Healthcare indemnity regulation
Serious shortcomings identified in the regulation of indemnity products for healthcare professionals, leading to patient disadvantage.
28 items
7 sources
2 inquiries
Source spread
Where this theme appears
Healthcare indemnity regulation has been flagged across 7 independent accountability sources:
4 inquiry recs
9 PFD reports
7 committee recs
2 CQC actions
2 PPO recs
1 IMB report
3 LGO/SPSO decisions
When the same issue appears across inquiries, coroner reports, and regulators independently, it indicates a recurring issue across the public record.
Browse by source
Source-grouped records are useful for tracing where a concern came from. Large sections show the 50 strongest matches for that source; counts still show the full theme total.
Inquiry Recommendations (4)
10 — Indemnity regulation reform
Recommendation: We recommend that the Government should, as a matter of urgency, reform the current regulation of indemnity products for healthcare professionals in light of the serious shortcomings identified by this Inquiry and introduce a nationwide safety net to ensure patients …
Gov response: Accepted in principle. Medical defence organisations launched a voluntary Code of Practice for discretionary indemnity on 6 January 2025. DHSC commissioned an independent evaluation of the Code. Government continues to consider further policy options to …
Accepted in Part
In progress
13 — Independent sector provider responsibility
Recommendation: We recommend that the government addresses, as a matter of urgency, this gap in responsibility and liability.
Gov response: Accepted in principle. Government acknowledges gap in legal responsibility when consultants work under practising privileges. CQC strengthened requirements for independent providers to have robust governance over consultants. Consideration being given to whether legislative change needed. …
Accepted in Part
No update 2+ yrs
BRIS-100 — Mandate ethics committee approval for all new untried invasive clinical procedures
Recommendation: Before any new and hitherto untried invasive clinical procedure can be undertaken for the first time, the clinician involved should have to satisfy the relevant local research ethics committee that the procedure is justified and it is in the patient’s …
Unknown
15 — Independent sector NHS contract qualification
Recommendation: We recommend that if the government accepts any of the recommendations set out above, it should make arrangements to ensure that these are to be applicable across the whole of the independent sector's workload, where relevant, and not only to …
Gov response: Not accepted but kept under review. Government concerned about proportionality and unintended consequences. NHS Standard Contract already requires providers to meet certain standards. CQC registration applies to all providers regardless of funding source. Government monitoring …
Response Unclear
No update 2+ yrs
PFD Reports (9)
Derek Brierley
Concerns: The suprapubic procedure was performed by a consultant after a long hiatus with inadequate preparation, likely incorrect insertion, and a lack of Trust guidelines for competence and training.
Response (The Pennine Acute Hospitals NHS Trust): The hospital has re-drafted the pathway for managing urinary retention, shared it with A&E staff, initiated a training program for inserting catheters outside of the urology division, and will continue …
Overdue
Rio Andrew
Concerns: The regulation of private medical companies at events is inadequate, creating false security and leaving event medical provision, including "ambulance technicians," largely unregulated, with insufficient checks on mentor suitability for trainees.
Response (Association of Ambulance NHS): The Association of Ambulance Chief Executives (AACE) acknowledges the concerns around private ambulance providers and unregulated 'Ambulance Technicians'. AACE supports the College of Paramedics' efforts to protect the 'Ambulance Technician' …
Response (Department of Health): The Department of Health is intending to consult later in 2016 on whether permanent companies that provide cover at temporary events should be regulated by the CQC. Officials will review …
Responded
Benjamin Orrill
Concerns: The lack of a regulatory body for advanced nurse practitioners, leading to inconsistent appraisal, revalidation, and potential unsupervised practice, poses a significant risk to patient safety.
Response (NHS England): NHS England states it has no jurisdiction over the regulation of nurses or independent practitioners, as the NMC is the regulatory body. However, it expects general practices to declare annually …
Response (NMC): The NMC acknowledges the concerns but asserts that its existing statutory framework and revalidation process are sufficient to protect the public in respect of advanced practice, so it will not …
Responded
Peter O’Donnell
Concerns: Private hospital care had no clear consultant review agreements, inadequate junior doctor oversight/training, absent patient transfer protocols, and failed to report nurse misconduct, creating systemic safety risks.
Response (Department of Health): The Department of Health acknowledges concerns regarding independent hospitals and refers to existing standards, CQC ratings, and quality monitoring data submissions, also noting the ongoing Paterson Inquiry looking into accountability …
Responded
Brian Rochell
Concerns: Concerns about an individual's professional practice were not referred to the relevant professional body in a timely manner. This delay in addressing competence issues poses a risk to future patients.
Overdue
Michael Walton
Concerns: Supply chain issues led to a sub-optimal cannula being used, which dislodged and contributed to the patient's death. Surgeons were restricted in their choice of appropriate medical equipment.
Response (NHS England): NHS England has engaged with Newcastle upon Tyne Hospitals NHS Foundation Trust, who have permanently suspended use of the cannula in question. All reports received are discussed by the Regulation …
Response (Department of Health and Social Care): The DHSC acknowledges the concerns, explains the roles of NHS England, MHRA and CQC, and outlines the NSDR's role in managing medical supply disruptions. They note that the supply disruption …
Responded
Susan Pollitt
Concerns: The absence of national regulation, clear training frameworks, and comprehensive competency assessments for Physician Associates creates significant patient safety risks and widespread role confusion.
Response (GMC): The GMC is bringing Physician Associates (PAs) into regulation in December. They will write to the NCA to request sight of the local trust framework and seek assurances around clinical …
Response (Royal College of Physicians): The Royal College of Physicians (RCP) is calling for a limit to the pace and scale of the roll-out of PAs and has set up an oversight group for PA-related …
Response (Faculty of Physician Associates): The Faculty of Physician Associates (FPA) acknowledges the lack of regulation and is working towards it. They will review the DOPS (Direct Observation of Procedural Skills) form to see whether …
Response (Department of Health and Social Care): The DHSC is working with NHS England and the GMC to ensure safe practice of Physician Associates (PAs), including work around regulation, training, supervision and competency. NHS Supply Chain is …
Responded
Chamali Bibi
Concerns: Concerns exist regarding the expertise and frequency of PAO surgeries, as many surgeons perform very few procedures annually without adequate oversight or recognition of the procedure's specialized nature.
Response (NHS England): NHS England acknowledges the concerns about periacetabular osteotomy (PAO) procedures and states that it is a specialist procedure that should be undertaken only by clinicians with the requisite training and …
Responded
Joan Read Prevention of future deaths report
Concerns: A single consultant lacking cross-cover for geriatric perioperative care creates a risk of urgent test results being missed during periods of absence.
Response (Cardiff and Vale University Health Board): • The Health Board has undertaken a detailed internal Patient Safety Review and enacted several improvements. • Further actions are planned to reduce risk and strengthen system resilience.
Responded
Committee Recommendations (7)
#24 — Remediation costs for severe installation defects can significantly exceed the £20,000 guarantee limit.
Recommendation: Where guarantees are invoked, the repairs will likely in some cases cost more than the £20,000 covered by guarantee. TrustMark advises it should normally cost between £250 and £18,000 per home to correct the faulty installations, if it can be …
Gov response: 1.5 All EWI and IWI measures installed under ECO4 and GBIS schemes should have a guarantee that lasts for 25 years, meaning should issues be found in the future, the protections within the guarantee can …
Response Pending
#22 — The guarantee market for solid wall insulation is notably limited to only three providers.
Recommendation: TrustMark told us that three organisations provided the bulk of the cover.47 In written evidence provided after the oral evidence session, the Department confirmed that the guarantee market for solid wall insulation is limited to three companies: QualityMark Protection, which …
Gov response: 1.5 All EWI and IWI measures installed under ECO4 and GBIS schemes should have a guarantee that lasts for 25 years, meaning should issues be found in the future, the protections within the guarantee can …
Response Pending
#21 — Guarantees cover remediation costs up to £20,000, excluding compensation for health issues.
Recommendation: If the installer has ceased to trade or fails to fix the issues, remediation costs up to £20,000 should be covered by a guarantee.44 TrustMark confirmed in follow-up correspondence that these policies do not cover compensation for ill health or …
Gov response: 1.5 All EWI and IWI measures installed under ECO4 and GBIS schemes should have a guarantee that lasts for 25 years, meaning should issues be found in the future, the protections within the guarantee can …
Response Pending
#10 —
Recommendation: Regarding the provision for clinical negligence, the WGA shows a levelling off of new cases and explains that in the second year of its new strategy to tackle clinical negligence laid out in April 2017, NHS Resolution mediated 380 cases, …
Gov response: 3.3 The Balance Sheet Review, which concluded in November 2020, aimed to strengthen control of long-term risks and the costs of liabilities, to identify opportunities to dispose of assets that no longer serve a policy …
Under Consideration
#4 — Bring in secondary legislation swiftly for register of industry payments to clinicians
Recommendation: Although the Government has also given itself the powers to set up a register of industry payments to clinicians, no decision has been made yet about how to implement it, and officials were not able to share a plan of …
Gov response: . healthcare organisations, individual clinicians, and linked recipients, including medical charities, professional bodies, and research institutions. We aim to launch a six-week public consultation in Spring 2023 to seek public and industry views on the …
Accepted
#22 —
Recommendation: The Department commented that the current legislative framework of medical licensing has not been looked at for a very long time and raised the question of whether it was still fit for purpose. Many factors have changed since the legislation …
Gov response: 5.4 The government disagrees with the Committee’s recommendation. 5.5 The department is currently unable to agree to this recommendation as Ministers will need to decide whether and how any strategic review or alternative action is …
Not Addressed
#3 — Set up register of clinicians' interests swiftly after pilot conclusion to prevent delay
Recommendation: We were encouraged to hear that the Government is going ahead with pilots of a register of clinicians’ interests, but we are disappointed by the speed at which the Government is acting on this recommendation. We urge the Government to …
Gov response: . We are currently piloting systems for doctors to declare their interests in NHS and independent settings across the UK, with the aim of achieving consistency in the information collected and made available to patients. …
Accepted
CQC Inspection Actions (2)
Verve Health
The service must ensure adequate medical governance processes and systems are in place to monitor and assess the practice and competence of clinical staff and ensure the safety of medical practices.
Must Do
Bellevue Healthcare Limited
The provider must ensure effective governance systems are in place, including ensuring that only appropriately licensed professionals sign DNACPR forms.
Must Do
PPO Death in Custody Recommendations (2)
Health Inspectorate Wales
Health Inspectorate Wales should consider whether the dentist and the dental therapist should be referred to their professional bodies with a view to considering their fitness to practice.
The healthcare provider and the NHSE quality team
The healthcare provider and the NHSE quality team should consider whether the behaviour of the nurse who cancelled multiple mental health referrals requires discussion with the appropriate regulator.
LGO / SPSO Decisions (3)
PSOW-202107539 — Ceredigion County Council
Ms X complained that the Council had failed to investigate and respond to her complaint about an increase in nursing home fees. In considering the complaint, the Ombudsman was concerned that the Council had not responded to Ms X despite informing her in August 2021 that enquiries were being made. …
PSOW (Public Services Om…
Health
Mar 2022
25-010-112 — Liberty House Clinic Limited
Summary: We cannot investigate Mr X’s complaint about the Care Provider’s decision not to issue a full refund after it decided his son, Mr Y, needed to be discharged immediately, within 24 hours of admission for treatment. The complaint lies outside our jurisdiction because it is not made about actions …
LGO (Local Government & …
Adult Care Services
Nov 2025
22-001-236 — Sue Ryder
Summary: We will not investigate Mrs X’s complaint about the therapeutic support she received at a privately funded residential unit. That is because we have no jurisdiction to investigate her substantive complaint.
LGO (Local Government & …
Adult Care Services
May 2022