Recommendation 91

Comply with NHS Litigation Authority risk management standards or an equivalent

Accepted in principle
The Department of Health and NHS Commissioning Board should consider what steps are necessary to require all NHS providers, whether or not they remain members or the NHS Litigation Authority scheme, to have and to comply with risk management standards at least as rigorous as those required by the NHS Litigation Authority.

We agree that the effectiveness of any national scheme of this kind to promote the improvement of risk management and any associated benefits for patient safety will be dependent on it continuing to have near universal coverage of providers. It is also accepted that the NHS Litigation Authority’s risk management standards and assessments have assisted in improving processes for risk management in the NHS. However, the existence of a risk management system, even one complying with the NHS Litigation Authority’s standards does not of itself mean that a trust is safe. There are many other factors that are relevant which should be considered when assessing whether practices are safe for staff and patients. The Government is clear that there should be fundamental standards that represent the basic requirements and that should be the core of all services. The new fundamental standards will sit within the legal requirements that providers of health and adult social care must meet to be registered with Care Quality Commission. Together with a new ratings systems, developed and published by the Care Quality Commission, providers will be assessed on how well they meet the standards for safe and high quality care.

All NHS Trusts and Foundation Trusts are currently members of the NHS Litigation Authority’s clinical negligence scheme. In addition, the number of independent providers funded to provide NHS health care joining the scheme, is increasing. The scheme is voluntary and there is no requirement for trusts that opt out to meet the NHS Litigation Authority’s standards,

As well as the inquiry, recent reviews led by Sir Bruce Keogh and Professor Dr Don Berwick, when considered with the views of the NHS Litigation Authority’s members, indicate that the time is right to move away from assessments against a set of risk management standards to a new outcome focussed approach. The new approach to safety and learning will support members to reduce claims by focussing on areas which cause significant harm and in working towards improving clinical outcomes. These changes will also seek to reduce bureaucracy and the burden on front line staff, and avoid duplication with other agencies.

This means that the NHS Litigation Authority risk management standards the inquiry refers to will be discontinued and the last assessment will be carried out in March 2014. Therefore, the Department considers it would not be appropriate to require any NHS provider leaving the scheme to have and to comply with the outgoing standards.

Update

The NHS Litigation Authority ceased their assessments of members’ compliance against their risk management standards from April 2014, reducing bureaucracy and the burden on front line staff and avoiding duplication with other agencies. Together with a new ratings system, developed and published by the Care Quality Commission, providers are now assessed by the Care Quality Commission on how well they meet the standards for safe and high quality care. The Care Quality Commission standards and inspection regimes apply across all registered providers of health and adult social care, and not only those organisations that are members of the NHS Litigation Authority’s clinical negligence indemnity scheme.