NICE and the NHS Litigation Authority

NHSLA Risk Management Standards

A key function of the NHS Litigation Authority (NHSLA) is to “contribute to the incentives for reducing the number of negligent or preventable incidents”. The NHSLA aims to achieve this through an extensive risk management programme. Most healthcare organisations are regularly assessed against the NHSLA Risk Management Standards, which have been developed to reflect issues arising in negligence claims reported to the NHSLA. In addition, maternity services are assessed against the Clinical Negligence Scheme for Trusts (CNST) Maternity Clinical Risk Management Standards.

Within the general Standards, one criterion relates specifically to how organisations utilise NICE guidance (Standard 5, Criterion 8: Best Practice - NICE). The criterion is worded slightly differently for ambulance trusts to take account of the wider guidance that also applies to these services:

• The organisation has an approved documented process for ensuring that agreed best practice as defined in NICE clinical guidelines and interventional procedures, is taken into account in the context of the clinical services provided by the organisation that is implemented and monitored. (Acute, community, mental health & learning disability and independent sector organisations).
• The organisation has an approved documented process for ensuring that agreed best practice as defined in Joint Royal Colleges Ambulance Liaison Committee (JRCALC) and NICE clinical guidelines, is taken into account in the context of the clinical services provided by the organisation that is implemented and monitored. (Ambulance trusts).

Assessment against the Standards occurs at one of three Levels. At Level 1, organisations are expected to have, as a minimum, approved documentation for responding to NICE guidance. At Level 2, the organisation is expected to demonstrate compliance with the objectives set out within the approved documentation described at Level 1. At Level 3, the organisation is expected to demonstrate that it is monitoring compliance with the minimum requirements contained within the approved documentation described at Level 1. Where monitoring has identified deficiencies, there must be evidence that recommendations and action plans have been developed and changes implemented accordingly.

The CNST Maternity Standards contain five broad Standards (organisation, clinical care, high risk conditions, communication, postnatal & newborn care), comprising 10 or 11 criteria within each. Rather than requiring an organisational level of assurance about implementation of NICE guidance in general, which is assessed as part of the assessment against the general Standards, the maternity Standards draw upon specific guidance and recommendations.

• More information on the NHSLA Risk Management Standards and Maternity Clinical Risk Management Standards

The NHSLA and NICE have jointly developed a model document template to help organisations set out a policy for the dissemination, implementation and monitoring of NICE guidance, which also highlights NICE Quality Standards and NHS Evidence as sources of good practice information.

• Download the template