Healthcare indemnity regulation
Serious shortcomings identified in the regulation of indemnity products for healthcare professionals, leading to patient disadvantage.
Source spread
Where this theme appears
This theme appears across 9 independent accountability sources, so the source mix matters as much as the headline total.
4 inquiry recs
9 PFD reports
7 committee recs
3 CQC actions
2 PPO recs
1 IMB report
3 LGO/SPSO decisions
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: Pending In 2018, the government launched a consultation on appropriate clinical negligence cover for regulated healthcare professionals. This sought views on whether to change legislation to ensure that all regulated healthcare professionals in the UK …
Response Unclear
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: Accept in principle The government is clear that independent sector providers must take responsibility for the quality of care provided in their facilities, regardless of how the consultants are engaged. The Medical Practitioners Assurance Framework …
Accepted in part
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 concerned, it should make arrangements to ensure that these are to be applicable across the whole of the independent sector's workload (i.e. private, insured and NHS-funded) if independent sector …
Gov response: Do not accept – keep under review This recommendation, if implemented, would change the way in which independent sector providers qualify for NHS contracts. As demonstrated in our response to the other recommendations, independent sector …
Not accepted
Prevention of Future Deaths reports(9)
Derek Brierley
Concerns: The coroner identified gaps in Trust guidelines for competence and training for a suprapubic procedure. Concerns were also raised about the performing consultant's infrequent practice and the pre-procedure difficulty in locating necessary equipment.
Response (The Pennine Acute Hospitals NHS Trust): • The pathway for managing urinary retention has been re-drafted. • A training program for supra-pubic catheter insertion has been initiated. • The governance lead for urology will continue to … (AI summary)
Overdue
Rio Andrew
Concerns: The report identifies a lack of regulation for private companies providing medical assistance at events, where medical knowledge was poor and CQC oversight was insufficient. It also highlights the unregulated status of 'ambulance technicians' and the absence of mentor suitability checks by private training providers.
Response (Association of Ambulance NHS): • The Association of Ambulance Chief Executives (AACE) has previously raised concerns with the Care Quality Commission (CQC) regarding the regulation of private ambulance providers at events. • AACE supports … (AI summary)
Response (Department of Health): • The Department stated its intention to consult on whether permanent providers of medical services at temporary events should be brought into the scope of Care Quality Commission (CQC) regulation. … (AI summary)
Responded
Benjamin Orrill
Concerns: The coroner identified that there is no regulatory body for advanced nurse practitioners, meaning they are not subject to the same stringent appraisal and revalidation processes as GPs and some may operate without supervision. This lack of regulation could impact patient safety.
Response (NHS England): • NHS England stated that it expects general practices to complete an annual electronic general practice self-declaration (eDEC) to confirm that staff possess the necessary knowledge, experience, qualifications, and skills. … (AI summary)
Response (NMC): • The NMC provided a document summarising its statutory framework and information on advanced practice. • The NMC stated it would not be taking further action in response to the … (AI summary)
Responded
Peter O’Donnell
Concerns: The coroner noted missing formal agreements for independent consultant reviews and undocumented communication/escalation procedures. Concerns were also raised about a single resident medical officer providing 24/7 post-operative care without clear hospital oversight, and the absence of protocols for transferring unwell patients.
Response (Department of Health): • The Care Quality Commission (CQC) conducts inspections of independent hospitals, including reviews of patient risk, escalation, and transfer processes, and uses incident and inquest information for future inspection planning. … (AI summary)
Responded
Brian Rochell
Concerns: The coroner noted that concerns about an individual professional's capabilities should be referred to the relevant professional body by the employer promptly, as delays risk other patients.
Overdue
Michael Walton
Concerns: The unavailability of the surgeon's preferred cannula due to supply issues led to a shorter-tipped alternative being used. This cannula contributed to its dislodgement and Mr Walton's death, highlighting risks when equipment choice is restricted.
Response (NHS England): • NHS England engaged with Newcastle upon Tyne Hospitals NHS Foundation Trust regarding the concerns raised. • The Theatre Department at Newcastle upon Tyne Hospitals NHS Foundation Trust permanently suspended … (AI summary)
Response (Department of Health and Social Care): • Departmental officials made enquiries with NHS England, the Medicines and Healthcare products Regulatory Agency, and the Care Quality Commission. • The Department confirmed that the supply disruption of the … (AI summary)
Responded
Susan Pollitt
Concerns: The coroner identified gaps in the regulation of Physician Associates (PAs), noting the absence of a mandatory national framework for their training, supervision, and competency. The report also raises concerns about limited understanding of the PA role and a competency sign-off that omitted broader patient care aspects like consent.
Response (GMC): • The GMC confirmed that legislation for its regulation of Physician Associates (PAs) and Anaesthesia Associates (AAs) has received Royal Assent. • The GMC stated it will become the statutory … (AI summary)
Response (Royal College of Physicians): • The Royal College of Physicians (RCP) has called for a limit in the pace and scale of the roll-out of Physician Associates (PAs) and asked NHS England to review … (AI summary)
Response (Faculty of Physician Associates): • The Faculty of Physician Associates (FPA) has lobbied successive governments for the regulation of Physician Associates (PAs) and contributed to the General Medical Council's (GMC) consultation on how regulation … (AI summary)
Response (Department of Health and Social Care): • Legislation was approved in early 2024 for the General Medical Council (GMC) to regulate Physician Associates (PAs) and Anaesthesia Associates (AAs) from December 2024. • The GMC has published … (AI summary)
Responded
Chamali Bibi
Concerns: The coroner raises concerns that surgeons performing Periacetabular Osteotomy (PAO) procedures often engage in infrequent practice, and the voluntary specialist register does not flag these cases. Uncertainty exists if trusts recognise PAO as distinct.
Response (NHS England): • The report has been sent to regional colleagues in London as part of internal Regulation 28 assurance processes. • All Prevention of Future Deaths reports received are discussed by … (AI summary)
Responded
Joan Read Prevention of future deaths report
Concerns: The coroner noted that a single medical consultant is responsible for geriatric perioperative care without adequate cross-cover, creating a risk that urgent test results could be missed during their absence.
Response (Cardiff and Vale University Health Board): • Interim mitigations have been implemented for POPS consultant absence, including escalation of abnormal results to on-call medical teams and review by relevant specialty teams. • The standard operating procedure … (AI summary)
Responded
Select 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 …
Response attribution not verified
#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 …
Response attribution not verified
#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 …
Response attribution not verified
#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, …
Response attribution not verified
#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 …
Response attribution not verified
#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 …
Response attribution not verified
#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 …
Response attribution not verified
CQC inspection actions(3)
Salisbury District Hospital
Review the effectiveness of ongoing board oversight and monitoring of the NHS resolutions scheme.
Should Do
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.
Independent reviews(13)
Williams GNM Review — Rec 9.1
The PSA should review whether the outcome of fitness to practise procedures is affected by the availability of legal representation of registrants. This needs to be considered alongside broader proposals for the reform of professional regulation which seek to establish a less adversarial approach to fitness to practise issues through …
Health & Social Care
Williams GNM Review — Rec 7.2
The PSA should review the outcomes of fitness to practise cases relating to similar incidents and circumstances considered by different regulators. This review should seek to determine the extent and reasons for different fitness to practise outcomes in similar cases and, if appropriate, recommend changes to ensure greater consistency.
Health & Social Care
Williams GNM Review — Rec 6.1
The Professional Standards Authority (PSA) should retain its right to appeal a decision of a fitness to practise panel to the High Court on the grounds of insufficient public protection. The duplicate power provided to the General Medical Council (GMC) to appeal decisions of the MPTS to the High Court …
Health & Social Care
Keogh Cosmetic Interventions Review — Rec 40
In order to ensure that all patients are adequately protected, overseas surgeons operating in this country should have the same level of professional indemnity as UK-based surgeons.
Health & Social Care
Keogh Cosmetic Interventions Review — Rec 39
The insurance status of all practitioners should be displayed on the practitioner register.
Health & Social Care
Keogh Cosmetic Interventions Review — Rec 38
Patients' rights should be protected even when a provider goes out of business. Providers of cosmetic surgery must either enter a risk pool or have appropriate insurance/financial arrangements to provide treatment following certain complications. The NHS should be able to recoup costs for management of certain complications following cosmetic procedures …
Health & Social Care
Keogh Cosmetic Interventions Review — Rec 36
All individuals performing cosmetic procedures must possess adequate professional indemnity cover that is commensurate with the type of the operations being performed.
Health & Social Care
Keogh Cosmetic Interventions Review — Rec 8
Entry to the register should be subject to: • achievement of accredited qualification • premises meeting certain requirements • adherence to a code of practice that covers handling complaints and redress, insurance requirements, responsible advertising practice and consent practices • continued demonstration of competence through an annual appraisal.
Health & Social Care
Paterson Inquiry — Rec 10
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 the Inquiry, and introduce a nationwide safety net to ensure patients are not disadvantaged.
Health & Social Care
Williams GNM Review — Rec 7.3
We recommend that professional regulators ensure that the healthcare professionals they rely upon for an expert opinion in fitness to practise cases have satisfied the requirements set out in recommendation 2.1.
Health & Social Care
Williams GNM Review — Rec 5.3
Those professional regulators that have a power to require information from registrants for the purposes of fitness to practise procedures should have this power modified to exclude reflective material. Registrants will still be expected to co-operate with their regulator in line with their code of practice and to be open …
Health & Social Care
Williams GNM Review — Rec 5.2
Both prosecuting authorities and professional regulators have been clear that they would be unlikely to use a healthcare professional's reflective material either for a criminal investigation or in considering a registrant's fitness to practise. The professional regulators should clarify their approach to reflective material through guidance.
Health & Social Care
Paterson Inquiry — Rec 13
We recommend that the Government addresses, as a matter of urgency, this gap in responsibility and liability.
Health & Social Care
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