I am tabling this statement for the benefit of Honourable and Right Honourable members to bring to their attention two contingent liabilities. One relating to clinical negligence liabilities incurred by pharmacy led Covid-19 vaccination sites between 1 January and 30 June 2021. And one relating to a targeted and time-limited state-backed indemnity to care homes, registered or intending to register as “Designated Settings”, which are unable to obtain sufficient insurance cover.
On the first, you will be aware that we have initiated the Covid-19 vaccination programme to deliver the vaccine across England. As this programme continues to roll out, we are working with NHS England and NHS Improvement (NHSE/I) to stand up sites in every community.
NHSE/I intend to administer the Covid-19 vaccine through Trusts, General Practice and community pharmacy-led settings to ensure adequate vaccination centre coverage across England. Healthcare professionals need clinical negligence indemnity for delivering Covid-19 vaccines. This is provided through the existing state schemes in England for NHS Trusts and GP Practices.
However, community pharmacy are not covered by state indemnity and are obliged to obtain their own commercial insurance. Following engagement with community pharmacy representatives, our assessment was that the insurance market would not be able to comprehensively provide cover for this risk at such short notice, and we agreed the state indemnity.
Without adequate indemnity cover, pharmacies would be unable to commit to the programme. Their participation is crucial as they have been selected to fill geographical gaps in cover or where NHS capacity is such that they are unable to participate. Therefore, DHSC has provided a time limited clinical negligence indemnity to community pharmacy to 30 June 2021, to enable them to engage at pace with this programme. The provision of such an indemnity enables pharmacy contractors to start to run services, whilst the Department and NHS England and Improvement continue to work with the community pharmacy sector on a longer-term approach to insuring community pharmacy for Covid-19 vaccinations. We had originally intended to time limit this to the end of March but with the decision to extend the period between vaccine doses, have decided to run the indemnity until the end of June.
All claims of clinical negligence will be managed through the provider of the current state backed schemes – NHS Resolution - in line with the existing schemes.
The need for the indemnity was extremely urgent as pharmacy led centres could not begin to vaccinate patients until this was in place and indeed vaccinations have begun at six centres as of 14 January 2021. Delaying would have postponed the roll out of this vital aspect of the vaccination programme, restricting access to the vaccine in some areas of the county. We concluded that such a delay was not acceptable, and I hope it is clear why this was indeed a case of special urgency. Therefore, the normal 14 sitting days for consideration has on this occasion not been possible.
I would also like to update the House on the DHSC’s scheme to provide a targeted and time-limited state-backed indemnity to care homes, registered or intending to register as “Designated Settings”, which are unable to obtain sufficient insurance cover.
The Government is committed to ensuring the best care possible for people with Covid-19. For people admitted to hospital who need social care support, we have worked closely with Local Authorities and the Care Quality Commission to register certain adult social care homes as Designated Settings. I welcome the response of the care sector to the demand for such care. It is our priority to ensure that people are discharged safely from hospital to the most appropriate setting, and that they receive the care and support they need.
I acknowledge the role of the insurance industry in continuing to provide cover, where possible, for this activity. However, we know that obtaining sufficient insurance to accept COVID positive patients and sign up to become a Designated Setting has been a barrier for some care home providers wishing to join the scheme. The designated setting scheme is for people who are medically fit for discharge from hospital (i.e., they do not require to be in an acute NHS bed) but whose ongoing care & support needs are such that they require full-time residential or nursing care. A large proportion of these people will already have been living in a care home.
The scheme forms part of wider policy on hospital discharge set out in Hospital discharge service: policy and operating model (August 2020) – which enshrines a principle of “Home First”, whereby at least 95% of discharges from hospital should be to a person’s own (private) home.
This is limiting the ability of a small number of Local Authorities to operationalise Designated Settings capacity, and in other areas is limiting the expansion of such capacity in response to rising demand.
Given the severity and immediacy of the pressures facing the NHS, we want to take all possible steps to remove obstacles to sufficient local Designated Settings provision. This includes ensuring that where the creation of Designated Settings has created barriers to insurance, the Government will introduce a targeted and time-limited indemnity offer to fill gaps in commercial cover.
The indemnity will cover clinical negligence, employer’s and public liability where a care provider seeking to become a Designated Setting is unable to secure sufficient commercial insurance, or where an existing provider has been operating without sufficient cover. Employer’s and public liability will be covered by a new indemnity scheme; clinical negligence will be covered by the Clinical negligence Scheme for Trusts, an existing state scheme. The indemnity arrangements will be supervised by DHSC and administered by NHS Resolution. The indemnity will cover Designated Settings until the end of March 2021, with a review point in mid-February.
I regret that in this circumstance, due to the need to take this action urgently to support timely discharge from the NHS at this stage of the pandemic, the normal 14 sitting days for consideration has not been possible. A departmental Minute has been laid in the House of Commons providing more detail on this contingent liability.