NICE and the NHS Litigation Authority
NHS LA Risk Management Standards
A key function of the NHS Litigation Authority (NHS LA) is to “contribute to the incentives for reducing the number of negligent or preventable incidents”. The NHS LA aims to achieve this through an extensive risk management programme. Most healthcare organisations are regularly assessed against the NHS LA Risk Management Standards, which have been developed to reflect issues arising in negligence claims reported to the NHS LA. 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 2, 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 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.
The NHS LA 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.
Update December 2012:
The NHS LA's current approach to risk management standards and assessments is being revised so that the standards are more focused on outcomes and the assessment process less burdensome for Trusts. The NHS LA is also looking at how it can better share knowledge and learning from claims to improve safety in the NHS.
In order to ensure the NHS LA gets the standards and assessment process right it requires time to consult with Trusts, and other key stakeholders, including NICE, and pilot some approaches to ensure that any revised approach works.
In the light of this, the NHS LA does not plan to carry out a full schedule of assessments in 2013/14 (i.e. from April 2013 to March 2014) and will only undertake assessments in the following circumstances:
- Where a Trust requests an assessment;
- Where a Trust has failed an assessmentin 2012/13 or where the NHSLA have a significant concern.
- Because maternity is a high risk area, the NHS LA will continue to assess Trusts at Level 2 or 3 in the CNST maternity standards that are due to be assessed.
In all other cases the NHS LA does not plan to assess Trusts, but will continue to give any discount for risk assessment levels payable as at 1 April 2013.
For clarity, the schedule of risk management assessments planned until 31 March 2013 will remain unchanged.
Further updates will appear on the NHS LA website as they become available.
This page was last updated: 02 July 2013