Scottish Government

THE RECOVERY OF NHS COSTS IN CASES OF PERSONAL INJURY COMPENSATION: A CONSULTATION ON THE DRAFT REGULATIONS

ANNEX F
REGULATORY IMPACT ASSESSMENT

Introduction

1. Department of Health carried out in November 2003 a final Regulatory Impact Assessment (RIA) of the Health and Social Care (Community Health and Standards) Act (prior to it receiving Royal Assent). As the scheme for the recovery of NHS costs in all cases involving personal injury compensation (the 2003 Act scheme) is a GB-wide scheme, no separate RIA was carried out in Scotland. The RIA provides the Governments' considered assessment of the regulatory impact, on businesses and voluntary organisations of the scheme. More detail about the legislative effects of the Act can be found in the Explanatory Notes which accompany the Act.

Summary of Regulatory Impact Assessment

2. These provisions, when enacted, will encourage people to take active steps to reduce the risk of causing injury to third parties, and will tackle the issue of taxpayers subsidising the wrongdoer by meeting part of the costs of his or her wrongdoing.

3. The Government will enact provisions to recover NHS treatment and ambulance costs following a payment of compensation. It is intended that the charges will be based on a daily tariff, will be cost-limited and that the money collected will be returned directly to the hospitals or ambulance trusts providing the treatment or service in question.

4. Any business or voluntary organisation, large or small, with potential liabilities where people receive compensation as either an employer, a producer of goods or transacting business in a public place, will be affected. Insurance companies providing cover in these areas would be affected by the administrative costs and the need to apportion costs amongst holders of policies. Individuals will also be affected.

5. The Government agreed to take into account the conclusions of the review of Employers Liability Compulsory Insurance conducted by the Department for Work and Pensions before commencing the provisions of the Act. The final report of the review was published in early December 2003 and it was agreed at the same time to delay introduction of the NHS costs recovery scheme until November 2004. (Subsequently it was agreed due to operational reasons that the introduction be delayed to 1 April 2005.)

Regulatory Impact Assessment

Issue

6. At present, except for cases involving compulsory motor vehicle insurance, where a person has agreed to pay compensation for an injury suffered by another person the compensator does not meet the costs of any NHS hospital treatment, or ambulance transport, which has been necessary. The estimated cost to the taxpayer of meeting these costs is approximately 150m in Great Britain per year, based on the road traffic accident tariff as set out below.

Objective

7. For people to be more aware of their responsibilities and to take active steps to reduce the risk of causing injury to third parties and to reduce the cost to the taxpayer of subsidising the wrongdoer by meeting part of the costs of his or her wrongdoing.

Background

8. The Law Commission for England and Wales proposed 33, following a public consultation, that the that the system of recovery of NHS costs following road traffic accidents should be extended to include cost recovery in all cases where a person receives compensation. An internal scoping study by the Department of Health's economists assessed the potential for the NHS to recover the costs of accidents/diseases other than those involving motor vehicles. This found:

• employer liability for accidents and diseases and public liability for accidents are the most common types of claims where a person receives compensation for their injuries;
• employer and public liability are therefore the areas where the taxpayer is currently providing the most significant subsidy for the costs of any necessary medical treatment for injuries sustained following accidents;
• the estimated amount that could be recovered by hospitals each year for treating injuries following employers liability accidents is 57 million for in-patient treatment; 15 million for out-patient treatment and 4 million for the cost of emergency ambulance transport;
• potential revenue for treating injuries following public liability accidents is likely to be on a similar scale, however more information would be required on the type of accidents to give a more accurate estimate;
• it would be difficult to quantify the cost of diseases (as opposed to accidents) to the NHS due to the complexity of the treatment path and the period of time over which a patient with an occupational disease would need treatment. If diseases were included in the scheme then much more work would be required to assess the patterns of treatment and the practicalities of running a scheme which includes more chronic conditions.
• further work is required on the type of injuries, cost to the NHS and the appropriate tariff.

Risk Assessment

9. The risks of not legislating were:

• the taxpayer would subsidise those liable for causing injury to others;
• unjust enrichment of those liable for causing injury to others;
• the NHS continuing to bear the cost of treating injuries that have been caused by wrongdoers;
• an increase in accidents and injuries if wrongdoers are not made to pay the full cost of their actions or negligence.

10. The total cost to the NHS in dealing with these cases is estimated to be 140 -150 million. This figure has been calculated using data supplied by the Health and Safety Executive (HSE) (2000-01 Numbers of Accidents at Work); and the Department of Health's Hospital Episode Statistics (HES) data (2000-01 average length of stay) and the road traffic accident tariff from April 2003 (556 per day for in-patient treatment and 452 per day for out-patient treatment). (The rates from 1 April 2004 are 582 per day for in-patient treatment and 473 per day for out-patient treatment.)

11. Apart from motor insurance, there are three other main areas of insurance that could be used to cover NHS treatment costs

• Employers' Liability Compulsory Insurance (ELCI) is mandatory for most employers and covers accidents (and industrial diseases).
• Public Liability insurance provides cover against accidents to the general public in locations open to them; whilst not mandatory, it is relatively common amongst reputable providers of services to the public.
• Product Liability provides cover against the adverse impact of any product. This insurance is not mandatory.

Employers' Liability

12. The HES data shows an average length of stay in hospital following an accident at work to be 3.5 days. It is assumed that this represents the total length of stay for an accident. There will however be a large variation around this average. The scheme will have a ceiling of charges (the cap) which from 1 April 2004 is set at 34,800 for the road traffic scheme. Statistics from the Compensation Recovery Unit show that approximately 500 cases per year would have reached this cap under the road traffic scheme which represents 0.25% of claims.

13. The road traffic accident tariff of 556 per in-patient day and 452 for out-patients (from April 2003) has been used with the estimated number of in-patient and out-patient cases to assess the likely revenue as shown in the table below. Note that the in-patient charge includes provision for subsequent out-patient treatment.

Table 1: Revenue Generation (Accidents at Work)

Source: Health and Safety Statistics 2000/01, HSE

14. The number of cases in Table 1 above is based on a combination of data provided by the HSE and the CRU (the CRU data used is shown in Table 2 below). The data supplied by the HSE includes all accidents at work and not all of these will lead to a claim for compensation. The data supplied by CRU only includes cases where a claim for compensation has been made, however this cannot be broken down by in-patient and out-patient treatment. To arrive at figures that will show in-patient and out-patient treatment that relates to a claim for compensation, it is assumed that the number of serious accidents provided by HSE (28,230) will result in a claim for compensation and that these cases will also require in-patient treatment. The number of out-patient appointments (36,277) assume that half of the remaining cases where a compensation claim has been made (CRU data) will seek hospital treatment and the remaining half will seek treatment in primary care. The scheme does not extend to primary care costs.

Public Liability

15. Data from the HSE and the Compensation Recovery Unit suggest that the number of accidents under public liability are similar to those under employers liability (see Compensation Recovery Unit data in Table 2 below). Therefore it is possible that cost recovery from public liability accidents could be in the same ball-park as employer liability accidents, ie 75 million. This would mean that recovery of NHS costs for hospitals in England, Scotland and Wales would be in the region of 150 million. However this amount would probably be reduced, possibly by a maximum of 5% as NHS costs will be reduced in cases where there is a court finding of contributory negligence (see the paragraph below on "Issues of equity and fairness). It is therefore estimated that the recovery of NHS costs to be in the region of 140 - 150 million.

Product Liability

16. At this stage, due to the absence of data for product liability, no consideration has been given to the potential cost of recovery for this area. However data from CRU (see Table 2 below) suggests that the number of claims for product liability are likely to be very small (less than 4% using the numbers of claims in the "other" and "not known" categories in the CRU table below) compared to employer and public liability. This would suggest that recovery of NHS costs in this area would be far less significant than for employer and public liability.

Who is affected?

17. The person paying compensation or buying insurance against paying compensation is affected. The provisions are not restricted to payments made as the result of compulsory insurance but even so the majority of payments are likely to come through insurance companies which will therefore incur additional administration even if the actual costs are passed on to those buying insurance.

18. The figures shown below provided by the Compensation Recovery Unit (CRU) shows the number of accident claims by liability

Table 2: Accident claims by liability, 2001/02

Source: Compensation Recovery Unit

19. Industries with the highest risk of non-fatal injuries at work are: construction, transport and communications and manufacturing. Occupations in transport and construction along with food, drink and tobacco operatives are the 'riskiest' occupations in terms of reportable injury relative to all other occupations.

20. The pattern for public liability is very different. HSE data suggests that the sector responsible for the largest number of non-fatal accidents is education. This is likely to be mainly public sector. Other high accident sectors are wholesale and retail trade, transport and 'other community'. It should be stressed though that the claims for compensation may not match the pattern of accidents seen in the HSE statistics. Consequently the cost implication for industry, the public sector and insurers is difficult to assess.

Options

21. This is not a regulatory measure in the sense of one which is intended to adjust a system to work correctly through the imposition of rules. It has more in common with a non-regulatory economic instrument but does bring with it responsibilities for business. Those responsibilities are meeting the cost of the NHS treatment plus the administrative costs associated with payment. Four options were identified:

Option 1

Do nothing. This did not address the issue raised by the Law Commission that by providing healthcare free of charge the NHS in effect discharges part of a wrongdoer's liability.

Option 2

Withdraw NHS services when liability was accepted. This would not have reduced the costs of immediate/short term care to the NHS as liability for causing the injury would probably be unknown at that stage. At a later stage, it would place an equal or, more likely, greater burden on the compensator of having to pay for private sector treatment. It was not known if there would be sufficient capacity available outside the NHS to provide the needed treatment or whether people entitled to use the NHS would be willing to be transferred to the private sector.

Option 3

Improve health and safety regulation. This is already comprehensive in the UK and whilst continuous efforts are made to improve regulation it is unlikely that this would have reduced the burden to the NHS in either the short or medium term.

Option 4

Introduce, through primary legislation, the recovery of NHS charges following payment of compensation, with the intention that this is based on a simple tariff system of NHS charges with central collection by Compensation Recovery Unit (CRU).

Recommended: Option 4 and benefits

22. The intention is that CRU (who administer the current road traffic accident scheme) is used to administer the proposed scheme to recover NHS treatment and ambulance costs.

23. This option meets concerns expressed in the risk assessment. Those who are liable should not be subsidised by the taxpayer. It also reinforces the duty to prevent accidents happening. Accident victims are not being required to pay for their own treatment - those responsible for the accidents are being asked to refund the NHS and the taxpayer for the cost of the treatment of people injured as a result of their actions. Other benefits are that the money raised would be returned directly to the hospitals providing treatment and could therefore be used to provide better hospital services for all UK residents.

24. These benefits need to be offset by the costs to the Exchequer. There will be reduced tax receipts on business profits and in the future productive capacity of the economy. Businesses can pass the additional insurance and other costs on to consumers through price rises and so the impact on business profits is likely to be reduced. Even if the costs are not passed on, the reduction in taxation elsewhere that will result from these savings to the Exchequer may lead to increases in economic growth and tax receipts

Issues of equity and fairness

25. This measure is based on the legal arguments advanced by the Law Commission of avoiding unjust enrichment of those liable for causing accidents if they do not have to repay all the costs associated with their actions and it would have the effect of addressing a number of current inequities. Those being treated more fairly would be:

• the general population benefiting from improvements in health and safety;
• the taxpayer by not subsidising wrong doers;
• the NHS by not having to bear the cost of treating injuries caused by wrongdoers;
• UK residents by seeing income that is currently being denied being recouped and directed to improving health services

26. If insurers do not weight insurance premiums in favour of those with few or no accidents then this could create a situation of inequity whereby employers who take positive action to improve the health and safety of their employees are subsidising those that do not or are negligent. However this inequity would be created by insurance providers and would not be an inequity caused by this scheme. Firms and individuals would have the right to search for an insurer that would recognise their responsible attitude to heath and safety and thus offer them discounted premiums.

Contributory Negligence

27. It could be argued, as the Law Commission has done, that the liable party should only pay NHS costs in proportion to their liability. In the vast majority of cases however no exact apportionment of liability takes place. If one was required it would add to the bureaucracy of claims and would need to be verified and agreed. This additional cost and delaying factor across all claims might outweigh any perceived gains in respect of fairness. However, in an effort to address issues of equity and fairness, where there was a finding in a court of contributory negligence and an exact apportionment was decided which could be provided as proof of apportionment then the NHS costs would be reduced accordingly.

28. The current road traffic scheme does not take into account a reduction in recovery of NHS costs where there has been an apportionment of blame. As the new scheme would take account of contributory negligence where there was a court finding, the amount of NHS cost recovery would be reduced by an unknown factor. However, judicial statistics show that in 2001 there were 2,280 small claims and 7,480 trials involving a claim where someone receives compensation where contributory negligence was involved. In 2001/02 there were more than 200,000 claims against employers and public liability insurance. These figures therefore suggest therefore that a reduction for contributory negligence would be taken into account in less than 5% of claims.

Benefits

29. The benefits are: those causing accident and injury to others bearing the full cost of their wrongdoing resulting in:

• added impetus to potential compensators to prevent accidents happening and a likely reduction in such accidents;
• the relief to the taxpayer of subsidising those liable for causing accident or injury to others;
• preventing unjust enrichment of those liable for causing accidents an injury to others;
• the NHS not having to bear the cost of treating injuries that have been caused by wrongdoers;
• the money raised would be returned directly to the hospitals providing treatment and could therefore be used to provide better hospital services for all UK residents.

Quantifying and valuing the benefits

Option 1

Would have no benefit to the taxpayer or the NHS user but would relieve the liable party of the full costs of his or her actions.

Option 2

Would have some benefit to the taxpayer and the NHS but only where the accident victim was still receiving care after liability had been accepted.

Option 3

Would have a benefit for the taxpayer and the NHS only if it could result in tangible and identifiable falls in the rate of accidents.

Option 4

Would see liable parties meeting NHS costs around 140 - 150 million per year, over and above the current recoveries made following road traffic accidents.

30. This estimate is made using the tariff of charges developed for road traffic accident recovery. Whilst that tariff was based on the treatment profile of road traffic accident victims it acts as a useful proxy for trauma treatment in general. The recovery of costs will be limited to the amount of NHS treatment received from the date of accident to the date that compensation is paid to the individual. Because there is a ceiling of charges (currently set at 34,800) for the road traffic scheme which equates to about 59 days in-patient treatment) and, once a claim is settled no further costs can be recovered, the scheme will be cost limited, and will not, in most cases, encompass the costs of longer term rehabilitation. The average time from accident to payment of compensation is around 18 months and it will therefore be rare that a claim would settle before the ceiling of charges was reached. The recovery is also limited to a fixed amount in any one individual case. This option will support a reduction in workplace accidents if employers are forced to pay some of the health care costs of accidents they have caused.

Compliance costs for business

31. Of the options explored option 1 has no associated costs for those who cause accidents or insurers. The cost of NHS care would however continue to be met by the taxpayer including businesses. Option 2 would have minimal benefit and the administrative costs are likely to be significant. It is also questionable whether the accident victim could be deprived of his or her right to opt for NHS treatment. There are few identifiable benefits to option 3. Additional regulation would be required and result in variable costs across the business sector. There would be additional compliance costs for the public sector in implementing improvements in health and safety which would have to be met through the public purse. This leaves option 4 as the only option open to worthwhile compliance cost assessment.

Business sectors affected

32. Any business with potential liabilities for people who receive compensation as either an employer, a producer of goods or transacting business in a public place - in other words, essentially all businesses - will be affected. Insurance companies providing cover in these areas would also be affected by the administrative costs and by the need to apportion costs amongst holders of policies.

33. Businesses can pass the additional insurance and other costs on to consumers through price rises and so the impact on business profits is likely to be reduced. Even if the costs are not passed on, the reduction in taxation elsewhere that will result from these savings to the Exchequer may lead to increases in economic growth and tax receipts.

Compliance costs for a typical business

34. For businesses in general the costs would either be the direct costs of paying any NHS charges or the increases in any insurance premiums taken out to cover against these costs. These costs would be similar for any organisation paying a claim where people receive compensation. Other costs that businesses may incur as a result of the scheme are the costs of implementing improvements to health and safety procedures, which could result in changes to working practices and possibly the cost of fighting compensation claims longer and harder. However there will be many instances where the cost of fighting a claim harder in the courts will be higher than the actual NHS charges, which will deter firms from taking this action.

35. For insurance companies, as well as exposure to claims made against them in their own right, there will be additional costs of processing recoveries for those purchasing insurance. However as all claims where people receive compensation currently have to be notified to the Compensation Recovery Unit and all motor claims already attract additional questions about NHS treatment the additional administration to extend the NHS scheme to all claims will be relatively small.

36. The additional costs for insurers will comprise:

(i) the need to identify the hospital providing treatment in all cases when notifying claims to CRU;

(ii) alterations to IT and any forms to capture the additional data;

(iii) any retraining of staff required.

Of these (i) is a recurring cost, whereas (ii) and (iii) should be one-off costs.

Total compliance costs for insurers

37. Information obtained in 1998 as part of the regulatory appraisal accompanying the Road Traffic (NHS Charges) Act 1999 suggested that the work involved in identifying an NHS hospital added approximately 30 minutes to the handling time of an insurance claim - equivalent to a financial increase of 7 - 8% on then current processing costs.

38. Again, based on experience gained in the implementation of the Road Traffic (NHS Charges) Act, the one-off costs for IT and staff training are not expected to be high and insurers will already have administrative processes in place for the handling of road traffic claims and the scheme will just be an extension of that system, therefore training and other costs are not expected to be significant.

Impact on businesses other than insurers

39. Any business, large or small, which could be the subject of a claim against it for a claim where someone receives compensation - through, for example, its liability as an employer, or producer of goods or organiser of public events - may be affected by these proposals. Some, but not all, business liabilities are the subject of compulsory insurance s. Where insurance is not compulsory most responsible businesses will have obtained adequate cover through the voluntary purchase of insurance. Many combined insurance packages, for example contractor's all risk insurance, also include an element of public liability cover.

40. The Department of Health (and the Scottish Executive) is aware that there are currently difficulties with Employers' Liability Compulsory Insurance (ELCI) and that the Department for Work and Pensions has been leading on a review of this, the final report on which was published in early December 2003. The Department of Health took account the review of ELCI and, while not wanting to miss this opportunity to put recovery of NHS costs on the statute book as this would mean denying hospitals of this income well into the second half of the decade, agreed, along with the Scottish Executive, to delay commencement of the provisions until November 2004. (Subsequently it was agreed due to operational reasons that the introduction be delayed to 1 April 2005.) Introducing cost recovery will never be popular with those that have to pay and it is likely that there will never be a "good" time to proceed

41. As these costs directly relate to the provision of NHS treatment where there has been a payment of compensation an organisation with a good record of no, or few, claims against it might not expect to see its insurer pass on these costs without some weighting in their favour. The Department of Health has been discussing with the insurance industry what measures may be in place or are being planned to allow the pricing system to be fairer to firms with good health and safety records.

Impact on small businesses

42. The vast majority of businesses in the United Kingdom employ fewer than 50 people and are therefore classed as small businesses. More than two thirds of these small businesses are sole proprietorships and partnerships comprising only the self employed owner manager(s) and companies comprising only an employee director.

43. Evidence on the relative impact on small business suggests that accident rates are lower amongst smaller workplaces (under 50 employees). The exception is for fatal injuries where the rate is higher for smaller workplaces. There is also evidence that injury rates are lower for very large workplaces (over 500 employees). Thus, medium-sized businesses have the highest accident rates and will thus undergo the greatest impact.

44. Where a small business is run on a tight margin the impact of any increase in either compulsory or voluntary insurance premiums will be unwelcome. However the small business attracts responsibilities for the safety and well being of people who come into contact with it in just the same way as any other business and should be encouraged to both reduce that risk wherever possible and to make sensible and prudent provision for meeting the costs of any accidents should they nevertheless occur. The principal risk to small businesses is if the insurance sector does not make use of health and safety management information in setting premiums for smaller firms. A lack of variation in premiums would greatly reduce the incentives to reduce risk for such firms.

45. The type of risks to which such small companies are exposed are not changed by the proposed extension of NHS recovery and there should be no question of additional costs for revised risk assessments or other financial services.

Impact on charities and voluntary organisations

46. The impact of these proposals on charities and voluntary organisations would be exactly the same as for businesses and small businesses. If the charity or voluntary organisation made a payment of compensation (either directly or through the medium of an insurance policy) then they would also be required to repay (either directly or through the medium of an insurance policy) the costs of any associated NHS hospital treatment.

Other costs

Costs to Local Authorities and Government

47. It is intended that all compensators will be required to repay NHS costs so that the body responsible for the injury meets the full costs of reparation. The only potential exception will be an NHS hospital where it is both the compensator and provider of healthcare services. Local authorities and government bodies will therefore be subject to the same provisions as other businesses and will be required to repay NHS costs in relevant cases. Although there is an element of financial circularity in such an arrangement, repayment by all local and central government organisations ensures that money allocated to the NHS to provide a health service for everyone is not diverted to subsidise other parts of government

48. There are additional administrative costs for the Department of Health and the Scottish Executive in extending the recovery from road traffic to all accidents and injuries. Currently the Departments of Health in England, Scotland and Wales pay the Department for Work and Pensions 1.9m per year to recover 100m per year from the road traffic scheme. The Department of Health and the Scottish Executive are currently discussing the costs administering the extended scheme with the DWP and an estimate is expected shortly. NHS boards will also see the number of claims they must verify rise with a consequent impact on staff time. A scheme to introduce electronic communication between the Compensation Recovery Unit and all relevant NHS boards was completed in the summer of 2002. This has produced efficiency savings within CRU and within all NHS boards.

Costs to citizens

49. Private citizens are involved in compensation payments most often as a result of private use of a motor vehicle. In these cases insurance cover is compulsory and the recovery of NHS costs already takes place under the provisions of the Road Traffic (NHS Charges) Act 1999. In the much rarer event of a private citizen making some other form of compensation payment to a third party it is possible that that person may have insurance cover as part of their domestic, or if appropriate, travel insurance. However as the recovery of costs follows the payment of compensation, where a private citizen fails to make a payment of compensation then the recovery of NHS costs will not take place.

Competition Assessment

50. It is considered that options 1, 2 and 3 have no (or no appreciable) effects for competition. Option 4 is a wide-ranging policy proposal which would impact on all undertakings whose operations create a potential liability, to employees or third parties, in the event of an accident caused by those operations. Implementation of policy proposal number 4 would have consequences for the insurance market in raising levels of risk for which insurers provide cover, and also in raising administrative costs of handling claims. Such increases are, however, likely to be recouped by insurers through increased insurance premiums. No competition concerns arising out of the proposal were identified other than those currently being examined by the Office of Fair Trading in its study of the liability insurance market and consequently it is considered unnecessary to carry out a detailed competition assessment.

Summary of Outcome of Scottish Consultation (Autumn 2002)

51. Twenty responses were received by the Executive in response to the consultation. The majority of consultees supported the need for the scheme to be simple to administer, and that restricting recovery to hospital and ambulance costs was the most effective option. One respondee had concerns that in the case of injuries which require long-term out-patient treatment, the related costs could not be easily calculated and would not be recovered subsequent to an initial settlement. Two insurance companies had concerns - one over the legitimacy and value of including medical negligence within the scheme, and the other over the identification of injuries resulting from the accident when the victim does not immediately attend for treatment. One insurance company was also concerned that the scheme would be retrospective and asked for a period of warning before it was introduced.

52. Five respondees agreed that industrial illness should be included, but one of these remarked that there may be difficulty in recovering amounts due to longer term illness - since time, causation, contributory negligence etc may be difficult and potentially time-consuming to prove. This would lead to additional administrative costs, which may lead to long-term conditions not being pursued. Three respondees were against the inclusion of industrial illness. Amongst their reasons were the complexities of recovery in such cases, which would run contrary to the desire to keep the system simple and the long lasting nature of the illnesses. Whilst disagreeing with the inclusion of industrial illness within the scheme, one respondee suggested that the NHS has a right to recover costs from wrongdoers whose actions have resulted in industrial disease and that that is an area that could be explored in the future.

53. On contributory negligence, only 8 respondees stated an opinion. Of those, 3 respondees stated that contributory negligence should be taken into account. Another respondee agreed but qualified that by adding, in the absence of agreement by the court, it would be difficult to apportion liability and, in those cases, the practicalities would outweigh the principle. Three respondees stated that contributory negligence should not be taken into account in all cases. The primary concern of the Association of Personal Injury Lawyers (APIL) was that injured victims' damages should not be reduced or affected in any way by the extended recovery of NHS charges. The Association of British Insurers (ABI) felt that, as a matter of principle, the imposition of full cost recovery in contributory negligence cases would be inequitable and, as such, opposed it.

54. The full summary of outcome of the consultation can be found on the Executive's website at www.show.scot.nhs.uk/sehd/nhschargesconsultation.

Summary and recommendations

55. Option 4 is the recommended option. This option would:

• see liable parties meeting NHS costs in the region of 140 - 150 million per year, over and above the current recoveries made following road traffic accidents;
• prevent increases in accidents and injuries if wrongdoers are made to pay the full cost of their actions or negligence.
• relieve the taxpayer of the burden of subsidising those liable for causing accident and injury to others;
• stop unjust enrichment of those liable for causing accidents and injury to others;
• stop the NHS having to bear the cost of treating injuries that have been caused by wrongdoers;
• see the money raised returned directly to the hospitals providing treatment and could therefore be used to provide better hospital services for all UK residents.

³³. The Law Commission proposal was contained in consultation paper 144 and report no 262 both available from the Law Commission's website at www.lawcom.gov.uk