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MPL Liability Insurance Sector Report: 2023 Financial Results Analysis and 2024 Financial Outlook

Wednesday, May 22, 2024, 2:00 p.m. ET
Hear analysis and commentary on 2023 industry results and learn what to watch for in the sector in 2024, including an analysis of the key industry financial drivers.

MPL Association’s National Advocacy Initiative in Full Swing

The MPL Association is shifting its focus toward state policy makers with a new program—the National Advocacy Initiative. This comes at an important time for the MPL community as the deteriorating policy environment in the states is resulting in increasing attacks on established reforms.


International Perspective

Kayll Steers UK Medical Protection Society Through Indemnity Changes, COVID, and More

By Amy Buttell

As the chief executive officer of the UK Medical Protection Society (MPS), Simon Kayll is responsible for leading the organization to protect and support the professional interests of its members. With more than 300,000 members in the UK, Ireland, South Africa, New Zealand, Hong Kong, Singapore, Malaysia, Australia, the Caribbean, and Bermuda, the MPS is the world’s largest member-owned, not-for-profit healthcare provider protection organization.

During a distinguished 30-year career with MPS, Kayll initially served as chief accountant, before serving 13 years as finance director and becoming chief executive in 2012. He’s observed many significant events in the international medical professional liability (MPL) industry during that time and shared his insights with Inside Medical Liability as he prepares to retire.

IML: What trends have you seen in the MPL space during your career?

Kayll: One of the most obvious is a constant increase in frequency and severity in MPL claims. I think if I was to draw a line for them over the last 30 years, both have been consistently upwards, with a few pauses in the trajectory, but always on the increase. I would also say that severity has grown much more than frequency. The costs of claims are now much greater than they were. There are many, many drivers of this, but that’s probably the most significant trend, the consequence of this is affordability of indemnity for clinicians. We still offer an uncapped indemnity for our members. The cost of that has had to increase significantly as the frequency and severity has increased, and thus our members are finding it harder to afford. In the past, our subscriptions were a small proportion of our members’ income and they weren’t too questioning about the amount or annual changes. But now our subscription represents a much greater proportion of a member’s take home pay and they’re rightly and understandably much more demanding: why is it going up? Why is it costing so much? What do I get for it? What more can we expect from you when things go wrong?

I’m not complaining about this, and I think that’s what everyone would expect, no matter what they’re paying. But it adds to the pressure we’re under when it comes to making sure we can be open and transparent with our members about what is driving these trends in subscriptions—we call them subscriptions, rather than premiums, because we’re not an insurance company.

I think the other trend that we’ve seen is a move away from what I would call mutual pricing. When I first started there was relatively little differentiation between what we charged groups of clinicians. But increasingly, we have sought much greater differentiation in how we’ve priced, so we’ve taken more account of the different risk of different clinical specialties and about what our clinicians are doing. I think that’s partly because we’ve become more sophisticated, and partly because clinical activity is much more diverse than it used to be. Doctors are doing lots of different things, both clinical and nonclinical. Stuff that would have been extremely rare, like dentists doing Botox treatments are now common, and we have to accommodate all of this as a risk element.

IML: How are you helping clinicians grapple with this environment of increased risk?

Kayll: We’ve invested a lot in risk management education for our members. When I first started that was very, very modest, but now it’s a big part of what we do—not only how we engage with our members, but how we try and educate them about all the risks that they face. A lot of it is basic stuff: consent, record-keeping, communication with patients, and so forth. It’s not rocket science, but it still needs to be enforced because these basics have a considerable influence on the outcomes of negligence cases. As everybody in the industry knows, if you haven’t gotten it written down in your notes, it’s very hard to persuade a judge that it happened the way you said.

IML: What other trends are you observing?

Kayll: I think the other trend is a much greater level of regulation within healthcare. We’ve not only seen a lot of the traditional regulators up their game and increase their influence and involvement, but also we’ve seen, in the UK at least, additional regulators being introduced to various parts of the healthcare system for more accountability. I’m not saying that’s wrong but it’s just an increased burden for healthcare clients to cope with.

IML: What have been some of the most notable MPL events and trends during your career?

Kayll:  One of the most notable events is the state choosing to take on the indemnity responsibility for large chunks of doctors, which we have seen in a variety of jurisdictions where we operate. After taking responsibility for the indemnity for all public hospital doctors in 1990, the English and Welsh governments followed up with taking responsibility for the indemnity of the public work of all family doctors/GPs in April 2019. These were two very large parts of our business that moved from the private sector to the public sector.

In 2002 in Ireland, the government chose to indemnify those doctors working in public hospitals and doctors in private practice on the site of a public hospital. In both the UK and Ireland, that action was prompted by the government’s concern that the indemnity was becoming too expensive and doctors couldn’t afford it, which might have an impact on clinical expenses. The final example we have is that of Singapore in 2017, where again the government chose to take on the indemnity for doctors in public hospitals, which was previously part of our business. So, we’ve experienced these shocks in the last 30 to 40 years across our business, but I’m pleased to say we have taken them in our stride.

Also, as part of the English and Welsh governments taking on the prospective risk of GPs as of April 2019, they also sought to take on their historical risk. So, we needed to negotiate with the government about whether we would pass over some assets to them to take over that liability. That was a quite long and complicated process. We came to an agreement, and we passed over those effective liabilities from April 2019. That was quite significant.

IML: What is the state of regulation of protective societies in your jurisdictions?

Kayll:  MPS is not regulated in any of the jurisdictions in which we operate. There were several times when we might have been regulated over the years. The most recent was in 2018, when the UK government issued a consultation as to whether the provision of clinical negligence indemnity should be regulated. That consultation is still ongoing, but we’re hopeful that the government might be willing to consider alternatives to regulation. We don’t believe that regulation would be in the best interest of our members. We’ve also had discussions with South African regulators over the years about MPS’ regulatory status, and I’m pleased to say that we continue to be unregulated in all the countries where we operate, having proven to the satisfaction of regulators that this is the appropriate status for us. Personally, I think it is very beneficial to our membership, and I’m hopeful it will continue.

IML: What issues are you most concerned about today as you prepare to retire?

Kayll:  One of the universal issues in countries where MPS operates is the clinical workforce. It doesn’t matter if you’re in Hong Kong, the UK, Ireland, South Africa, or New Zealand, there isn’t enough clinical resources for the healthcare needs. Many countries are trying to source clinical staff from a lower-income country, but there are obviously social consequences around the globe for that. The major concern for us regarding a lack of clinical resources is the impact on patient safety and the clinical negligence consequences. We see healthcare systems that are under a huge amount of demand from their normal workload, let alone any COVID backlog. But they don’t have the clinical resources to meet the demand.

IML: How does this impact patient safety?

Kayll:  It definitely does, because it means those clinicians we do have are being forced to work harder and longer hours. All of this adds up to a greater potential risk of clinical negligence. At the MPS, we are concerned not just about clinical negligence, but also professional protection. We help our members with lots of things arising out of their professional practices other than negligence claims: reports to the regulator, attending a coroner’s or fatal accident inquiry if a patient has died, all these types of things will also increase and thus there will be more members’ demand for support. You can see that this greater pressure can drive people out of healthcare. At a certain point they’ll say, I’ll just go and do something else, I don’t need this stress. So, it seems like a bit of a downward spiral.

IML: This leads to the bigger question, which is how to do you balance the compensation for individuals who have been harmed with what’s affordable to society?

Kayll: We see cases in the UK and elsewhere where plaintiffs are getting compensation of £20 to £30 million. Of course, if you’re that individual, you believe you deserve it. You’ve been harmed, it’s not your fault, you’ve got complex healthcare needs for the rest of your life, but this has to be paid by somebody, and that somebody is society, whether the healthcare system is private or public. There must be a tipping point where it is unaffordable for the wider society to make large compensation packages to a small number of harmed individuals. It’s not a pleasant concept to think about, but we can’t go on like this forever. If we do the system will break, as we saw in the US during the 1970s, and no one will be able to get healthcare, because doctors will say they can’t afford to be insured or indemnified, and withdraw from clinical practice, which is obviously very harmful to society.

IML: Do you have thoughts about artificial intelligence and its impact on healthcare?

Kayll: It’s both a risk and an opportunity, so we shouldn’t only look at the downside, but it’s unknown how it will shake out at the moment. If I was to look at the implications for my colleagues as they continue the business after I retire, it’s going to be an ever-increasing issue for them to understand AI’s impact on clinical care, its impact on negligence, but also its impact on us as we run our business. How do we use AI and make the most of it? How do we use it and not disenfranchise our colleagues? Because we still need people, we’re always going to need people, but they have to learn to work with AI as it develops. I don’t know what it’ll look like, but that’s a concern for my colleagues who do stay.

IML: What have been your major accomplishments during your career?

Kayll: I’m pleased to say that I leave MPS in a much stronger financial position than it was when I took over as CEO. During those 12 years we’ve built and reshaped the organization to meet our members’ changing needs, and that’s not just a one-off but something that will continue. I’m also very pleased about our net promoter score. When I took over, I think our score was in the high 20s, as I leave it’s 52. We’ve had a similar increase in our colleague engagement scores over the past 12 years, which hit the peak of 88% two years ago. We’ve created the MPS Foundation, which is quite nice. We decided that we would take some of the subscription fees our members paid to us and use it to fund research into patient safety initiatives and clinician well-being. It’s only in its second year now, so it’s very new, but I think it has the potential to deliver a lot of value back to our members. It’s too soon yet to see much of the benefit since it takes a while to research and publish and then for us to work out how to use its value, but I’m quite proud that we launched that through the latter stages of COVID.

IML: What advice would you give to peers about the industry?

Kayll: First, MPS as a membership organization is all about the members. Yes, we are financially strong. Yes, we’ve got to write business that covers our costs, but we can’t forget that we’re a membership organization. Our members pay us the money that we use to run MPS, and we have to be there for them and run the business absolutely for their needs and requirements. I hope that the strong member focus I’ve tried to engender over my time can continue with my colleagues once I’m gone.

Second, at the moment, the clinician is still the one held to account. The delivery of healthcare takes place through a system that’s getting more and more complex with the introduction of AI and so on, yet it’s still an individual who’s held to account at the very end of that. I think we need to start drawing this out to the regulators, the legislators, and the negligence community whether it’s still appropriate that one individual is being held to account for something. Yes, they may have had a part in it, but it’s unlikely that they are the sole problem, and the rest of the system doesn’t get the same level of scrutiny as the clinician. That’s something which will be increasingly significant in the future and I’m not sure I see many people addressing it. I think since we’re really struggling to attract and retain clinicians, this sort of thing is likely to make them question more and more whether they wish to pursue or continue a career in medicine. Why should they bother? That’s some of the points I would highlight to those who continue after me in the MPL industry.

IML: Finally, what are you grateful for?

Kayll: I’m grateful for my good health, so far, at least. I’m grateful for a supportive wife who has enabled me to work and travel without my family suffering, because she’s been there to hold down the fort. I’m grateful to the people who placed their faith in me by putting me in the positions I’ve had, and I’m grateful to the people I’ve worked with. I think work is all about relationships. It’s only in teams and as groups that you get things done. Working with good people, inspiring people, entertaining people is crucial. I’m very fortunate that I’ve had the opportunity to work with some great people, and I’m grateful for that.


Amy Buttell is Editor of Inside Medical Liability Online.
“One of the universal issues in countries where MPS operates is the clinical workforce. The major concern for us regarding a lack of clinical resources is the impact on patient safety and the clinical negligence consequences.

We see healthcare systems that are under a huge amount of demand from their normal workload, let alone any COVID backlog. But they don’t have the clinical resources to meet the demand."