NHS Litigation Authority Improvement of risk management

Accepted in principle.
As in the response to recommendation 91, the NHS Litigation Authority will move away from assessments against a set of risk management standards to a new outcome focused approach. The new approach which 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.
The NHS Litigation Authority is not in a position to introduce requirements with regard to the observance of guidance in relation to staffing levels, or to require the assessment of appropriate skill mix, staffing level and staff patient ratios. It is for trusts (and where appropriate, regulators) to have regard to evidence based guidance and benchmarks and to undertake effective risk assessments when changes to numbers or skills of staff are under consideration.
However, the NHS Litigation Authority’s revised pricing methodology for setting member contributions for their indemnity cover takes account of staffing and activity levels. This mean that if all other factors are equal, organisations which have more staff to undertake activities with the same level of risk will pay less for their indemnity cover. It also ensures that organisations with fewer claims pay less for the indemnity cover, therefore rewarding safer organisations.

The Thirlwall Inquiry has noted action taken in response to this recommendation following the conclusion of the Inquiry.

The NHS Litigation Authority, now NHS Resolution (NHSR), adopts guidance from organisations, where relevant, on staffing and activity levels in higher risk areas. For example, as part of its requirements for Trusts to meet the relevant workforce safety actions as part of its Maternity Incentive Scheme, NHSR will consider input from the Anaesthesia Clinical Services Accreditation and the British Association of Perinatal Medicine. This scheme does not extend beyond maternity and perinatal care. NHSR also takes into account more general staffing guidance produced by NHS England in its risk assessment.

Safe Staffing

Evidence-based decision-making on safe and effective staffing is a requirement for all NHS organisations.

The National Quality Board sets out expectations for nursing and midwifery staffing to help NHS provider boards make local decisions that will deliver high-quality care for patients within the available staffing resource.

The NHS Standard Contract requires that providers ensure that there are sufficient appropriately registered, qualified and experienced medical, nursing and other clinical and non-clinical Staff to deliver services, and have regard to applicable staffing guidance (GC5). Service Specifications may set out further requirements around staffing levels.

Please see our response to recommendation 187 for related detail on the NHS Long-Term workforce plan.

From April 2013 the pricing approach for the Clinical Negligence Schemes for Trusts was changed to take greater account of claims paid and those in the process of being resolved. It also takes into account staffing and activity levels across higher risk service areas. The pricing approach rewards organisations with fewer less costly claims and thereby financially incentivises organisations to reduce their claims and thereby reduce harm and improve patient and staff safety.

This recommendation was accepted in principle by the Government.

In the January 2014 Hard Truths report, the Government said that the time was right to move away from assessment against risk management standards towards an outcome-focused approach. NHS Litigation Authority risk management standards were discontinued from April 2014 onwards. The Government said that the NHS Litigation Authority was not in a position to introduce requirements in relation to staffing levels, skill mix, or staff-patient ratios, which were instead a matter for trusts.

Nevertheless, the Government said the new pricing methodology implemented by the NHS Litigation Authority took into account staffing and activity levels across higher risk areas.