Mr. Simon Kayll:

We have provided a submission and I will speak to it briefly. I thank the committee for the opportunity to present to it today. We absolutely appreciate the difficulty that our subscription rates may cause some consultants. The subscription increases that we felt it necessary to apply over recent years have certainly made the rates significant and difficult for some consultants to afford. We appreciate that this may be causing them concern and potentially driving them away from practice, which may put more pressure on the State. We feel we have to charge the subscription rates we believe are necessary to cover the costs we are incurring on behalf of our members. We have to be financially secure as we are providing an indemnity to them for many years into the future.

It can be five, ten, 15 or even 20 years, in extreme cases, between an incident and the payment of compensation. MPS, the Medical Protection Society, is a not-for-profit organisation that does not have shareholders but is a mutual company owned by its members. All moneys paid by them are retained in the organisation for their benefit. It has been operating for 123 years, providing membership in Ireland for 100 years. It is the world’s leading protection organisation for doctors, dentists and health care professionals, protecting and supporting the professional interests of more than 290,000 members around the world and more than 16,000 in Ireland. MPS is committed to Ireland and will stay for as long as its members wish. It is not an insurance company, and all benefits of membership are discretionary.

MPS provides indemnity for clinical negligence claims, a range of additional supports for our members who may be subject to regulatory matters, complaints or inquests, and a range of risk management and education courses. The indemnity provided is occurrence-based protection, while that of insurance companies is on a claims-made basis. Occurrence-based indemnity means that if a practitioner is a member at the time an adverse incident occurs, he or she can ask for assistance years later even if he or she is no longer a member or has ceased practising. Claims-made cover, as provided by insurance companies, means the member must pay continuously.

There has been a deterioration in the claims environment for GPs, dentists and consultants. The latter has been more extreme as a combination of both the number of claims reported and their severity. We provided a graph in our submission comparing the experience in Ireland to that in other countries, in which one will see a rapid increase over the past several years in Ireland. I must point out that these are actuarial estimates of the cost of indemnity for claims per member for the year in question. The impact of the deteriorating claims environment is felt differently by MPS than the State Claims Agency because MPS has to fund itself on a prospective or pre-funded basis, collecting money now for incidents which occur this year but for which claims may not arise for many years in the future.

How are we dealing with this deterioration of claims? Before we put up our subscriptions in the middle of 2014, we delayed for three months while we communicated with stakeholders, including the Department of Health, the Irish Hospital Consultants' Association, IHCA, the Irish Medical Organisation, IMO, and our members. This was to educate and communicate to them what was going on and to see whether there was any short-term relief that could be applied, particularly through a reduction in the indemnity caps. Subsequently, we developed a campaign highlighting the effects that the reform of tort law and the legal process would have on the future costs of clinical indemnity.

We do not believe indemnity costs have increased because of a deterioration in professional standards. The economic climate that has pertained may have given rise to some issues. There is growing evidence, not only in Ireland but other countries, that a poor economic climate encourages patients to sue. Lawyers who might previously have earned income through commercial work that has dried up may turn their attention to personal injury claims. These problems are further compounded by the lack of an efficient and predictable legal process. General damages, special damages and the legal costs associated with resolving claims tend to be higher in Ireland than we experience elsewhere.

We have launched a campaign for procedural and tort law reform. There is a need for urgent introduction of a pre-action protocol, recommended by the working group on medical negligence and periodic payments, as well as judge-led case management.

Following a review of the US and Australian experience of similar deterioration in the claims environment and their responses to this, we have put forward several significant recommendations which we believe could begin to tackle these concerns, such as a tariff of general damages, a limit on general damages and making legal fees more proportionate to the size of claims.