negligence4 each
year is small although the financial value can be high depending on the nature of the claim and the
impact on the patient.
The CNORIS scheme covers both clinical and non clinical claims5. In 2015-16 there were 291
claim payments made, this was higher than in previous years and a 14% increase on last year’s
figure of 255. The total value of claims was £52.8 million which was a 36.9% increase on the
£38.6 million claimed in 2014-15. The split in claims showed that 235 totalling £49.7 million related
to clinical claims while 56 totalling £3.1 million were non-clinical. The highest settlements were in
obstetric care and, as illustrated in Graph 2 below, these type of claims can take many years to
conclude due to a number of factors.
It should be noted that although a claim may have been received in 2015-16 it often relates to an
incident that occurred many years previously. Of the claims received in 2015-16 there were only
15 of the 291 where the incident date was between 2013-14 and 2015-16. This highlights the
lengthy time for some claims to reach a resolution and is not necessarily indicative of an increasing
number of incidents compared with previous years. This is analysed in greater detail in Graph 1.
Outturn for 2015-16
The value of claims settled in 2015-16 was £52.8 million. Taking account of the carry-forward of
£0.2 million from 2014-15, the total commitment on the pool in 2015-16 was £53.0 million.
The breakdown of the number and value of claim payments made during 2015-16 is detailed in
Table 1 below. Of these payments, 27 related to high value cases (where settlement is over £1
million) and of these, 9 payments, all of which related to clinical claims, were in excess of £1
million.
NHS National Services Scotland
— Supporting Scotland's Health
Table 1: CNORIS Payments by Members 2015-16
CNORIS Member
Number of Claims*
NHS Ayrshire and Arran
NHS Borders
NHS Dumfries and Galloway
NHS Fife
NHS Forth Valley
NHS Grampian
NHS Greater Glasgow and Clyde
NHS Highland
NHS Lanarkshire
NHS Lothian
NHS Orkney
NHS Shetland
NHS Tayside
NHS Western Isles
NHS 24
National Waiting Times Centre
Scottish Ambulance Service
TOTAL
23
<5
8
10
11
22
70
22
25
56
<5
<5
23
<5
<5
<5
9
291
Value of Claims
(£ 000’s)
2,138
723
312
774
1,831
4,554
15,695
2,079
11,424
5,935
0
143
5,642
131
10
23
1,390
52,805
*Where the numbers of claim payments are less than 5 then “<5” is entered in column 2 above.
Incident Timeline
Graph 1: Claims Paid 2015-16 by Year of Incident
2015-16 Claims by Incident Year 8.00
7.00
50
40
5.00
30
4.00
3.00
20
2.00
10
0
1.00
Employme…
No Date…
Pre 1997
1997-98
1998-99
1999-00
2000-01
2001-02
2002-03
2003-04
2004-05
2005-06
2006-07
2007-08
2008-09
2009-10
2010-11
2011-12
2012-13
2013-14
2014-15
2015-16
Number of Claims
6.00
Incident Year
0.00
Value of Claims (£ million)
60
Number of
Claims by
Incident Year
Value of
Claims by
Incident Year
NHS National Services Scotland
— Supporting Scotland's Health
The above graph shows for all claims paid in 2015-16 the value and number of claims attributed to
the year of incident. The majority of claims are settled more than 5 years after the date of the
incident, with some settlements taking considerably longer. The peak in value during 1999-00
relates to a single large claim worth over £7m that was claimed in 2015-16.
Trends in Payments
Table 2 below shows how payments over the last 10 years have risen from £4.45 million to £52.8
million, reflecting increasing volume and value of claims. Peak expenditure was in 2010-11 when
claims, net of deductibles, totalled £58.25 million.
Table 2: Payments made since 2005-06
Payments made since 2005-06, Net of Deductibles, As at 31 March 2016*
Clinical & Residual
Non - Clinical
Total
Financial Year
(£ million)
(£ million)
(£ million)
2005-06
4.1
0.3
4.5
2006-07
9.4
0.2
9.6
2007-08
18.3
0.6
18.9
2008-09
27.1
1.3
28.4
2009-10
30.8
0.3
31.1
2010-11
57.4
0.9
58.2
2011-12
27.1
2.0
29.2
2012-13
33.1
1.8
35.0
2013-14
34.9
3.5
38.4
2014-15
37.0
1.6
38.6
2015-16
49.7
3.1
52.8
TOTAL
328.9
15.8
344.7
* Values relate to reimbursements made from CNORIS and not payments to claimants and their
legal representatives.
The trend in the number and value of payments continues upwards, year on year. Of the 2015-16
payments, 27, totalling £26.98 million, relate to 25 cases where the total case value is greater than
£1 million.
The breakdown of the number and value of claims by speciality highlights that obstetrics claims
account for 42.8% of the total value of claims over the last 3 years (2013-14, 2014-15 & 2015-16),
although only 16.3% of the number of claims. Refer to Graphs 2 and 3 below for the percentage
breakdown of values and numbers of claims paid by specialty during 2013-14, 2014-15 and
2015-16.
NHS National Services Scotland
— Supporting Scotland's Health
Graph 2: Value of Claims Paid during 2013-14, 2014-15 & 2015-16
% of Total Claims
Claim Values by Speciality
60.00%
50.00%
40.00%
30.00%
20.00%
10.00%
0.00%
2013-14
2014-15
2015-16
Speciality
Graph 3: Number of Claim Payments made during 2013-14, 2014-15 & 2015-16
% of Total Claims
Claim Numbers by Speciality
40.00%
35.00%
30.00%
25.00%
20.00%
15.00%
10.00%
5.00%
0.00%
2013-14
2014-15
2015-16
Speciality
NHS National Services Scotland
— Supporting Scotland's Health
Periodic Payment Orders (PPOs) and Structured Settlements6 2015-16
The increasing number of PPOs will continue to affect the future profile of payments by CNORIS.
At present there are 11 PPOs and 4 older structured settlements across 5 NHS Boards; one paid
quarterly and the others annually, currently totalling £2.48 million each year, subject to inflation
changes.
Contributions and Claims Paid
Contributions and claims paid in the last 3 years are illustrated in Graph 4 below. Contributions are
set based upon a formula that includes claim history, more recent claims and an assessment of
risk of incidents occurring. Contributions do not therefore match payments in a particular year.
Graph 4: Contributions & Claims Paid – 3 Year Total
CNORIS Member
3 Year Contributions
3 Year Claim Values
State Hospitals Board for…
Scottish Ambulance Service
NHS National Services…
NHS Healthcare…
NHS Health Scotland
NHS Education
NHS 24
National Waiting Times Centre
Mental Welfare Commission
NHS Western Isles
NHS Tayside
NHS Shetland
NHS Orkney
NHS Lothian
NHS Lanarkshire
NHS Highland
NHS Greater Glasgow & Clyde
NHS Grampian
NHS Forth Valley
NHS Fife
NHS Dumfries and Galloway
NHS Borders
40.00
35.00
30.00
25.00
20.00
15.00
10.00
5.00
0.00
NHS Ayrshire and Arran
Value (£ million)
3 Year Contributions vs Claims
NHS National Services Scotland
— Supporting Scotland's Health
Analysis of Claims by Year of Incident and Year
Graph 5 below provides a breakdown of the total number of medical and nursing (clinical) claims for compensation together with all other
claims for compensation, by the years the claims were received by NSS CLO. There has been a decrease in the number of claims
received in 2015-16 compared with years 2013-14 and 2014-15.
It is important to bear in mind that this graph shows the total number of claims received each year regardless of amount and merit, and is
not related to the number of claims that may eventually be a call on the CNORIS scheme, generally those in excess of £25,000 where
responsibility is accepted or judgement is awarded.
Graph 5 - Breakdown of No. of All Claims Received by NSS CLO
Breakdown of Claims Received by NSS CLO
(by financial year in which received)
1,300
Total No of Other Claims
Total No of Medical & Nursing Claims
1,200
TOTAL NO of CLAIMS > £25K (CNORIS Threshold)
1,100
No of Claims Received by CLO
1,000
900
800
700
600
500
400
300
200
100
0
2000-01
2001-02
2002-03
2003-04
2004-05
2005-06
2006-07
2007-08
2008-09
2009-10
2010-11
2012-13
2012-13
2013-14
2014-15
2015-16
The bar chart element of the above graph illustrates the total number of claims received by CLO broken down between medical & nursing claims (Type 1 and 2) and all other claims (Types: 3 - 9,11 & 12),
whilst the line graph element highlights those claims where the total cost (award payments plus adverse expenses, plus members' legal costs) was in excess of the £25K CNORIS threshold, or, for
outstanding claims, the anticpated cost is likely to be above the threshold .
NHS National Services Scotland
— Supporting Scotland's Health
Graph 6 below profiles claims where payments were made between 2005-06 and 2015-16 (total value of net payments made was £344.74 million), This
shows the growth in the payments for all claims, but particularly obstetrics and gynaecology claims in the earlier years and that whilst obstetrics and
gynaecology claims have levelled out, there is continued growth in other clinical claims reaching a record level in 2015-16, with these clinical claims
increasing by 43.4% on the previous high observed in 2014-15.
Graph 6 – Breakdown of CNORIS Payments (£344.74 million, net of deductibles), made between 2005-06 and 2015-16
Claim Type Total Value
60,000k
50,000k
Value (£)
40,000k
30,000k
20,000k
10,000k
0k
2005-06
314k
2006-07
240k
2007-08
628k
2008-09
1,337k
2009-10
322k
2010-11
868k
2011-12
2,046k
2012-13
1,849k
2013-14
3,529k
2014-15
1,615k
2015-16
3,101k
Other Clinical
1,238k
1,258k
3,205k
3,685k
6,148k
16,392k
11,132k
15,179k
16,174k
19,944k
28,597k
Obstetrics & Gynaecology
2,903k
8,117k
15,101k
23,402k
24,649k
40,983k
14,762k
17,949k
18,698k
17,012k
21,107k
Non Clinical
Financial Year
NHS National Services Scotland
— Supporting Scotland's Health
Graphs 7 and 8 below analyse these same claim payments between April 2005 and March 2016 (£344.74 million). Graph 7 analyses, in percentage terms,
how the payments over these years were divided between non-clinical and clinical, with a separate analysis of obstetrics and gynaecology claims. Graph 8
profiles the same period of payments, but analyses them by the years in which incidents that led to each claim occurred and also by the years in which
these claims were received; highlighting how some claims can take many years to conclude. For claims paid in 2015-16, where dates are provided, the
average period between the date of the incident to the date the claim was received by CLO was 2.74 years, with the median period being 1.89 years.
Graph 7 –CNORIS Payments (£344.74 million, net of deductibles), made between 2005-06 and 2015-16 by Specialty Group (Updated
Claim Type % of Total Value
100.00%
Overall Claim %
90.00%
80.00%
70.00%
60.00%
50.00%
40.00%
30.00%
20.00%
10.00%
0.00%
2005-06
2006-07
2007-08
2008-09
2009-10
2010-11
2011-12
2012-13
2013-14
2014-15
2015-16
Obstetrics & Gynaecology
65.17%
84.43%
79.75%
82.33%
79.21%
70.37%
52.83%
51.32%
48.69%
44.11%
39.97%
Other Clinical
27.79%
13.08%
16.93%
12.96%
19.76%
28.14%
39.84%
43.40%
42.12%
51.71%
54.16%
Non Clinical
7.05%
2.49%
3.32%
4.70%
1.04%
1.49%
7.32%
5.29%
9.19%
4.19%
5.87%
Financial Year
NHS National Services Scotland
— Supporting Scotland's Health
Graph 8: CNORIS Payments (2005-06 to 2015-16) by Year of Incident and Year Claim Received
60.00
By Year of Payment
By Year Claim Received
By Year of Incident
50.00
30.00
20.00
10.00
2015-16
2014-15
2013-14
2012-13
2011-12
2010-11
2009-10
2008-09
2007-08
2006-07
2005-06
2004-05
2003-04
2002-03
2001-02
2000-01
1999-00
1998-99
1997-98
1996-97
1995-96
1994-95
1993-94
1992-93
1991-92
1990-91
0.00
1989-90 &
Earlier
£ million
40.00
NHS National Services Scotland
— Supporting Scotland's Health
Pipeline Analysis7
A pipeline analysis of estimated values of open (unsettled) claims as they were at year ends for 2010-11 to 2015-16, broken down by clinical claims,
obstetrics & gynaecology claims non-obstetrics & gynaecology claims, and non-clinical claims, is provided in Graph 9a below. In addition, the graph profiles
the years in which the claims open “@ Year End 2016” were estimated to be settled (paid), although not all will settle above the CNORIS threshold.
However, this does not take into account the relevant risk profiles8 evaluating how many of these claims were anticipated to be settled in favour of the
claimant. Graph 9b illustrates the significant reduction in estimated values when risk profiles are taken into account. There is also an impact on the
estimated profile of settlements (payments). Both risks and settlement profiles will continue to be revised as claims advance through the legal process.
Graph 9a
Graph 9b
Graph 9a - Unadjusted* Total Estimated Value for Open Claims
Graph 9b - Risk Adjusted*, Total Estimated Value for Open Claims
Obstetrics & Gynaecology Claims
Clinical - Non Obstetrics & Gynaecology Claims
Obstetrics & Gynaecology Claims
Non-Clinical Claims
Estimated Settlement Date Profiles
Non-Clinical Claims
600.00
600.00
250
Clinical - Non Obstetrics & Gynaecology Claims
Estimated Settlement Date Profiles
250
Line graph represents the estimated settlement values
of those claims open @ Year End 2016, by the year in
which they are currently estimated to settle.
Line graph represents the estimated settlement values
of those claims open @ Year End 2016, by the year in
which they are currently estimated to settle.
500.00
500.00
200
200
400.00
400.00
150
100
£ million
£ million
£ million
300.00
£ million
150
300.00
100
200.00
200.00
50
50
100.00
100.00
0.00
0
@ Year End @ Year End @ Year End @ Year End @ Year End @ Year End
2011
2012
2013
2014
2015
2016
2016-17
2017-18
2018-19
2019-20
2010-21 &
Later
*Estimated settlement values have not been adjusted to reflect the risk (minimal , up to 50% and more than 50%) of settlement.
0.00
0
@ Year End @ Year End @ Year End @ Year End @ Year End @ Year End
2011
2012
2013
2014
2015
2016
2016-17
2017-18
2018-19
2019-20
2010-21 &
Later
*Estimated settlement values have been adjusted to reflect the risk (minimal , up to 50% and more than 50%) of settlement.
NHS National Services Scotland
— Supporting Scotland's Health
Appendix 1: Background, Definitions, and Key Delivery Partners
Background to the CNORIS Scheme:
The scheme was established under the Clinical Negligence and Other Risk Indemnity Scheme
(CNORIS) Scotland Regulations 2000 as amended9, with effect from 1 April 2000. Participation in
the scheme is mandatory for all NHS Boards in Scotland with responsibility for delivering patient
care. Private contractors including General Dental Practices and General Medical Practitioners
(GPs) are outwith the scheme (they have their own indemnity scheme arrangements). GPs may
be covered in instances where they have been directly employed by Health Boards (e.g. out of
hours scheme).
With the introduction of the Public Bodies (Joint Working)(Scotland) Act10 from April 2015, the
Scheme was broadened to enable Integration Joint Boards and Local Authorities to become
Members.
Definitions of the CNORIS Scheme:
The Scheme - Clinical Negligence and Other Risks Indemnity Scheme (CNORIS)

Scheme Contractor – NHS National Services Scotland (NSS) manage the scheme on
behalf of Scottish Government.

Scottish Government Scheme Manager – the lead individual within Scottish Government
Health & Social Care Directorates with responsibility for the policy and operation of the
CNORIS scheme

NHSScotland – the publicly funded healthcare system for people in Scotland.

NHS Boards – the individual territorial and Special Health Boards with direct responsibility
for patient care in Scotland and who comprise the scheme membership.

Integration Joint Boards – bodies established to take responsibility for functions
delegated by Local Authorities and Health Boards in regard to Health and Social Care
Services.
CNORIS Key Aims & Objectives:

To encourage a rigorous and logical approach to risk management in both the clinical and
non-clinical sectors of Health and Social Care services in Scotland;

To provide advice on clinical and non-clinical scheme coverage to all parts of Health and
Social Care services in Scotland;

To support scheme members in an advisory capacity in order to reduce their risks;

To indemnify scheme members against losses which qualify for scheme cover;

To allocate equitable contributions amongst Members to fund their qualifying losses;

To provide Members with scheme financial updates throughout the year to help with
planning and forecasting;

To help manage risk by providing Members with clinical and non-clinical loss analysis
throughout the year
NHS National Services Scotland
— Supporting Scotland's Health
Appendix 2: Organisations covered by the CNORIS are as follows*:
NHS 24
NHS Lanarkshire
NHS Ayrshire and Arran
North Lanarkshire Integration Joint Board
East Ayrshire Integration Joint Board
South Lanarkshire Integration Joint Board
North Ayrshire Integration Joint Board
NHS Lothian
South Ayrshire Integration Joint Board
Midlothian Integration Joint Board
NHS Borders
West Lothian Integration Joint Board
NHS Dumfries and Galloway
Mental Welfare Commission for Scotland
Dumfries and Galloway Integration Joint Board
National Services Scotland
NHS Education for Scotland
National Waiting Times Centre
NHS Fife
NHS Orkney
Fife Integration Joint Board
NHS Quality Improvement Scotland
NHS Forth Valley
Scottish Ambulance Service
NHS Grampian
NHS Shetland
Aberdeenshire Integration Joint Board
Shetland Islands Integration Joint Board
NHS Greater Glasgow and Clyde
The State Hospital
Glasgow City Integration Joint Board
NHS Tayside
East Dunbartonshire Integration Joint Board
Angus Integration Joint Board
West Dunbartonshire Integration Joint Board
Dundee City Integration Joint Board
Renfrewshire Integration Joint Board
Perth and Kinross Integration Joint Board
NHS Health Scotland
NHS Western Isles
NHS Highland
* As at 31 March 2016
NHS National Services Scotland
— Supporting Scotland's Health
NOTES
1
Refer to Appendix 2 for a list of all CNORIS members as at 31 March 2016
2
Through the Clinical Negligence and Other Risks Indemnity Scheme (CNORIS) members
contribute annually to the CNORIS fund for meeting the award costs and legal expenses in
regard to any claims for negligence pursued by patients, employees, third parties and
members of the public.
Members are reimbursed for the costs incurred, less the relevant deductible value per
individual claim, in regard to award payments made to claimants, the claimants legal costs
and the members’ own legal expenses in any given year. The deductible value for claims
raised since 2001 is £25,000 per claim; previously £75,000 or £100,000 was applicable.
The CNORIS Annual Report provides details in regard to the historical reimbursements paid
to members of the Scheme from CNORIS in any given financial year (1 April to 31 March).
The figures quoted do not include any costs not reimbursed to members, but include any
interim awards where claimants have received payments in advance of settlement and PPO
payments.
The CNORIS Annual Report does not provide information in regard to the total number and
value of claims settled by members.
3
Information based upon Official Statistics provided by NSS / ISD on their website.
4
Clinical negligence claims relate to those incidents whereby the care and treatment by
medical, nursing and other healthcare professionals is considered to have been below
expected standards and caused harm.
5
The non-clinical areas covered by CNORIS include: employers liability, public liability,
product liability and non-clinical professional risks. Refer to the CNORIS website for further
details.
6
Periodic Payment Orders (PPOs) and Structured Settlements are where instead of receiving
a lump sum award payment claimants receive periodic payments (normally annually) for a
defined number of years, or life depending upon what is agreed. PPOs are primarily agreed
where there are ongoing costs associated with the care and wellbeing of the claimant and/or
their family/guardians, such as the costs associated with the ongoing care of a severely
disabled child into adulthood.
7
A Pipeline Analysis is being used in this instance as a method of comparing, on a like for like
basis, the number and value of claims over time.
8
All claims are evaluated and allocated a risk rating based upon the probability of the outcome
resulting in a settlement being made to a claimant. Risk ratings are re-assessed as claims
are progressed and new information reduces the uncertainty of outcomes.
9
For further information refer to the Scottish Government website pages for CNORIS.
10
For further information refer to the Government website on legislation