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Claims Toolkit

This Event Toolkit supports logging and management of clinical/care and non‑clinical claims (including property and liability). It provides a structured, auditable record for investigations, evidence gathering, legal liaison and learning, enabling collaborative review and resolution while supporting regulatory and governance requirements.

Overview

The Claims Toolkit enables organisations to:

• Record claim type (clinical negligence, property, liability), claimant details and relationships to the resident.
• Link claims to incident events, safeguarding activity and duty of candour actions.
• Store legal contacts (solicitor), financial data (estimated/actual costs) and supporting documents.
• Track investigation workflow, owners, review outcomes and lessons learned.
• Provide dashboards and reports for governance, external bodies and legal teams.

Legislative Requirements

• Care Act 2014 — where a clinical claim arises from an incident, record directorate/department involvement, incident details, safeguarding flags (including whether resident is deceased) and learning outcomes to support transparency, review and inspection readiness.
• Mental Capacity Act 2005 — capture claimant relationship and representation; document capacity considerations and best‑interests processes where relevant; record decisions, reflections and lessons learned.
• Data Protection Act 2018 / UK GDPR — claims contain personal and special category health data (Articles 6 & 9). Restrict access to authorised staff, use secure document upload/storage and document lawful bases for processing and sharing.

Regulatory Guidance

Toolkit fields align with expectations from UK regulators:

• CQC (England) — person‑centred records (resident and claimant data), consent and solicitor fields; duty of candour prompts; evidence of learning and governance; safeguarding integration and incident tracking that inform KLOEs (Safe, Effective, Caring, Responsive, Well‑led).
• Care Inspectorate (Scotland) — responsive documentation, wellbeing and lessons learned that support service improvement and inspection evidence.
• CIW (Wales) — legal and financial fields to demonstrate compliance, incident tracking and safeguarding outcomes aligned to National Minimum Standards.

Statutory Guidance

• Duty of Candour — prompts and record fields for disclosures, statutory declarations and communication with the person/representatives.
• Safeguarding — integration with safeguarding workflows, capacity to record referrals, notifications and multi‑agency actions.
• Records retention and audit trails to meet statutory, regulatory and legal obligations.

Health care Guidance

• Records Management Code of Practice (DHSC / Scotland / Wales) — supports structured capture of legal/professional obligations, metadata, retention and disposal rules; include incident documentation, financials, and learning outcomes.
• NICE / SIGN — clinical guideline references to assess standard of care; capture deviations from guidance as part of investigation evidence.

Evidence Based Practice

Claims investigations rely on objective evidence to determine whether care met accepted standards. The toolkit supports:

• Linking clinical records, guidelines (NICE/SIGN), investigation notes and expert opinions to build a defensible timeline.
• Documenting attempts to follow best practice and reasons where deviations occurred.
• Recording learning actions and measurable improvement plans informed by evidence.

Toolkit Statistics

• NHS Resolution (2024/25): 14,428 new clinical negligence claims (up 4.7%); 13,329 claims resolved (slight decrease); £3.1bn compensation paid in 2024/25.
• High‑value cases (≥£1m) remain a small proportion of claims but account for the majority of costs.
• Social care: rising demand for adult social care increases exposure to claims; record volumes and financials where available for local oversight.

Clinical governance and Safety (NHS)

• Use claims data to feed patient safety systems: identify contributory factors, trend analysis and thematic learning (PSIRF alignment).
• Risk stratification to prioritise high‑risk residents, services or practices and to focus prevention activity.
• Link incidents and claims to improvement plans, training needs and governance dashboards to reduce recurrence and support defensibility.

Using the Toolkit — Practical Steps

1. Create a Claim Event — record claimant, resident (if applicable), claim type, date of event, and link to original incident/safeguarding event.
2. Attach Legal & Clinical Documents — upload incident reports, medical records, photographs, correspondence, solicitor details and legal notices; maintain access controls.
3. Log Investigation Tasks — assign owners (clinical lead, legal, governance), set deadlines, record interim findings and expert opinions.
4. Record Duty of Candour Actions — document disclosures, offers of remedy, communications and timestamps.
5. Capture Financials — estimate exposure (budgeted vs actual), record reserves, invoices and settlement details.
6. Document Outcomes & Learning — record closure decisions, lessons learned, policy changes and training actions; link to governance evidence.
7. Escalate High‑Risk Cases — flag to senior leadership, insurers and external regulators where required.

Templates & Data Fields (recommended)

• Claim reference, claim type and status
• Resident details (if applicable), claimant name and relationship, solicitor/claimant contact
• Linked incident/safeguarding event references, date/time and location
• Summary of allegation, clinical/legal issues and relevant guidelines (NICE/SIGN)
• Investigation log, owners, deadlines and actions
• Document uploads (clinical records, correspondence, photos, legal notices)
• Duty of candour record, communications log and consent/legal bases for sharing
• Financials: estimated liability, reserves, actual costs, payment details
• Outcome, lessons learned, action owner and review date
• Access control, data sensitivity flag and retention metadata

Monitoring, Audit and Reporting

• Maintain a claims register to monitor open cases, ageing, and financial exposure.
• Dashboards for trends by service, incident type, department and cost impact.
• Audit completeness of evidence, timeliness of responses, and duty of candour compliance.
• Extract reports for board papers, insurers, regulators and legal teams.

Value Proposition

• Meets statutory, regulatory and records‑management expectations for claims handling.
• Captures both clinical and non‑clinical claims in a single structured workflow.
• Supports investigation, legal liaison, financial tracking and governance oversight.
• Enables learning from claims to prevent avoidable harm and improve care quality; supports dashboard insight (budgeted vs actual claim costs).

References

• Care Act 2014
• Mental Capacity Act 2005
• Data Protection Act 2018 / UK GDPR
• Duty of Candour statutory guidance
• Records Management Code of Practice (DHSC / Scotland / Wales)
• NICE Guidelines; SIGN Guidelines
• NHS Resolution annual reports
• NHS Patient Safety Incident Response Framework (PSIRF)

Disclaimer

Radar Healthcare provides configuration templates and implementation guidance to support effective use of the platform. Any data protection, legal or regulatory examples are for general guidance only and do not constitute legal, clinical or compliance advice. Radar Healthcare acts as a data processor under customer instruction. The customer, as data controller, remains responsible for assessing and managing data protection risks, determining lawful processing, and ensuring compliance with applicable regulations.