Medical Practitioners and Dentists (Professional Negligence Insurance)

– in the House of Commons at 1:19 pm on 20th May 2003.

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Photo of Desmond Turner Desmond Turner Labour, Brighton, Kemptown 1:19 pm, 20th May 2003

I beg to move,

That leave be given to bring in a Bill to require the holding of professional negligence insurance as a condition of registration to practise in medicine or dentistry.

It is generally assumed that doctors and dentists are indemnified against professional negligence, both for their sake and the patient's. Indemnity insurance for professional negligence is a mandatory requirement for several professions, few of which are in a position to inflict as much damage to their clients as a negligent or incompetent doctor or dentist. Sadly, that is not the case, and serious consequences can flow from it.

At present, staff employed by health service bodies are covered by the NHS indemnity scheme while they are providing services under the NHS. Private practitioners, however, are not necessarily covered by insurance. They may be members of the Medical Defence Union or Dental Defence Union and may have discretionary insurance cover, but it is not mandatory, and the provision of an indemnity insurance by the MDU is a recent development. About 40 per cent. of doctors in private practice and 70 per cent. of dentists may not have the contractual certainty of insurance and are thus exposed to the risk of being pursued in the courts for professional negligence. Their patients are equally at risk if they are unable to pay judgments that the courts may hand down.

Such an example arose in my area. A dentist practising privately was sued for negligence because of the damage to one of his patient's teeth. It is estimated that it will cost £11,000 for further treatment to repair the damage so that he can use his teeth to eat. The court awarded £6,000 in damages and the costs were another £6,000, but the dentist declared himself bankrupt and has left the country without paying a penny. The solicitor who represented the patient has another 40 cases pending against the same dentist, and it is believed that about 1,000 patients have been similarly damaged by the same dentist. Clearly, he is an outstandingly bad example, and I do not suggest for a moment that that case is typical of medical practitioners. None the less, it illustrates what can happen.

The sums involved in medical cases can of course be much larger, especially in obstetrics where the delivery of a baby with cerebral palsy can lead to court judgments of the order of £3.5 million to cover the cost of a lifetime's care for the child. The bill for claims in obstetric cases to the NHS currently runs into billions of pounds, and, unsurprisingly, independent midwives are virtually extinct. Clearly, the current situation in which insurance is discretionary is not acceptable. Insurance against damage to third parties is mandatory for motorists. Professional negligence insurance is mandatory for other professions and an overwhelming case exists for making it mandatory for health professionals.

Clearly, the Government recognise that there is a problem, as the Health Act 1999 contains an enabling provision that would provide for mandatory insurance:

"Regulations may make provision for the purposes of securing that, in prescribed circumstances, prescribed Part II practitioners hold approved indemnity cover."

It continues:

"The regulations may, in particular, make provision as to the consequences of a failure to hold approved indemnity cover, including provision—

(a) for securing that a person is not added to any list unless he holds approved cover;

(b) for the removal from a list prepared by a Health Authority of a Part II practitioner who does not within a prescribed period after the making of a request by the Health Authority . . . satisfy the Health Authority that he holds approved indemnity cover."

In moving the clause in another place, the noble Lord Hunt, speaking for the Government, said:

"At the moment neither doctors nor dentists are required legally to maintain professional indemnity cover. Although those employed in the NHS, for example in an NHS trust, are covered by NHS indemnity for general medical practitioners and high street dentists, we rely on the guidance of the regulatory bodies and the professional organisations. We consider that to be unsatisfactory."

He went on to say:

"This amendment would allow the Secretary of State to require Part II family health service practitioners—those are the professions providing general medical services, general dental services, general ophthalmic services, or pharmaceutical services—to hold indemnity cover. I should say that the vast majority of those practitioners already act responsibly by arranging suitable indemnity cover for their work. By covering all, this amendment seeks to address the small minority who are not so responsible."—[Hansard, House of Lords, 15 March 1999; Vol. 598, c. 550.]

That was the Government position at the time of the Health Act 1999, but, sadly, the power has not been exercised. That is why I am seeking the leave of the House to bring in this Bill, the thrust of which is that in order to practice as a part II practitioner any health professional must hold a valid certificate of indemnity insurance, and that to practice without insurance would be an offence.

I know that the Government are seized of the problem and are considering a system of no fault compensation to operate in the NHS, which would address the acute public sector, but insurance cover already exists for NHS staff and patients. My Bill would ensure that there is protection in place for both practitioners and the public, in the public sector and the private sector. I commend the Bill to the House.

Question put and agreed to.

Bill ordered to be brought in by Dr. Desmond Turner, Mr. David Lepper, Dr. Ian Gibson, Dr. Brian Iddon, Mr. David Hinchliffe, Vera Baird and Mr. David Heath.