NHS Resolution – Board meeting (Part 1) Wednesday 11th September 2019 10:00 – 16.00 Venue: Thomas House, 84 Eccleston Square, London SW1V 1LP
Agenda
Note Item Time Description Review Presenter Approval 1 10.00 Administrative Matters 1.1 Chair’s opening remarks and apologies Note Chair 1.2 Declaration of conflicts of Interest of Members Note Chair 1.3 Minutes of Board Meeting held on 17th July 2019 Approval Chair 1.4 Review of actions from Board meetings Note Chair 2 Operational Items Note Chief 2.1 10.15 Chief Executive’s report Executive Note Chief 2.2 10.30 Performance review Executive Management proposals requiring Board input or 3 approval 3.1 No items to consider 4 Liaison with key stakeholders 4.1 10.45 MSE Report Note DoSE 5 Key Developments 5.1 No items to consider 6 Oversight of key projects 10.55 One year on - evaluation of our publication ‘learning from Note 6.1 DoS&L suicide related claims’ 7 Board Committee Reports and Minutes 7.1 No items to consider 8 Other matters requiring Board approval
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8.1 11.05 Responsible Officer Annual Report Approval DoPPA 9 Any Other Business 9.1 11.15 10 Date and Venue for next meeting Wednesday 13th November 2019 at 10.00am – venue to be 10.1 confirmed 11.20 BREAK
Key
Note for information Presented to the Board for review, comment and agreement Presented to the Board for a decision where this is reserved to the Board or to provide approval
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Board meeting minutes (Part 1) 17th July 2019 10:00 – 15:30 Venue: Room G-01, Ground Floor, 151 Buckingham Palace Road, London SW1W 9SZ
Present Ian Dilks Chair Keith Edmonds Non-Executive Director Mike Pinkerton Non-Executive Director Charlotte Moar Non-Executive Director Nigel Trout Non-Executive Director Mike Durkin Non-Executive Director (Associate Board Member) Helen Vernon Chief Executive Denise Chaffer Director of Safety & Learning Vicky Voller Director of Practitioner Performance Advice John Mead Technical Claims Director (Associate Board Member) In attendance Simon Hammond Director of Claims Management Cheryl Lynch Representative of DHSC Sponsor Team Nick Rigg Corporate Communications Lead Laura Yearsley Deputy Director of Policy and Strategy Sara Pollock Deputy Director of Finance and Planning Tinku Mitra Head of Information Governance Julia Wellard Executive Personal Assistant (Minutes) Apologies Sam Everington Non-Executive Director (Associate Board Member) Joanne Evans Director of Finance & Corporate Planning
1 Administrative matters
1.1 Chair’s opening remarks and apologies
The Chair opened the meeting by welcoming everyone.
Apologies for absence were received from Sam Everington and Joanne Evans.
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1.2 Declaration of conflicts of interest of members There were no conflicts of interest to note.
1.3 Minutes of Board Meeting held on 22nd May 2019 The minutes of the Board meeting held on Wednesday 22nd May 2019 were APPROVED and a copy signed by the Chair.
1.4 Review of actions from Board meetings The actions from the last Board meeting were noted and the closed actions removed.
The following actions were rolled forward: Learning from suicide related claims: A thematic review of NHS Resolution data – Director of Safety and Learning to bring a report back to Board in 6-9 months on what has happened since the report was launched – action due September 2019. Board Effectiveness Review - Chair and Chief Executive to review the actions from the review with a proposal to be brought back to Board for discussion before the end of the year. This will be on the agenda for the Board awayday in October and as necessary brought to the November 2019 Board meeting.
There following actions were closed. CNSGP – Director of Membership and Stakeholder Engagement to make contact with the RCGP to suggest a speaking slot or workshop at their annual conference. Contact was made but the RCGP conference programme has already been set.
2 Operational items
2.1 Chief Executive’s Report Annual Report and Accounts 2018/19 The Annual Report and Accounts 2018/19 were laid before Parliament on Thursday 11th July alongside other DHSC key health bodies. A copy of the report is available on our website together with an article. There has been some press interest, in particular we received correspondence from The Times which we are responding to. Our newsletter, Resolution Matters, was distributed this week which also headlined the Annual Report and Accounts.
Discount rate On Monday 16th July the Lord Chancellor announced that the discount rate used to calculate compensation for personal injuries will change to minus 0.25% from minus 0.75% from 5 August 2019 and be reviewed within five years. The discount rate, which determines the lump sum victims of accidents should be compensated with, corresponds to the net return the victims should expect from their investment. The rate takes into account returns available to investors and investments made, allowances for tax, inflation and investment management costs, as well as wider economic factors. A lower Odgen rate requires insurers to make larger lump sum payments on personal injury claims, as it assumes lower annual investment returns for that amount.
The Board noted the Chief Executive’s Report.
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2.2 Performance review The performance review detailing financial performance and key performance indicators for the period under review was presented. The data which support the measurement of our performance in relation to claims management are commercially sensitive and disclosure could adversely impact our ability to manage claims effectively. Consequently, whilst claims activity is reported in Part 1, claims KPIs are reported and monitored in the Part 2 private Board session.
Finance Performance The summary financial report to the end of May 2019 together with an updated position at the end of June 2019 was presented. In terms of the Departmental Expenditure Limit (DEL) budgets, the year to date net expenditure on all budgets is £64m overspent. We are still however waiting to hear on the budget for PIDR costs noting that the rate has recently changed from -0.75% to -0.25% which will take effect from 5th August. Indemnity scheme budgets, excluding the PIDR impact, are overspent against budget by £20m and year to date expenditure across all schemes in relation to PIDR is £45m. The new CNSGP scheme will be included in future performance reports but to date there has been no expenditure for the scheme.
In terms of Annually Managed Expenditure (AME), a budget of £8.4bn has been agreed for this year and work on updating the 2019/20 AME forecasts and the assumptions underpinning them is to be carried out over the coming months.
As mentioned earlier, the Annual Report and Accounts were laid last week. The Finance team are working through the lessons learned on the process which will be fed back to the Audit and Risk Committee meeting in October.
In terms of performance relating to the number of invoices paid within 30 days, this continues to remain below target (95%) at 81%. It is expected that achievement will improve considerably once the new finance system is in place.
Claims Performance In terms of the open book (number of open claims under all schemes), for the three principal indemnity schemes for the financial year up to 31st May, numbers of claims and incident reports received for CNST, LTPS and CNSGP are 1,879, 636 and 8 respectively compared with 1,882, 628 and 0 in the same period in 2018/19 indicating that claims volumes appear to be static with little variance when considering overall averages and little movement in claims numbers in the entirety. Specialties and profiles of claims also appear to be static with the previous reporting period in 2018/19.
It was noted that it will be some time before we can report on the profile of specialties or patterns for the new CNSGP scheme but the number of claims and incident reports received will be provided.
Practitioner Performance Advice An update on the advice requested by sector and professional group at 31st May 2019 was presented. The Advice service is reviewing the five month trend in detail as recent figures have seen a further decrease of 17% in new cases referred. The Advice team are exploring possible reasons and initial analysis indicates that this could relate to a number of issues including change in case adviser allocations to individual organisations, primary care reorganisation and decrease in awareness of Advice
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services. In addition, following the reorganisation of NHS England and NHS Improvement moving to align their operations, NHS England’s operating model has moved from delivery through 14 local offices to seven regional local teams. Responsibility for contracting and managing the delivery of primary medical care has currently been delegated to CCGs and it is considered that these changes will also have an impact on the number of cases referred to the Advice service. We will be looking to establish partnership working on these issues with the relevant senior contacts at NHS England / Improvement and a meeting will be arranged in order to brief E/I on the work the Advice service provides.
Primary Care Appeals All KPIs for the reporting period have been fully met save for the KPI for the percentage of appeals where Decision Maker agreed with recommendation of Case Manager. This related to there being a low volume of cases through Committee during the period meaning figures were skewed. There were only two cases where the Committee did not agree with the Case Manager: one case involved the Appeal Committee referring the appeal to a hearing rather than considering it on the papers, and one case involved the Appeal Committee allowing the appeal after receiving advice from the pharmacy member.
Safety and Learning All KPIs have been fully met for the year to date. There has been a lot of activity by the Safety and Learning team in a short period of time and thought needs to be given to the demand on resources. A number of national conferences have been held and there is a continued demand for these events to be repeated which are extremely resource intensive and we will need to think about this going forward so that it can be fed into business planning. We are now beginning to capture speakers on film which we can use through webinars or remotely., However, feedback has indicated that clinicians across different specialties value coming together to share experiences and learning as being the most effective format.
We will be looking to work with other organisations to run events on a joint basis in order to share resources, funding and facilities. In particular, the GMC were involved in our consent conference in terms of looking at how junior doctors are currently dealing with consent and following a recent meeting with the GMC, it was interesting to see how our strategies are aligned.
The Board noted the performance report for the Finance, Claims, Practitioner Performance Advice, Safety and Learning and Primary Care Appeals functions.
2.3 HR&OD Report Michael Humphris, Head of HR and OD, attended the meeting to present the HR and OD report which provides information on the organisation’s key workforce indicators, equalities characteristics and the HR and OD activities for the period June 2018 to May 2019.
Key activities of note were:
High Level Objectives – the HR&OD objectives were presented together with key activities and next steps to be taken for each objective. The HR&OD function are procuring a payroll provider from September 2019. The previous payroll provider was
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procured through DHSC, however DHSC are no longer involved in this process. In the meantime, we have secured a six month extension with the current provider to the end of the financial year. It was considered whether the potential change in payroll provider, being a core change in system, should have been reported to the ARC so that it is included on the strategic risk register and the Head of HR confirmed that this is included on the HR&OD risk register. It should be noted that there will not be a change to the system and rather that any new provider will be given access to our system.
Establishment - The number of staff in post has risen by a further 13.4 FTE since October and turnover has remained consistent at around 11% despite an increase in headcount over the last year.
Agency Workers – There has been a slight increase with a total of 52 agency workers engaged during the reporting period which is mainly as a result of a rise in activity within the IT and Facilities department and Corporate Governance where vacancies have been covered pending permanent recruitment to the roles. The length of agency worker assignments remains positive and most are on a six month threshold with those beyond this turning into substantive offers or fixed term contracts. All agency activities continue to be monitored through the Workforce Strategy Group on a case by case basis to ensure that we are not extending them unnecessarily.
Leavers and Recruitment – Reports for leavers are broken down by non-voluntary and voluntary showing that by excluding non-voluntary leavers, the turnover rate is 8.7%. Leavers are from across the organisation and there are no trends or patterns that we are concerned about.
Absence – sickness absence for the reporting period has been relatively low with a slight increase noted throughout November 2018 through to February 2019 and we are now able to report this on a rolling 12 month basis. Despite the increase, the organisation overall continues to report below the national average rate which is extremely positive.
There continues to be a large proportion of sickness attributed to anxiety, stress, depression and other psychiatric illnesses. However this relates to a total of 15 individual employees, six of whom have since left the organisation which made up over 34% of the total days lost. Four of the other cases related to bereavements whilst others related to both workplace and personal matters. All the absences relating to anxiety, stress, depression and other psychiatric illnesses are continually monitored, in terms of being managed and supported. The capturing of absence sub categories will be included in the new contracted payroll provision which is due to change from September 2019 onwards.
Employee Relations - Since the last reporting period, there have been five new employee relations cases which relate to absences and dignity at work issues and are being managed to resolution in a timely manner and where possible on an informal basis. The outstanding Employment Tribunal (ET) case hearing which commenced in April 2018 was concluded in June 2019.
HR and OD Supportive Activities - The HR&OD team continue to implement and deliver a number of workstreams to support the delivery of the Workforce and Organisational Development Strategy. In particular we now have an apprenticeship scheme in place
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and we are arranging a number of apprenticeships within the claims function in terms of establishing a pathway to develop in the claims area. The proposal is to have a rolling programme of apprenticeships which will also feed into succession planning. This means that we are now utilising our apprenticeship levy which we had not been doing previously.
Appraisals – annual appraisals are underway and statistics on completion rates, approximately at 57%, are reported regularly to the Senior Management Team. We are already three months into the cycle and the Board considered they needed assurance that they were being completed and that we should be more towards the 90% mark. It was pointed out that most appraisals had been completed and that it was mainly the paperwork which was a factor due to workloads and this needs to be reflected on for next year in terms of there being a process confirming that the appraisal has happened, followed by compliance with the paperwork and objectives.
Mandatory and Statutory Training – There are seven Mandatory and Statutory Training (MAST) courses with which all staff are required to comply, with Non-Executive Directors (NEDs) required to complete the information governance and equality and diversity training. MAST compliance has remained consistently high since the last reporting period with all categories, except fraud and bribery awareness, being over 90% compliant which is a significant improvement from 12 months ago. Fraud and bribery awareness training was introduced in 2018 with all staff attending a session with our LCFS and is also now included as part of the corporate induction programme. The annual renewal is already currently being rolled out with a number of sessions already run and planned. We are looking at how we can increase compliance on this training and the HR&OD team are looking at introducing an e-learning package.
Equality and Diversity - Our organisational profile as at 31st May 2019 remains unchanged and shows we are closely aligned to the regional figures of 60% white and 40% BME at 64% and 35% respectively, with a slight underrepresentation within the BAME categories. An equality, diversity and inclusion session was held with the Senior Management Team and other key stakeholders from across the organisation which explored the information and associated recommendations from the race equality report and what it means for the organisation. As a result of the session, we have committed to voluntarily publishing our workforce race equality data. We have also, as part of our Race at Work charter, committed to have an executive sponsor who is the Director of Finance and Corporate Planning. The HR&OD team are working on mapping an equality, diversity and inclusion agenda for the next three years.
The Head of HR&OD was thanked for the report.
The Chair reported that following the letter received about the Lord Holmes of Richmond Review into why so few disabled people apply for public appointments and fewer still make it through to appointment, discussed previously, he had responded as agreed. The Chair has received a constructive response which will go into the reading room. Action: Chair The Board noted the HR and OD report.
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2.4 Complaints Report A comparative summary of the complaints activity received for Q1 to Q4 for the past three years detailing numbers of complaints received during the year, performance in responding to complaints, and learning points and areas to be taken forward was presented.
Key points of note are that there has been a small decrease in complaints logged as part of the formal complaints process notified through the policy. The claims function remains the subject of the largest number of complaints but this is also in the context of the significant volume of activity. There were a small number of complaints where the outcome was partially or totally upheld and very few go on to Stage two which involves the Chair.
The largest number of complaints relate to claims and in particular claimants who remain dissatisfied with the outcome of their claim and we are exploring further work to consider how we might address this as the procedure is not designed to manage disputes in relation to the outcome of claims.
There is also pressure on staff in dealing with challenging behaviours from complainants and we are looking at providing support and training for staff.
It is uncertain whether we will need a different procedure for CNSGP. We have received information from the MDOs in relation to their complaints processes which we will be able to build into our own complaints policy which is shortly to be reviewed. It was noted that the Corporate Governance team will need dedicated resource to deal with complaints going forward.
The Board noted the Complaints Report.
3 Management proposals requiring Board input or approval
3.1 There were no items to consider.
4 Liaison with Key Stakeholders
4.1 Communications and Stakeholder Engagement Report
An update on recent communications and stakeholder engagement was presented detailing key activity relating to proactive/reactive media management, issues management, digital communications, stakeholder engagement and events across NHS Resolution.
The Membership and Stakeholder Engagement (MSE) team have had a busy period with the publication of the Annual Report and Accounts for 2018/19 as well as Resolution Matters, and publication of our Being Fair report which supports a just and learning culture for staff and patients following incidents in the NHS. The team have also supported the Getting it Right First Time (GIRFT) programme in distributing data packs.
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CNSGP remains the highest volume of page views on the website following the launch of the scheme which is good in terms of people looking at the scope of coverage and it is expected that this trend will continue.
The Being Fair report was launched at this year’s Patient Safety Congress which was a good opportunity as the conference is a large event with high attendance. The document was a product of the Faculty of Learning and aims to support staff, patients and their families at the point of incident which was very much a theme of the whole conference. The report has also had support from AvMA. The real challenge will be to focus on what happens next and for organisations to be more candid and supportive. The Being Fair event which was scheduled for the evening of the 24th July is to be postponed due to the holiday period and will be rescheduled to take place in the autumn.
The Safety and Learning team held a joint workshop with HSIB which was facilitated by our DHSC sponsor representative and NHS England / Improvement’s DHSC representative and we are working on a joint working agreement and partnership as work is progressing looking at types of cases in the EN scheme and identifying combined concerns and we want to ensure that we are not duplicating effort.
The Safety and Learning team continue to meet with a high number of members and participate and lead on a number of events.
A lunchtime education session was delivered by the Chief Executive supported by the executive team at DHSC recently, facilitated by our DHSC sponsor representative. The aim was to discuss and heighten the understanding of our role and we are considering holding a further event for the wider DHSC team.
The Board noted the Communications and Stakeholder Engagement Report.
5 Key Developments
5.1 There were no items to consider.
6 Oversight of Key Projects
6.1 There were no items to consider.
7 Board Committee Reports and Minutes
7.1 Audit and Risk Committee Meeting Minutes – 8th May 2019
The minutes of the Audit and Risk Committee Meeting held on the 8th May were noted by the Board.
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8 Other matters requiring Board attention
8.1 Policies for approval/noting
8.1.1 Workforce Development Policy
The Workforce Development Policy has been updated to acknowledge the role of the Deputy Directors and their responsibilities around developing staff, organisational values to acknowledge that staff are treated inline with the values and to support the IiP work, clearer links between policy and workforce and organisational development strategy to ensure the policy is rolled out in practice, and funding for learning agreements has been increased from £2,000 to £3,000.
The Board noted the Workforce Development Policy which has been approved by the Senior Management Team.
8.1.2 Policy For the Management of Fire and Emergency Safety
The Policy for the Management of Fire and Emergency Safety has been reviewed to include updated job titles, closure of the Northern Ireland office, addition of the office at Leeds Arena Point, closure of the Leeds Trevelyan Square office and various clarification points following Senior Management Team input.
The ARC Chair commented that it was useful to note the annual update on Health and Safety and Fire Risk Assessment.
In terms of emergency contacts, it was noted that we now have an emergency contact card for NEDs, Senior Management Team and other key members of staff and that there needs to be a mechanism in place for ensuring that it is regularly kept up to date, every six months, and that this should be written into a policy. Action: HoG
The Board approved the Policy for the Management of Fire and Emergency Safety.
8.2 Hospitality Report
The Board noted the Hospitality Report.
8.3 Code of Conduct
The Code of Conduct for Board members of Public Bodies has been revised by the Cabinet Office and sets out the personal and professional standards expected from non-executive Board members of UK public bodies forming part of their terms of appointment. The updated 2019 Code includes provisions making clear that bullying, harassment or other discriminatory behaviour will not be tolerated. There is also a new requirement for Board members to notify the DHSC sponsor department of any
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bankruptcy, current police investigation, unspent criminal conviction or disqualification as a company director.
The new Code also reminds office holders of their role in promoting diversity and inclusivity within their organisation, including at Board level.
The Code’s obligations will be taken into account when reviewing our Standing Orders and Standing Financial Instructions.
The Board noted the Code of Conduct for Board members of Public Bodies.
9 Any Other Business
9.1 Transparency update: policy on openness Attendance at Part 1 Board meetings has been considered by the Board and it was agreed that we should test our overall approach to openness against our statements made in the Policy on Openness which was approved by the Board in January 2018, consider how much information we are putting into the public domain and measure ourselves against the government transparency commitment. There are two areas where we could be more proactive which is around ensuring that Part 1 Board papers are promptly put on our website and the proposal is that this should be done within seven working days of the meeting being held. It was also considered that further work was needed around our transparency commitments on contracts although this is fairly up to date on our website.
Board members were asked to feed back to the Director of Membership and Stakeholder Engagement whether they considered there was anything further we should be doing to ensure that we are as open and transparent as possible.
Wording has been agreed with the Senior Management Team regarding public attendance at Board meetings as follows:
Members of the public can register for attendance at our Annual General Meeting once the date is published. If anyone wishes to attend, please email [email protected]. Our Board holds regular meetings which are not open to public attendance but we do aim where possible to publish papers and minutes within seven days of these meetings. Where papers are not published this is because they fall in one or more of the categories shown below:
Any matter arising from a contract of employment or otherwise concerning an employee and/or officer of the Board Contract negotiations and all other commercially sensitive matters, including comments on the performance of suppliers to NHS Resolution Actual or anticipated litigation, including any arbitration or dispute resolution process Any matter which involves the consideration of confidential information held by or provided to NHS Resolution including information which cannot be disclosed without breaching Data Protection principles.
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Relates to any matter relevant to the prevention or detection of crime or the prosecution of offenders. Relates to matters which if disclosed may adversely affect the delivery of our strategic objectives Relates to early stages in developing policy or consultations where matters under consideration are not yet in the public domain. Contains information provided to NHS Resolution under license which prohibits publication, or by other bodies on the understanding that confidentiality of such information will be preserved. Minutes of meetings which have not yet been approved.
Work continues across functions to ensure that the website is up to date with information. Our Publication Scheme details the classes of information which a public authority publishes or intends to publish which is a requirement of the Freedom of Information Act.
The Board noted the update on compliance with our policy on openness.
9.2 World Patient Safety Day – 17th September Dr Mike Durkin reported that the Foreign Secretary is proposing to host a conference in London on World Patient Safety day on 17th September as well as create a global patient safety collaborative and global action on patient safety.
In terms of the collaborative, it has been announced that the academic partner will be Imperial College London and Dr Durkin has been asked to be the Director. This will give an opportunity to learn and spread learning in terms of safety to a more diverse group.
It was noted that NHS Resolution would be willing to participate in the conference and planning.
It was suggested whether the NHS Confederation Conference and Patient Safety Congress could be aligned going forward which would make it a very powerful conference.
10 Date and Venue for next meeting
10.1 The next Board meeting is scheduled for Wednesday 11th September 2019 at 10.00am, venue tbc.
Signed ……………………………………………………….………
Date ………………………………………………………………….
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Board Actions – July 2019 Part 1
Action Ref Date of Board Part 1 or Date action No. Reference Action Officer responsible RAG rating Meeting Part 2 due Status of action
Learning from suicide DoS&L to bring a report back to Board in 6-9 months related claims: A thematic September 2019 Paper in part 1 18.26 14.11.18 Part 1 on what has happened since the report was DoS&L Board review of NHS Resolution launched. data Contact has been established. DoMSE to make contact with the RCGP to suggest a Speakers for their conference have 19.06 22.5.19 Part 1 CNSGP ASAP DoMSE CLOSED speaking slot or workshop at their annual conference. already been set.
Chair and CE to review the actions from the review Session under preparation for the Board effectiveness Awayday and 19.07 22.5.19 Part 1 with a proposal to be brought back to Board for Chair/CE November 2019 October away day. review discussion before the end of the year. Lord Holmes of Richmond Chair to arrange for the response to be uploaded to Done 19.08 17.7.19 Part 1 ASAP Chair Review Boardpad. This is to be reviewed as part of our HoG to ensure that updating of the emergency business continuity review 19.09 17.7.19 Part 1 Emergency Contact card contact card undertaken every six months and is ASAP HoG included in the policy and actioned going forward. arrangements.
Chief Executive’s Report Board meeting (Part 1) 11th September 2019
GIRFT Partnership Working
As part of ongoing work, both to improve patient outcomes and to reduce litigation costs, the Getting It Right First Time (GIRFT) programme and NHS Resolution - in association with the British Hip Society (BHS), British Association for Surgery of the Knee (BASK) and the British Orthopaedic Association (BOA) - have produced professional standards guidance for hip and knee arthroplasty documentation.
A GIRFT and NHS Resolution Orthopaedic Working Party worked with expert contributors including BOA, BHS, BASK, NHS Patient Safety, NHS panel firms, claimant law firms, expert witnesses and the medical defence organisations (Medical Defence Union, Medical Protection Society, and Medical and Dental Defence Union of Scotland) with the goal of communicating lessons learned from previous and ongoing claims. A strategy was agreed to promote claims learning through GIRFT data packs provided to trusts and to produce best practice guidance, starting with hip and knee arthroplasty documentation.
These documents aim to provide advice on aspects of surgery which should be available and clearly documented in a hip or knee arthroplasty operation record. They are not a comprehensive guide to hip or knee surgery but highlight what is considered best practice and, importantly, documentation guidelines. This guidance can be found both on the BOA and GIRFT websites at: http://gettingitrightfirsttime.co.uk/cross-cutting-stream/litigation/ https://www.boa.ac.uk/resources/best-practice-hip-arthroplasty.html
EU Exit – No Deal Planning
Since the change in Cabinet under a new Prime Minister in July 2019, cross-government planning in relation to a No Deal Brexit on 31 October 2019 has intensified.
At DHSC, the former Minister with responsibility for EU Exit preparations, Stephen Hammond MP, has been replaced by Chris Skidmore MP.
At the DHSC/ALB Delivery Partners meeting on 31 July 2019, there was a discussion regarding additional EU Exit funding being made available to the Department and its delivery partners, and attendees were asked to identify financial pressures against existing EU Exit allocations. Following this, HM Treasury made £15m available for increasing preparedness across DHSC partner organisations in the run-up to 31 October 2019. This was addition to what had already been made available to support EU Exit. It has not been necessary for us to bid for any funds.
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ALB EU Exit SROs were asked in August 2019 to reassess their organisation against the core standards for readiness to respond to disruption following EU Exit. SROs originally completed this exercise in February 2019 in advance of a 29 March leave date. This time the exercise was lighter touch, involving SROs updating previous information, ahead of joining a workshop in September.
Finally, we continue to take part in fortnightly DHSC/ALB EU Exit communications meetings.
Apprenticeship scheme
We have launched our first apprenticeship scheme within the organisation. We are working with a leading education provider to offer an apprenticeship scheme in the claims management function. We aim to have a cohort of at least six commence the program in Q3 this year.
On successful completion of the two year course each apprentice will obtain the Diploma in Insurance qualification certified by the Chartered Institute of Insurance. They will learn on the job skills provided by a dedicated apprentice team leader. At the conclusion of the two year period the apprentice should be in a position to progress to a full case manager. This will assist the organisation with recruitment and capacity needs. So far we have received in excess of 120 applications for the apprentice scheme.
HR continue to work with other function areas of the organisation to identify appropriate apprentice opportunities to develop.
The Board is asked to note the Chief Executive’s report.
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Board meeting – Part 1 11th September 2019
Agenda item: Item 2.2
Title of paper: Performance Report
Responsible Director/Lead: Chief Executive
Summary of paper:
This paper provides a report on financial performance and key performance indicators for the period under review. Where performance is below target an explanation is given together with details of plans to bring performance back in line.
Board action requested:
The Board is asked to note the report.
Potential risks:
Our performance is detailed in public documents such as the Business Plan and our Annual Report and Accounts as well as reported on a regular basis to the Department of Health. Any failure to perform against agreed targets or to have plans in place to remedy under performance would bring into question our effectiveness in delivering the aims of our Business Plan.
Equality, diversity & inclusion:
We review all the proposed measures of performance against our standards in this area when agreeing definition of thresholds with the Department of Health at the outset of the financial year.
Has the patient and public interest been taken into account?
All performance measures are focused ultimately on the interests of patients and the public be that in relation to patient safety or preserving resources for NHS care.
Performance Report Board meeting (Part 1) 11th September 2019
Finance Summary Financial Position as at July 2019
Executive Summary
Departmental Expenditure Limit (DEL) budgets
Net expenditure on all budgets as at July is an overspend of £93m, noting that we currently don’t have an agreed budget for PIDR costs.
Indemnity scheme budgets, excluding the PIDR impact, are overspent against budget by £10m.
Additional PIDR costs are £83m, this compares to £92m for the same period last year. The PIDR budget is yet to be agreed with DHSC.
We have yet to incur any payments on the CNSGP.
Administration costs are £1.7m underspent primarily due to vacant posts in claims and the support functions.
Capital expenditure is £310k at the end of July 2019 against a budget of £195k. The capital expenditure is expected to be on budget (£1,390k) for the full year
Annually Managed Expenditure (AME) budget
This budget relates to the change in the value from one year to the next, of liabilities expected to be settled in the future, arising from NHS Resolution’s indemnity schemes.
A budget of £8.4bn has been agreed for this year. The work on updating the 2019/20 AME forecasts and the assumptions’ underpinning them will be carried out over the coming months.
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Department Expenditure Limit (DEL) Position
Year to Date
Budget Actual Variance
£'000 £'000 £'000
Income Member Contributions (666,348) (667,865) 1,517 Other income (355) (382) 27 Total Income (666,703) (668,247) 1,544
Expenditure Total Member Funded Schemes 514,792 607,488 (92,696) DHSC Funded Schemes 28,011 28,716 (705) Administration 10,856 9,144 1,713 Total Expenditure 553,660 645,348 (91,689)
Net Expenditure (113,044) (22,899) (90,145)
The income and expenditure for the year on Department Expenditure Limit (DEL) budgets is shown above, this represents the settlement of claims in year and NHS Resolution’s administration costs. The total overspend at July is £90m.
There is a favourable variance on income mainly as a result of the underutilisation of funds available to make corrections to member contributions where data issues have arisen.
Expenditure for the schemes consists of two elements: expenditure estimated at a personal injury discount rate of 2.5% (referred to as baseline expenditure), and expenditure related to the impact of the change in the PIDR. The indemnity schemes are overspent by £93m.
Administration costs are underspent by £1.7m, mainly due to lower than anticipated staff costs as recruitment has been slower than expected.
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Detailed Indemnity Schemes Expenditure at July 2019
Year to Date Budget Actual Variance £'000 £'000 £'000
Ex-RHA 333 259 75 ELS 7,177 8,672 (1,495) DH Clinical Liability 19,168 17,867 1,301 DH Non-Clinical Liability 1,333 1,919 (586) CNST 499,028 593,692 (94,664) PES 2,000 1,376 624 LTPS 13,763 12,419 1,344 CNSGP 0 0 0 Total 542,803 636,204 (93,401) The table above shows a breakdown of expenditure by scheme at July. This includes baseline expenditure of £553m and PIDR expenditure of £83m. Across all schemes the damages budgets are overspent by £19m (6%), claimant costs underspent by £2m (1%), defence costs budget is underspent by £3m and periodic payment budget is underspent by £3m.
Prompt Payment Policy and Reporting of Performance
The number of invoices paid within 30 days remains below the target of 95% at 82%. Relevant payments in July totalled £9m. The majority of our spend is damages and claimant costs which are not included in the calculation as they are not covered by the legislation on payments to suppliers of goods and services.
The new finance system is set to go live on the 4th of October 2019. Our expectation is that the new system will help drive process changes to improve our performance against this target.
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Claims
Executive Summary
This paper reports the number of claims for compensation received by NHS Resolution under our three principal indemnity schemes alongside a high level overview of the portfolio of those claims.
Our performance in the management of claims against our key performance indicators is commercially sensitive and included in the papers in Part 2.
Findings
The table below shows the number of claims and incident reports received under our three principal indemnity schemes in 2019/20 to date compared with the same period in 2018/19. This report confirms numbers up to 31 July 2019.
Schemes 2018/19 2019/20 Change
Clinical Negligence Scheme for Trusts (CNST) 3,687 3,785 +2.66%
Liabilities to Third Parties Scheme (LTPS) 1,217 1,317 +8.22%
Clinical Negligence Scheme for General Practice N/A 47 N/A (CNSGP) The figures for CNST exclude birth injury events notified under the Early Notification initiative.
The chart below shows the month-on-month volatility of new claims received in the last fourteen full financial years, excluding CNSGP.
There has been a slight increase in the volume of claims and incidents reported so far this financial year, excluding CNSGP which is a new scheme from April 2019. This is compared to a fairly stable number of reports being noted in the first two months of the financial year. LTPS reports have increased generally, with a sharp increase in this reporting period. This
4 will be monitored to see if the trend continues. This scheme has lower volumes than CNST and therefore can be subject to slight variances period on period that will show a greater percentage impact on the overall numbers. The chart below shows the number of reported EL and PL claims in 2018/19 compared to 2019/20 in the first four months of the financial year.
We have investigated the volume of claims reported to date and there are no group actions. Whilst some members have reported more claims than the previous year there does not appear to be a cohort of members who have significant increases compared to their usual claims pattern. We have no intelligence to suggest that there is a specific reason for this increase or that we expect to see a large increase in LTPS claim numbers in the full financial year. Clinical The chart below shows the breakdown of CNST claims received in the financial year to date split by the top five specialties.
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The profile of claims received to date in 2019/20 follows a similar profile for the last financial year. Orthopaedic surgery was the largest reported specialty year to date, followed by emergency medicine and obstetrics. We expect this pattern to look similar throughout this financial year. The chart below shows the breakdown of CNST claims received in the financial year to date in the top five volume specialties, split by value.
Obstetric claims account for over 70% of the total value of new CNST claims received in the top five volume specialties. The chart below shows the breakdown of CNST claims received in the financial year to date, split by value. Only the top five are shown.
Obstetric claims account for 49.29% of the total value of new CNST claims received to date in the financial year. Non Clinical
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Employers’ liability claims account for 70% of new LTPS claims received in 2019/20 to date. This follows a similar pattern to previous financial years and is expected in this scheme due to the profile of risks covered. There has been an equal percentage increase in both EL and PL claims.
The chart below shows the pattern of behavior in the last 5 years.
There is no evidence to suggest this pattern will alter significantly.
The chart below shows the breakdown of LTPS claims received in the financial year to date split by the top five injury types.
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Orthopaedic injuries are the largest injury type by some margin, which also follows a similar pattern to previous financial years. The chart below shows the breakdown of LTPS claims received in the financial year to date split by the top five causes.
Slips and trips are the highest cause of LTPS claims received in 2019/20 at 39%, however assault claims have seen an increase to 27% of new claims in year. This is a pattern we are seeing develop and will be monitored.
The chart below shows the gradual increase in the percentage of assault claims reported in year, over the past five financial years.
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We have investigated the claims reported to date in year and there are no group actions. There are a wide spread of members reporting claims with no one member standing out as an outlier. There would also appear no pattern of behaviour in solicitors who are representing the Claimants.
Practitioner Performance Advice
Case advice service
All performance up to 31 July 2019.
A total of 278 new requests for advice have been received in FY19/20 (Chart 1). The number of new requests for advice, as at 31 July 2019, indicates a decrease of 16% compared to the same period last year (and compared to 20% reported to the Board previously). However, as shown in Chart 2, there has been a month on month increase in new requests received in this FY, with the number of new requests in July being above the historical monthly average.
Chart 1: New requests for advice received YTD
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New requests for advice YTD
500 400 350 326 335 332 300 289 278 200 100 0 FY14/15 FY15/16 FY16/17 FY17/18 FY18/19 FY19/20
Requests for advice YTD Requests for advice YTD Average
Chart 2: New requests for advice – month on month YTD
New requests for advice (month on month) 110 100 90 78 78 78 78 78 80 78 70 103 106 88 91 74 74 77 98 74 88 90 90 60 68 84 80 80 71 70 84 75 69 66 50 64 56
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FY14/15 FY15/16
FY 17/18 FY 18/19 FY 19/20 FY 16/17 April May June July Historical monthly average
Chart 3: New requests for advice – by sector YTD
Requests for advice (by sector) - YTD 300 279 267 268 250 245 229 238 200 150 100 81 71 68 60 64 50 40 0 FY14/15 YTD FY15/16 YTD FY16/17 YTD FY17/18 YTD FY18/19 YTD FY19/20 YTD Primary Secondary
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Chart 4: New requests for advice – by profession YTD
As regards the overall decrease in the rate of new requests compared with the previous FY, we are continuing to take steps to understand the factors that may be contributing to this position and take appropriate action. Key steps include:
We have strengthened internal reporting arrangements to identify healthcare organisations who are requesting advice in fewer cases than might be expected. Utilising our link adviser model, we are taking steps to proactively re-engage with those organisations in order that they are fully appraised of the support we are able to offer. Progress is being monitored closely (including fortnightly reporting to the Core Operational Group). The above is underpinned by a new case management framework for all advisers which sets out the expected arrangements for establishing and maintaining links with their respective healthcare organisations as link adviser. We have reaffirmed our internal arrangements with Primary Care Appeals regarding a specific category of cases (Regulation 18) in which notifications of action taken in primary care are brought to NHS Resolution’s attention. This can lead to the generation of new cases where we can proactively offer assistance to primary care organisations. We are also currently reviewing our regional model of working to ensure this is aligned with the changing landscape of the NHS (in line with the revised seven NHSE & NHSI regions). On this basis we are setting up a series of meetings starting in the autumn within the revised regional boundaries to create a stronger interface between Advice, Safety and Learning and the existing RO networks and the GMC to promote collaborative working.
We will continue to monitor progress carefully and report to the Board on progress against the above.
Healthcare Professional Alert Notices (HPANs)
At the end of July 2019 there were 10 active HPANs. By comparison, in July 2018 there were 17 active HPANs.
Chart 6: Healthcare Professional Alert Notices – YTD
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External education and learning 100% of education events delivered in FY19/20 were rated at least 4 out of 5 for effectiveness/impact by participants.
Activity summary in FY19/20 Activity summary in FY18/19 WORKSHOPS (to 31 July 2019) (to 31 July 2018) Total: 13 18 - In-house 9 11 - Public 2 6 - Bespoke 2 1
In-house workshops are organised for healthcare managers and clinicians involved with handling practitioner performance concerns who are all based within a single organisation, and can therefore be tailored to meet their individual requirements.
Public workshops are held at national, regional and local level and for audiences defined by specialty and sector interests, as well as for multi-disciplinary groups.
So far in FY19/20, we have seen less workshops delivered out compared with the previous financial year. Firstly, decrease in demand for primary care public workshops, despite improved marketing and communication which has strengthened the profile of our events, in part can be attributed to the changes happening within NHS England. Secondly, while requests received for in-house workshops is comparable to last year we were limited in our ability to fulfil these requests in April and May due to adviser availability around Easter. All requests have been or are in the diary to be delivered – no request has been turned away.
We are currently refreshing of our standard content based on delegate and trainer feedback, changes within national guidance, and emerging case law. Our refreshed content for case investigator training is due to be rolled out in Sept. We are developing a regular review schedule for all content to ensure it remains fit for purpose.
Exclusions in England (secondary care only)
90% of exclusions in England (secondary care) were reviewed within the target timeframes, representing a total of 37 out of 41 cases. In all but one of the cases where the KPI was missed, this was due to the lack of availability of the employing/contracting organisation to engage in the review but action was taken by ourselves to review these cases at the earliest opportunity available. In the remaining case, this was due to an internal oversight that has now been addressed. It should be
12 noted that the next iteration of our case management system (EKS2), which is due for implementation in September 2019, will provide improved functionality in respect of monitoring exclusions which will further support our local arrangements to meet this KPI.
Assessments and other interventions
The table below shows the activity for the assessment and interventions service so far this year, as well as current activities being planned.
Area Activity summary YTD Assessment and Clinical performance assessments other • 1 assessment report issued interventions • 3 clinical performance assessments being planned
Professional Support and Remediation action plans • 11 action plans issued • 2 action plans being prepared • 2 reviews of local action plan prepared by external healthcare organisations
Other interventions 10 behavioural assessment reports issued 5 behavioural assessments being planned or report being prepared 4 assisted mediations completed 4 assisted mediation being planned
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Key performance indicators
FY19/20 to 31 FY18/19 to 31 May Service Measure to report July 2019 2019 Advice Service 90% of requests for advice 100% 100% responded to within 2 working days (or within an alternative timeframe requested by the Employing/Contracting organisation) Healthcare 90% of HPANs issued/released 100% 100% Professional Alert (where justified) within 7 working Notices (HPANs) days
90% of HPANs revoked (where justified) within 7 working days 100% 100%
External education 90% of education events rated by 100% 100% and learning participants at least 4 out of 5 for effectiveness/impact
Exclusions and 90% of all exclusions/ suspensions 90% 90% suspensions critically reviewed (where due)
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Primary Care Appeals
Performance against Key Performance Indicators 2019-20
Target Indicator
June 2019 July 2019 (June 2018) (July 2018) 90% % of "first step" letters sent out within 7 days of receiving the appeal or 100% 100% dispute (100%) (100%)
100% % of appeals or disputes where 14 or more days notice of hearing has 100% 100% been given (NA) (100%)
80% % of appeals where Decision Maker agreed with recommendation of Case 89% 100% Manager (75%) (100%)
90% % outcome of quality audits for appeals and dispute files 100% 100% (100%) (100%)
15 weeks The average number of weeks taken to resolve appeals and disputes - 10 12 Internal input only (13) (11)
19 weeks The average number of weeks taken to resolve appeals and disputes – 18 15 additional input (18) (14)
25 weeks The average number of weeks taken to resolve appeals and disputes - 22 24 Oral Hearing (27) (27)
33 weeks The average number of weeks taken to resolve disputes – CMR valuation NA NA input required (NA) (NA)
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Safety and Learning
This report features two new KPIs which became effective from 1 April 2018 (numbers 2 & 3) the other two are continued from the previous year.
Response to Members
1. 95% response rate to Members following a request for contact within five working days.
The log records all contacts mainly related to safety and learning events; the maternity incentive scheme; Early Notification Scheme and ‘Consent Event (Bristol) with clarification requested on scorecard data and the differences in relation to the GIRFT data.
38 requests for information or support have been received via the Safety and Learning enquiries generic inbox. These represent general contacts on a range of areas e.g. scorecards, Consent event Bristol. All email responses completed within the time scale target. This KPI compliance is 100%
Engagement
2. Participation in eighteen regional engagement events for members which include two National sharing and learning events.
Engagement events to date: Event Event number of 18 Kings Partnership – Learning from Suicide Report 1 NHS England Risk Management event – Learning from suicide 2 Royal College of Medicine – Learning from paediatric claims 3
Attendance at London Responsible Officer training 4 Conversation on Consent (Bristol) 5 Inquest Event –Brown Jacobson London 6 Spotlights on Inquest – Kennedys –Midlands & East. 7 Mental Health and Court of Protection Seminar 8 Data Triangulation North Region Trusts 9 Patient Safety congress 10
The Safety and Learning Team on track to achieving this KPI. Compliance is 55%.
Products
3. Eight safety and learning products to be made available for members in 2019/20.
Products to date: Assault leaflet 1 Case story in development with Capsticks (Learning from Deaths module) 2 Case story in development with Bevans (Learning from deaths) 3 Being Fair Guidance report and leaflet Launched 4 Early Notification maternity report – due for publication in September 2019 5 Scorecard update 6
The percentage compliance of the KPI (currently achieved. 6 products of 8) **
This KPI is 75% going into the second quarter.
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4. Positive feedback from trusts visited on recognition of products (at least 60%).
Following each Trust site visit, the Safety and Learning Lead gathers feedback on our products to help us improve future leaflets. Five Individual Trust site visits have taken place. Overall, feedback has been positive. A small number of visits did not meet the criteria for collecting member feedback, for example the purpose of the visit had a targeted topic, such as sharing information on the mental health report.
NHS Resolution leaflets are distributed at all regional events and feedback invited, particularly around new topics. Regional events enable the team to access a wider reach of trusts and display leaflets. The ‘Consent’ and ‘Saying sorry’ leaflets have generally been well received by our members at meetings and conferences, such as the Royal College of Nurses (RCN) annual conference and the Bristol Patient Safety Conference and Mental Health event in London. The ‘Saying sorry’ leaflet has been requested, and used, by a London trust to support its simulation training. The Safety and Learning team are currently updating our leaflets, in terms of contemporary claims data and NHS Resolution branding.
User acceptance is important in the development of new leaflets and the draft visuals have been shared at a meeting of mental health trusts in relation to the assaults leaflet and the discussion around themes and potential solutions have informed the content thus far.
Case stories are an area of discussion at site visits to encourage trusts to share their stories in the NHS Resolution format focussing on what the trust has done differently as a result of the claim.
This KPI compliance is 95%
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Membership and Stakeholder Engagement report Board meeting (Part 1) Wednesday 11 September 2019
Agenda item: Item 4.1
Membership and Stakeholder Engagement activity report, July to Title of paper: September 2019
Responsible Director/Lead: Director of Membership & Stakeholder Engagement
Summary of paper:
This paper provides an update on recent communications and stakeholder engagement activity
Board action requested:
The Board are asked to note this report.
Potential risks:
Without effective managed relationships through media channels and with external stakeholders, we will fail to mitigate the following strategic risk: “fail to develop and maintain effective relationships with key stakeholders, members and customers”
Equality, diversity & inclusion:
We will reflect relevant aspects of Equality, Diversity and Inclusion in our media relations and stakeholder engagement, in particular reflecting the diverse range of patient and public interests served.
Has the patient and public interest been taken into account?
We will be mindful of the need to serve the interests of different groups of patients and members of the public in preparing and issuing statements to the news media and while engaging with our external stakeholders.
Membership and stakeholder engagement activity report, July to September 2019.
This paper updates the Board on recent membership and stakeholder engagement. The purpose of the paper is to draw together key activity relating to proactive/reactive media management, issues management, digital communications, stakeholder engagement and events across NHS Resolution.
The paper is organised as follows: Section A: Corporate communications / media relations Section B: Stakeholder engagement Section C: Events Section D: Digital communications Section E: Safety and Learning engagement report
The Board are asked to note the contents of this report.
Membership and Stakeholder Engagement report Board meeting (Part 1) Wednesday 11 September 2019
A: Corporate communications/media relations Publications Resolution Matters – issued on 15 July 2019
On Monday 15 July we dispatched Resolution Matters to our members and panel will have received a copy via our leads Topics covered included: Our Annual report and accounts 2018/19 Being fair: supporting a just and learning culture for staff and patients following incidents Learning for Deaths event Core system review Case of note: causation in stroke case Practitioner performance assessments and a review of our professional support and remediation service Supporting GIRFT (as we recently sent out the latest data packs to legal contacts in our membership) CNSGP updates (updates on our website on activities in scope) The emergency medicine event. http://createsend.com/t/i-E428FAA1B3912D472540EF23F30FEDED
As Board members will be well aware we published our Annual report and accounts on 11 July 2019. Publication was supported by the launch in Resolution Matters. An article on the website: Clinical negligence numbers steady, but rising costs remain a concern.
The document was also presented to the public at our Annual General Meeting held on Thursday 1 August 2019.
An email was sent from our Chair, Ian Dilks, to member chairs on Tuesday 6 August 2019: http://createsend.com/t/i- E4FAAEC51D7776CC2540EF23F30FEDED
An email was also sent from our Chief Executive, Helen Vernon, to member chief executives on Monday 12 August 2019 http://createsend.com/t/i-C211B2F320B438F42540EF23F30FEDED
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On 4 July we published our Being fair report and Did you know? leaflet.
Did you know? Being fair Being fair Supporting a just and learning culture for staff and patients following incidents in the NHS
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Direct marketing Maternity incentive scheme year two (Monday 12 August) A reminder of the date for submissions and that these must be made using the Excel form provided not pdf http://createsend.com/t/i-C4BC946FCC84C5942540EF23F30FEDED
Secondary care: Practitioner Performance Advice training (Thursday 8 August) A range of secondary care events including case investigator and case manager training as well as Resolving performance concerns. http://createsend.com/t/i-629BDEBB3174EA5E2540EF23F30FEDED
NHS Resolution Claims management essential maintenance (Friday 2 August 2019 and Thursday 8 August) Note of weekend downtime removing access to the extranet/CMS and DTS http://createsend.com/t/i-E08F4C95CF6DFC452540EF23F30FEDED http://createsend.com/t/i-8772DADC2D926D1A2540EF23F30FEDED
GIRFT: Learning from clinical negligence claims (31 July 2019) Access to GIFTS national report a http://createsend.com/t/i-75290C404EC5CA172540EF23F30FEDED
Keeping your workforce and patients safe – a new primary care event (corporate primary care engagement event – first event in Taunton) (25 July 2019/ 5 August 2019/ 8 August 2019) http://createsend.com/t/i-4D88AC968ECA90B02540EF23F30FEDED http://createsend.com/t/i-7EC10C14547BC8FE2540EF23F30FEDED http://createsend.com/t/i-D11AAAF8AF67F5892540EF23F30FEDED
Maternity incentive scheme year two – deadline reminder, update and advice for members (18 July 2019) http://createsend.com/t/i-04667516D4024E9A2540EF23F30FEDED
Being fair last call email (15 July 2019) http://createsend.com/t/i-AF7B84497998306F2540EF23F30FEDED
Resolution Matters July 2019 (15 July 2019) http://createsend.com/t/i-E428FAA1B3912D472540EF23F30FEDED
NHS Resolution Wales workshops for Practitioner Performance Advice (12 July 2019) http://createsend.com/t/i-1401C99F03F7D9BA2540EF23F30FEDED
Being fair event – multiple mailings (5, 8, 9, 10 July 2019) http://createsend.com/t/i-4E08C5350BC40C302540EF23F30FEDED http://createsend.com/t/i-3D522BE6ED43509E2540EF23F30FEDED http://createsend.com/t/i-0A83B06C3E05C2922540EF23F30FEDED http://createsend.com/t/i-DFA411D1D532673C2540EF23F30FEDED
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Media relations: to 16 August 2019 Media enquiries per month
June: 9 July: 19 Aug: 4
Media highlights In July, we supported Denise Chaffer as she co-launched our Being Fair report with Roger Kline at the Patient Safety Congress in Manchester.
New guidance calls on NHS to embed a learning and just culture to support staff, patients and carers Challenging the NHS’ workplace culture is key to improving patient safety says NHS Resolution in their latest guidance. Being fair: supporting a just and learning culture for staff and patients following incidents in the NHS highlights the need for the NHS to involve users of care services and staff in safety investigations. New guidance calls on NHS to embed a learning and just culture to support staff, patients and carers
The guidance received positive coverage (see examples below). Denise and Suzette Woodward were interviewed for a follow up piece with Nursing Standard for the September edition.
HSJ, Nick Carding, Thursday 4 July 2019 New charter launched to help trusts deal with safety incidents (Note paywall)
National Health Executive, Thursday 4 July 2019 Guidance aims to help NHS create environment to better support staff in safety investigations
The King's Fund Blog, Monday 8 June 2019 Being fair: supporting a just and learning culture for staff and patients following incidents in the NHS
Nursing Standard, Stephanie Jones-Berry, Monday 8 June 2019 ‘Just and learning’ culture can reduce stress and bullying – new guidance
July saw the publication of our Annual report and accounts 2018/19. We posted a news story on our website and much of the media coverage continued to focus on the cost of negligence.
Clinical negligence numbers steady, but rising costs remain a concern Thursday 11 July 2019 Our Annual report and accounts 2018/19 published today shows the number of clinical negligence claims has remained relatively steady, despite rising activity in the NHS. Overall, claims are falling as a proportion of the number of treatment episodes. However the report highlights the concern around rising
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Clinical negligence numbers steady, but rising costs remain a concern Coverage include:
Politics, Friday 12 July 2019 NHS under strain from rocketing clinical negligence costs
The BMJ, Friday 12 July 2019 Clinical negligence: NHS paid out £2.4bn last year (note paywall)
The MDU, Friday 12 July 2019 NHS under strain from rocketing clinical negligence costs
MPS, Friday 12 July 2019 MPS calls on Government to publish long awaited strategy on the rising costs of clinical negligence
Mail online, Sam Blanchard, Friday 12 July 2019 NHS pays out £2.4BILLION in compensation to patients who sued over poor care with more than three quarters of the money paid to just 188 maternity cases.
Litigation futures, Neil Rose, Friday 12 July 2019 Claimant costs fall as NHS targets greater use of mediation
Law Society Gazette, By John Hyde, Friday 12 July 2019 NHS spending on claimant legal costs drops by £24m in a year
HB News, Monday 15 July 2019 NHS negligence defence fees rise by eight per cent
The Times, Monday 15 July 2019) NHS negligence defence fees rise by 8% (note paywall)
On Medica, Ingrid Torjesen, Tuesday, 16 July 2019 NHS litigation bill rises while claim number remains steady
BM Law, Wednesday 17 Jul 2019 NHS Resolution annual report and accounts
The Times, Jonathan Ames, Thursday 18 July 2019 The £140 million cost of defending NHS negligence (note paywall)
Claims Mag, Mark Dugdale, Thursday July 18 2019 NHS claims steady but costs rise, reports NHS Resolution
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B: Stakeholder engagement
Participation at national conferences and events HSJ Patient Safety Congress, 2 July, Manchester Denise Chaffer had a key note speaker slot at this event to launch Being Fair, co-authored with Suzette Woodward and Roger Kline. It is hoped that the event will be followed with articles featuring in HSJ. The document also featured in a Secretary of State video message especially recorded for the congress.
Yorks and Humber Local Medical Committee (LMC) conference, 3 July, Harrogate This is the first time we have exhibited at a LMC event. It provided the opportunity to engage directly with general practitioners from the region about the Clinical Negligence Scheme for General Practice (CNSGP) and other services relating to primary care.
Next steps for improving maternity services in England - personalisation, workforce and inequalities, 10 July, London Denise Chaffer had a speaker slot.
Being Fair webinar, 25 July, London Hosted by the National Guardian’s Office Denise Chaffer led a live webinar on Being Fair for NHS speak-up guardians. Due to the popularity of the webinar it was repeated on 5 September with Suzette Woodward delivering the presentation as one of the co-authors. The provided an opportunity to prepare a podcast which we aim to disseminate and use as one of the Faculty of Learning products.
C: Events
Future events Panel conferences The autumn conference will be held Clyde & Co on 29 November. The programme will have a broader learning flavour, focusing around the emergency medicine report and featuring several external speakers.
Claims engagement events, date and location TBC A request for more direct contact with our claims teams has featured frequently in feedback from our customer survey. To meet this demand Claims Management and Membership and Stakeholder Engagement are developing a half-day event for member claims leads. We hope to hold events at panel firms and are currently exploring the availability of suitable spaces, with the aim of piloting the first event in the North before the end of the financial year.
SW primary care regional engagement event, 10 September, Taunton Working with Practitioner Performance Advice and Safety and Learning, early work has started on scoping out a series of half-day events to engage primary care audiences in each of the NHS England regions.
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The inaugural event takes place in Taunton with the NHS England regional director opening the morning.
RO Networks (NORTH), 13 September, Durham Practitioner Performance Advice and Safety and Learning representatives will be sharing details of CNSGP and our primary care offer at these events.
Being fair, 25 September, London Rescheduled from July, Weightmans are hosting an evening event, on our behalf, to build stakeholder engagement to support our work to develop a just and learning culture for staff and patients following incidents in the NHS. Suzette Woodward, Roger Kline and Peter Walsh from AvMA will speak alongside Denise Chaffer on how NHS organisations can apply the good practice and implement the charter contained in Being Fair.
Safety and Learning national event, 21 November, Newcastle This conference will focus on emergency medicine and we hope to attract 180 delegates, ideally those in clinical roles. We will start marketing this event once the date and venue are confirmed.
Turning the curve of liability: global medical indemnity conference, 23-25 June 2020, London (working title) NHS Resolution agreed to manage the next global conference following Helen Vernon’s speaker slot at the first event in Melbourne in December 2018, hosted by the Victoria Medical Indemnity Association (VMIA). Our event will be held at Kennedys and Helen has extended invitations to her counterparts in Wales, Scotland, Northern Ireland and RoI to co-host. Work to develop the conference programme and associated activities has started, with additional input from panel, DHSC colleagues including the sponsor team and the Australian team from the previous event.
Training and education Practitioner Performance Advice training Despite a slower start to 2019-20 than the previous year, by the end of September 2019 the MSE team will have managed the marketing and logistics for 25 training events in England and Wales since April. This is marginally higher than compared to this time last year.
In addition to delivering training, with practical support from MSE, since April Practitioner Performance Advice have promoted their services through: speaker slots at five events organised by other organisations eleven Responsible Officer network meetings, which are attended by a Safety and Learning representative wherever possible
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D: Digital communications
This reporting period has seen the online publication of the 2018/19 Annual report and accounts. We also published the Being fair report and accompanying Did you know? leaflet.
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Overall user statistics for www.resolution.nhs.uk
Jun- Aug- Oct- Dec- Feb- Apr- Jun- Aug18 Oct18 Dec18 Feb19 Apr19 Jun19 Aug19 Users 7,130 9,002 18,828 19,811 38,842 27,070 27,103 Sessions 9,516 11,866 26,343 28,571 55,036 38,881 39,403 Page 20,410 23,698 83,614 81,133 134,411 108,727 108,331 views Page per 2.14 2.00 3.17 2.84 2.44 2.80 2.75 session Avg. 1.40 1.28 2.25 2.07 1.58 2:18 2:15 session mins mins mins mins mins mins mins duration % New 78% 78.3% 80.3% 78.1% 79.6% 76.3% 75.7% sessions Bounce 56.06% 60.19% 50.35% 52.76% 61.75% 54.33% 55.28% rate
The values for these data points have plateaued following the post-CNSGP launch. Across all of the user statistics we monitor in the above table there has been minimal percentage change from the last reporting period.
Percentage change in pageviews between reporting periods
Website launch
CNSGP launch
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Google search popularity – ‘NHS Resolution’
CNSGP Launch
Rebrand Alice Oates’ report
This graph shows the popularity of ‘NHS Resolution’ as a search term on Google in the UK from August 2014 – 2019.
Our popularity as a search term in google has steadily grown over the last five years. There is a significant uptick after the rebranding to NHS Resolution and a high at the launch of CNSGP. There are more specific peaks at similar points each year that likely represent the release of the Annual report and accounts.
If there are no major strategic changes to the organisation or the environment we operate in then we would expect this trend to plateau with peaks for specific events like we have seen with CNSGP and Alice Oates’ report.
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Overall content performance on the website
Page Unique Avg. time Entrances Content views page views on page
CNSGP (main page) 9,716 6,854 1.42 mins 5,274 CNSGP scheme scope 4,342 3,176 2.29 mins 489 Contact 3,225 2,692 2.14 mins 1,134 Resources 2,612 2,020 0.44 mins 84 Advice (main page) 2,567 1,611 0.43 mins 556 Advice for claimants 2,562 2,212 3.38 mins 1800 Corporate reports 1,930 1,497 3.31 mins 664 CNST (main page) 1,874 1,378 1.22 mins 785 Maternity incentive scheme 1,723 1,318 1.28 mins 1,045 Being fair report 1,565 1,281 2.30 mins 873 About 1,620 1,253 1.09 mins 457 Careers 1,248 867 1.23 mins 522
Above: The CNSGP page and accompanying scheme scope information continue to receive the highest page views. More of our core webpages (contact, resources, about, careers) have received more traffic this reporting period. The Being fair report has performed well despite only being published mid-way through the reporting period.
Below: Entrances are the number of times users enter the site through a specific page. A high percentage are entering via the CNSGP main page. The low number of entrances for Resources suggests users don’t search Google for our Resources as a whole (to be expected) but clearly navigate to Resources upon reaching the homepage.
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Being fair analysis Content Page Unique Avg. time Entrances views page on page views Being fair (news item) 1,231 1,042 1.46 mins 789 Being fair report 1,565 1,281 2.30 mins 873 Did you know? Being fair 387 285 2.13 mins 182
Twitter statistics Our Twitter statistics increased in every category we currently monitor. We believe this is due to the publication of the Annual report and accounts and Being fair report and Did you know? leaflet. As well as this we have begun to more proactively manage our Twitter output in terms of promoting events, speaking engagements and promoting existing content. We are continuing to develop our new social media strategy and will be monitoring any change in engagement as part of our evaluation.
Jan19 Feb19 Mar19 Apr19 May19 Jun19 Jul19 Tweets 27 1 10 12 13 11 29 Profile visits 2,559 91 1,337 1,659 1,266 696 1,921 New followers 45 59 47 64 48 36 90
Tweet 38.7k 24.4k 18.6k 28.4k 21.3k 15.9k 50.9k impressions Mentions 339 59 152 126 170 131 584
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Safety & Learning report Board meeting (Part 1) [Wednesday 11 September 2019] Summary highlights
Since the last Board meeting the Safety and Learning team have organised and worked collaboratively on the following events:
1. National engagement – The team has continued to work collaboratively with a wide range of national and international stakeholders, including Health Education England and Parliamentary and Health Service Ombudsman to support collaborative work to improve safety in the NHS.
Our national learning event Conversations on consent provided the opportunity for more than 150 staff from across member organisations to engage in challenging and productive conversations in support of best practice. It was also an opportunity to hear powerful human stories told through both staff and patient perspectives.
We have spoken at a number of national conferences and events, providing opportunities to both deliver our message and develop our networks with external stakeholders.
There have been multiple engagements with NHS England/Improvement to support maternity and patient safety work streams.
2. Regional engagement - There were 33 events across Safety and Learning and Early Notification team with 22 additional trust visits to members. Sharing learning from claims to safety, clinical and legal audiences highlights learning through the claims lens and provides the opportunity for members to gain insight in to the human and financial costs of claims and engage in learning opportunities. These engagements also provide input and feedback to support the development of our learning resources. Our presentations are well received and generate more demand and new lines of work beyond scorecard.
3. Early Notification scheme - There has been significant engagement with maternity partners either singly or in clusters from the Early Notification scheme (ENS).
These include network or work stream events as well as inclusion of an Early Notification scheme slot on Safety and Learning regional meetings and collaborative meetings with arm’s length bodies (ALBs) and other stakeholders.
4. Individual trust visits - The Safety and Learning and Early Notification team have collectively visited 21 individual trusts. Areas covered include: user testing resources and sharing claims scorecards and leaflets, with specific focus areas and further visits discussed.
Breakdown: London: 3, South: 3, Midlands and East: 7, North: 4 Early Notification:4
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5. Infographic The table below provides a summary of direct engagements made with NHS Resolution’s Safety and Learning team with member trusts and others. Some of the visits include colleagues from claims, Early Notification, Practitioner Performance advice teams or finance to support the content as requested. This data does not include telephone and email communications- response to queries and awareness of products is covered in the KPI summary. Details of each engagement are contained in the written Board report **Data below reflects engagements since the previous Board report (-):
Figure 1: Safety and Learning Engagement July/August
Engagement July August London 1 2 South 1 2 Midlands and East 4 3 North 4 1 Early Notification team 0 4 Independent health care provider 0 0 ALB 5 9 Conference & regional events (i.e.trust attendance) 453 147 Non-governmental 1 2 Panel 6 6 Royal colleges 2 0 Others 4 10
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Safety and Learning/Early Notification Engagement Chart. (Mid June - 02 August)
1000 453 147 100
9 10 10 6 6 4 4 4 5 4 3 2 2 2 2 Engagement Figures 1 1 1 1 1 Sum of July Sum of August
Engagements
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Member trust visits e.g. site visit, request to Depicted by trust number per region present to trust staff
Independent heath care providers Independent Members
Conferences and regional events (NHS National events numbers where NHS Resolution has a stand or clusters of engagement with Resolution-led and those with NHS Resolution membership. It may be difficult to capture trust numbers within this format but reports on these in attendance). engagements can be found separately. Therefore trust contacts may not be wholly accurate in this report. Attendance at these events will be captured in future and added to these figures.
Regional events led by NHS Resolution will include trusts engaged with at the event without specifying geographical reach which is usually wide.
Other contacts made here will be included their respective groups in this table e.g. RCN congress, Bristol safety conference, elderly care conference
Arm’s length bodies and Department of Health e.g. Care Quality Commission, NHS Improvement, NHS England and NHS Blood and Transplant and Social Care
Non-governmental and third sector Charities, associations and organisations e.g. Health Watch, AVMA, Sign up to Safety, Listening place
Panel other events Depicted by number of trusts in attendance per region. Other contacts made here will be included in their respective groups.
Royal Colleges e.g. collaborative work on e.g. Royal College Midwives, Royal College Nursing, Royal College of Anaesthetists, Royal College of guidance representing NHS Resolution at Physicians, Royal College of Radiologists, Royal College of Obstetrics and Gynaecology meetings
Others e.g. CCGs, Patients, families individual experts, networks and communities Future finance group, Safer Needles Network
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Board meeting 11 September 2019
Agenda item: Item 6.1
One year on - evaluation of our publication ‘learning from suicide Title of paper: related claims’
Justine Sharpe, Safety and Learning Lead, London region and Author: mental health lead Responsible Director/Lead: Denise Chaffer, Director of Safety and Learning
Summary of paper:
Introduction 12 months following publication of ‘learning from suicide related claims’ this paper provides an evaluation of the report for the purpose of informing and improving future clinical fellow reports and identifying areas to progress mental health related claims. Specifically, the two ambitions identified in ‘learning from suicide related claims’ report were: a) Support wider health system b) Share learning and recommendations.
Findings: The report has been cited in 15 media articles and promoted through 9 safety and learning events (detail available on request). It has helped influence national policy changes and support resources for providers. It has also helped us to understand the drivers and costs to our customers and forge new relationships that help foster collaborative safety improvement advice. Next steps We will continue to share the report in a number of settings. We are also in very early discussions with some stakeholders regarding the exploration of the development of mental health incentive scheme linked to reducing suicide in mental health inpatients. We will feedback to board the outcomes of these discussion over the next few months.
Board action requested:
(Insert clear action i.e. whether Board are asked to agree, note, discuss) Board is asked to note the report.
Potential risks:
(Detail of risks/alignment with Strategic Risk Register).
Equality, diversity & inclusion:
(Evidence how this is addressed in the paper) Draft paper shared and informed with staff who the recommendations impact.
Has the patient and public interest been taken into account?
(Scope and how feedback was incorporated/actioned) N/A
One year on - evaluation of our publication ‘learning from suicide related claims’
In September 2018 we published our clinical report ‘learning from suicide related claims a thematic review’. Nearly a year on, has the report achieved its ambition? What is the reach of our report? Our ambition was two-fold: (i) Support the wider health system leaders and providers with data intelligence needed to undertake focussed improvement work to reduce the likelihood of similar problems in the future. (ii) Share learning and recommendations from our detailed analysis of completed and attempted suicide related claims. The anticipation that this is then used to improve safety and reduce avoidable harm (thereby decrease future litigation costs).
Using the 9 focussed recommendations generated from our analysis of claims, this paper observes our progress against these two ambitions (table 1 below). It also makes further recommendations for consideration of future work in this area and reflections that may inform continuous improvement for future deep dive clinical papers we develop.
Table 1: Progress of ambition against the nine recommendations in our report to derive safety and quality improvements.
Ambition 1: Ambition 2: Nine recommendations for improving safety and Support wider health system Share learning quality for those at risk of taking their own lives’ Outcome measures: Outcome measure: policy change Media coverage quality improvement Safety and learning closer collaboration with engagements system leaders
1 Substance Misuse: Media:
referral to specialist substance Unknown The report was cited in 15 media misuse services should be articles (refer to appendix for considered for all individuals details). This included national presenting to either mental press and radio, regional health or acute services with newspapers, panel publications, an active diagnosis of law publications, NHS provider. substance misuse
2 Communication: Policy and quality improvement Safety & Learning engagements: change: a) There needs to be a NHS Resolution stakeholder meeting One national event and eight systemic and systematic informing new NHSE/I Safety Strategy regional learning forums (hosted by approach to communication, as well as a new safety improvement panel, NHS providers, local which ensures that important framework (replacing serious incident improvement/ safety networks). information regarding an reports). The new approach is grounded (Refer to appendix for detail). individual is shared with in improving system communication
appropriate parties, in order to https://improvement.nhs.uk/resources/patient- best support that individual. safety-strategy/
b) Trust boards should Closer collaboration with system consider how communication leaders is best enabled within their NHS Resolution contributed to creation existing systems. of national guidance https://www.england.nhs.uk/publication/learning- from-deaths-guidance-for-nhs-trusts-on-working- with-bereaved-families-and-carers/
Policy change:
Information sharing protocol to improve communication
https://www.england.nhs.uk/publication/information -sharing-protocol-across-secure-and-detained- settings/
3 Risk assessments: Closer collaboration with system leaders: Assessment should not occur NHS Resolution contributed to risk in isolation – it should always summit hosted by NHSE with focus on occur as part of a wider needs reducing suicide and preventing homicides. Looking at standardising assessment of individual one risk assessment (rather than 156). wellbeing. Quality improvements: Professional training should Not measured be repeated every three years and risk assessment should be reviewed regularly during clinical supervision.
4 Staff training:
Every mental health trust Incorporated by Confidential Inquiry should ensure that all staff recommendations. undergo specific training in therapeutic observation
5 Prisons:
NHS Resolution should Technical claims and safety and Potential future safety and learning continue to support both local learning met with Ministry of Justice engagement with regional quality and national strategies for November 2019 to inform, discuss and surveillance action group. support Prison Safety Programme and learning from deaths in National Partnership Agreement action custody. plan.
6 Influence:
The Department of Health and Close working with HSIB, DHSC, and Safety & Learning engagement: Social Care should discuss plans to follow up with HEE re education Safety and Learning has work with the Healthcare and training contributed to work undertaken by Zero Suicide Alliance. Safety Investigation Branch (HSIB), NHS Improvement, Health Education England
and others to consider creating a standardised and accredited training programme for all staff conducting SI investigations.
7 Working with families: Policy change: Safety & learning engagement:
Family members and carers NHSI promotes patient and family Meetings and regular offer invaluable insight into the involvement in the safety strategy. communication on event, product https://improvement.nhs.uk/resources/patient- care their loved ones have resources with: safety-strategy/ One hundred families received. Commissioners AvMA should take responsibility for Patient Association ensuring that this is included NHSE endorsed by NHS Resolution in all SI investigations by not provides guidance to involve families. https://www.england.nhs.uk/publication/learning- ‘closing’ any SI investigations from-deaths-guidance-for-nhs-trusts-on-working- unless the family or carers with-bereaved-families-and-carers/ have been actively involved throughout the investigation process.
8 Staff support:
Trust boards should ensure Creation of four new inquest staff Most panel provide inquest training that those involved in support films targeted at different events to providers. arranging inquests for staff aspects. Launch in September
have an awareness of the
impact inquests and NHS Resolution co-creation with system investigations can have on leaders on our ‘Being Fair guidance’ to individuals and teams. support staff.
Every trust should have: Formal support pathways to staff including information about the inquest process.
9 Prevention of future death – Closer collaboration with system Safety & learning engagement: learning leader:
Chief Coroner provides Working collaboratively with the Senior Anecdotally Chief Coroner training for all coroners Coroner’s office to create inquest films, feedback that simulation training participate in safety and learning events has been offered and taken up by around the PFD process. and facilitating meetings between coroners coroners and members. Monitoring of the PFDs given,
both in terms number and content should lie with both . the CQC and other external bodies.
Observations:
As above table 1 demonstrates, we have had measurable and meaningful influence on informing new national safety policy specifically in patient and staff support materials in mental health area. Media coverage and our own engagements have also helped to raise awareness of costs and solutions for improvements. The report has also provided a new platform to engage and contribute to safety initiatives such as Zero Suicide Alliance and strengthen relationships with patient organisations and clinical staff in member trusts. Measurement and assurance that our recommendations are adopted by NHS providers could be achieved by exploring whether an incentive scheme for mental health would improve patient and staff outcomes in this area.
Next steps being considered
1. Aiming for 10% increase in media coverage year on year (currently 15 related articles last year).
2. Surveying contributing stakeholders at six and twelve month post publication to measure impact, change and adoption.
3. Exploring possible incentive scheme for reducing Mental health inpatient suicides
Summary:
‘Learning from suicide related claims’ has been well received and has helped to influence national policy changes through improved collaboration with health system leaders.
Board Meeting
Agenda Item: Item 8.1
Title of Paper: Responsible Officer’s Report to the Board for 2018-2019
Responsible Director/Lead: Director: Vicky Voller Lead: Sally Pearson
Summary of Paper: NHS Resolution is a Designated Body (DB) under The Medical Profession (Responsible Officers) Regulations 2010 and as amended in 2013. All designated bodies who employ licensed medical practitioners must have a RO. The RO role is intended to strengthen the way in which doctors are regulated with the aim of improving the quality of care provided to patients, improving patient safety and increasing public trust and confidence in the system. The RO has a particular responsibility in relation to the revalidation of any licensed medical practitioners who have a prescribed connection to NHS Resolution as their DB. A prescribed connection exists between those licensed doctors employed by NHS Resolution for whom NHS Resolution is their DB.
The DB has responsibility under the regulations for providing adequate support to the RO to enable the role to be carried out and for oversight of the performance of that role.
In NHS Resolution there are only a small number of doctors with a prescribed connection, but there are a large number who may be contracted to undertake work for the organisation in other ways, and the RO also has a role in sharing information about these doctors with their ROs to support their appraisal within their DB or if performance concerns are noted, In addition there are instances, where a doctor comes to the attention of NHS Resolution and there is concern that appropriate action is not being taken; in these situations it may be appropriate for our RO to make contact with the practitioner’s RO or in extreme cases with the regulator.
This is the formal annual report of the Responsible Officer, to inform the Board of the work of the Responsible Officer during the year, to support the Board to discharge its oversight function and to meet the expectations of regulators. It follows the new template published in June 2019 and recommended by NHS England in “A Framework of Quality Assurance for Responsible Officers and Revalidation” and includes the Statement of Compliance which must be submitted to NHS England by the end of September 2019.
Board Action requested:
The Board is asked to note the Responsible Officer’s Annual Report and to approve the statement of compliance for submission to NHS England by the end of September 2019.
Potential Risks
None identified
Equality, Diversity & Inclusion
The organisation’s Equality, Diversity and Inclusion Policy includes a commitment to provide equality monitoring reports for the Board three times a year which is used to identify any potential barriers in relation
Board Meeting
to recruitment, selection, education and learning and career development but does not explicitly refer to use of the organisation’s processes for responding to concerns. A review of this section of the in the Equality, Diversity and Inclusion Policy September 2020 is identified as a future action in this report.
Has the Patient and Public Interest been taken into account?
It is in the public interest that NHS Resolution has in place appropriate governance processes to ensure that any licensed medical practitioners that the organisation contracts with are subject to appropriate appraisal and revalidation processes.
Board Meeting OFFICIAL
A Framework of Quality Assurance for Responsible Officers and Revalidation Annex D – Annual Board Report and Statement of Compliance.
NHS England and NHS Improvement A Framework of Quality Assurance for Responsible Officers and Revalidation Annex D – Annual Board Report and Statement of Compliance.
Publishing approval number: 000515
Version number: 3.0
First published: 4 April 2014
Updated: February 2019
Prepared by: Lynda Norton, Claire Brown, Maurice Conlon
This information can be made available in alternative formats, such as easy read or large print, and may be available in alternative languages, upon request. Please contact Lynda Norton on [email protected].
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Contents
Introduction: ...... 3 Designated Body Annual Board Report ...... 5 Section 1 – General...... 5 Section 2 – Effective Appraisal ...... 8 Section 3 – Recommendations to the GMC ...... 10 Section 4 – Medical governance ...... 10 Section 5 – Employment Checks ...... 12 Section 6 – Summary of comments, and overall conclusion ...... 13 Section 7 – Statement of Compliance ...... 14
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Introduction:
The Framework of Quality Assurance (FQA) for Responsible Officers and Revalidation was first published in April 2014 and comprised of the main FQA document and annexes A – G. Included in the seven annexes is the Annual Organisational Audit (annex C), Board Report (annex D) and Statement of Compliance (annex E), which although are listed separately, are linked together through the annual audit process. To ensure the FQA continues to support future progress in organisations and provides the required level of assurance both within designated bodies and to the higher-level responsible officer, a review of the main document and its underpinning annexes has been undertaken with the priority redesign of the three annexes below:
Annual Organisational Audit (AOA):
The AOA has been simplified, with the removal of most non-numerical items. The intention is for the AOA to be the exercise that captures relevant numerical data necessary for regional and national assurance. The numerical data on appraisal rates is included as before, with minor simplification in response to feedback from designated bodies.
Board Report template:
The Board Report template now includes the qualitative questions previously contained in the AOA. There were set out as simple Yes/No responses in the AOA but in the revised Board Report template they are presented to support the designated body in reviewing their progress in these areas over time.
Whereas the previous version of the Board Report template addressed the designated body’s compliance with the responsible officer regulations, the revised version now contains items to help designated bodies assess their effectiveness in supporting medical governance in keeping with the General Medical Council (GMC) handbook on medical governance1. This publication describes a four-point checklist for organisations in respect of good medical governance, signed up to by the national UK systems regulators including the Care Quality Commission (CQC). Some of these points are already addressed by the existing questions in the Board Report template but with the aim of ensuring the checklist is fully covered, additional questions have been included. The intention is to help designated bodies meet the requirements of the system regulator as well as those of the professional regulator. In this way the two regulatory processes become complementary, with the practical benefit of avoiding duplication of recording.
1 Effective clinical governance for the medical profession: a handbook for organisations employing, contracting or overseeing the practice of doctors GMC (2018) [https://www.gmc-uk.org/- /media/documents/governance-handbook-2018_pdf-76395284.pdf] page 3
The over-riding intention is to create a Board Report template that guides organisations by setting out the key requirements for compliance with regulations and key national guidance, and provides a format to review these requirements, so that the designated body can demonstrate not only basic compliance but continued improvement over time. Completion of the template will therefore:
a) help the designated body in its pursuit of quality improvement, b) provide the necessary assurance to the higher-level responsible officer, and c) act as evidence for CQC inspections.
Statement of Compliance:
The Statement Compliance (in Section 8) has been combined with the Board Report for efficiency and simplicity.
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Designated Body Annual Board Report
Section 1 – General:
The board of NHS Resolution (NHS Litigation Authority) can confirm that:
1. The Annual Organisational Audit (AOA) for this year has been submitted. Date of AOA submission: 21 May 2019 Action from last year: None required Comments: The AOA Comparator Report for 2018/19 is included as annex 1. The report compares NHS Resolution’s submission with that of other designated bodies across England, both in a similar sector and nationwide. The number of connected doctors has reduced from 4 to 1 due to individuals leaving or relinquishing their license to practise. Action for next year: None
2. An appropriately trained licensed medical practitioner is nominated or appointed as a responsible officer. Action from last year: None required Comments: The responsible officer has now been in post for over a year and is increasingly being involved in appropriate issues across the organisation Action for next year: none
3. The designated body provides sufficient funds, capacity and other resources for the responsible officer to carry out the responsibilities of the role. Yes Action from last year: None required Comments: The responsible officer is contracted for 0.5wte which is sufficient to fulfil the requirements of the role. The postholder flexes the time available across the working week to mitigate any risks of the post not being full time. Administrative support for the responsible officer is provided by the administrative support to the adviser team Action for next year: None
4. An accurate record of all licensed medical practitioners with a prescribed connection to the designated body is always maintained. Action from last year: none required page 5
Comments: During the year the HR team have developed their internal processes to ensure there is an accurate record of all doctors contracted by the organisation and there is liaison with the responsible officer to ensure connections to the appropriate responsible officer are clear and lines of communication with that responsible officer are established Action for next year: None required
5. All policies in place to support medical revalidation are actively monitored and regularly reviewed. Action from last year: To review the disciplinary and capability policies for compliance with Maintaining High Professional Standards in the modern NHS (MHPS) Comments: During the year the responsible officer with colleagues in HR have reviewed the existing disciplinary, capability and appraisal policies and have suggested minor amendments to them to refer appropriately to MHPS and revalidation in circumstances where a doctor’s employment is reliant on them maintaining a license to practise Action for next year: None
6. A peer review has been undertaken of this organisation’s appraisal and revalidation processes. Action from last year: none required Comments: The NHS England Framework of Quality Assurance for Responsible Officers and Revalidation requires that independent verification is undertaken once in every revalidation cycle (5 years) for each designated body. A review was undertaken 3 years ago but there is no existing documentation of it. Once the amended Disciplinary and Capability Policies have been ratified an external review will be organised in consultation with the office of the higher level RO at NHS England.
Action for next year: Peer review of organisation’s medical appraisal and revalidation processes
7. A process is in place to ensure locum or short-term placement doctors working in the organisation, including those with a prescribed connection to another organisation, are supported in their continuing professional development, page 6 appraisal, revalidation, and governance. Action from last year: None required Comments: The processes in section 1.4 identify any doctors on short term placements to ensure they are supported in their continuing professional development, appraisal and revalidation in partnership with the responsible officer in their designated body where appropriate
Action for next year: None
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Section 2 – Effective Appraisal 1. All doctors in this organisation have an annual appraisal that covers a doctor’s whole practice, which takes account of all relevant information relating to the doctor’s fitness to practice (for their work carried out in the organisation and for work carried out for any other body in the appraisal period), including information about complaints, significant events and outlying clinical outcomes. Action from last year: None Comments: All doctors are required to have an annual appraisal that covers their whole scope of practice, with a trained appraiser identified by the responsible officer, using the Medical Appraisal Guide (MAG) Model Appraisal Form Action for next year: None
2. Where in Question 1 this does not occur, there is full understanding of the reasons why and suitable action is taken. Action from last year: None required Comments:
Action for next year: None
3. There is a medical appraisal policy in place that is compliant with national policy and has received the Board’s approval (or by an equivalent governance or executive group). Action from last year: None Comments: NHS Resolution’s Appraisal Policy is being reviewed to reflect the requirements of medical appraisal and revalidation. Action for next year: Review and update existing Appraisal Policy
4. The designated body has the necessary number of trained appraisers to carry out timely annual medical appraisals for all its licensed medical practitioners. Action from last year: Comments:
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Three doctors employed by NHS Resolution (in addition to the responsible officer) are trained appraisers and available to carry out timely annual medical appraisals for all connected doctors. Action for next year: None
5. Medical appraisers participate in ongoing performance review and training/ development activities, to include attendance at appraisal network/development events, peer review and calibration of professional judgements (Quality Assurance of Medical Appraisers2 or equivalent). Action from last year: None required Comments: All medical practitioners that are appraisers are supported to maintain their competence by NHS Resolution as a component of their continuing professional development plan Action for next year: None
6. The appraisal system in place for the doctors in your organisation is subject to a quality assurance process and the findings are reported to the Board or equivalent governance group. Action from last year: None required Comments: The responsible officer reviews all appraisal outputs using the NHS England’s Appraisal Summary and PDP Audit Tool (ASPAT). Any concerns arising from these audits would be reported to the Board through this report Action for next year: None
2 http://www.england.nhs.uk/revalidation/ro/app-syst/ 2 Doctors with a prescribed connection to the designated body on the date of reporting.
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Section 3 – Recommendations to the GMC 1. Timely recommendations are made to the GMC about the fitness to practise of all doctors with a prescribed connection to the designated body, in accordance with the GMC requirements and responsible officer protocol. Action from last year: None required Comments: There were no recommendations for revalidation due in the year, and none are currently expected in the next year. Action for next year: None
2. Revalidation recommendations made to the GMC are confirmed promptly to the doctor and the reasons for the recommendations, particularly if the recommendation is one of deferral or non-engagement, are discussed with the doctor before the recommendation is submitted. Action from last year: None required Comments: There were no recommendations for revalidation due in the year, and none are currently expected in the next year. Action for next year: None
Section 4 – Medical governance
1. This organisation creates an environment which delivers effective clinical governance for doctors. Action from last year: None required Comments: The support for doctors is set out in the organisation’s Workforce Development policy Action for next year: None
2. Effective systems are in place for monitoring the conduct and performance of all doctors working in our organisation and all relevant information is provided for doctors to include at their appraisal. Action from last year: None required Comments: Systems are in place to provide doctors connected to NHS Resolution with access to 360 feedback and all relevant information to include in their page 10
appraisals. For other, doctors appraisal statements are provided by the responsible officer, informed by input from their line managers Action for next year: None
3. There is a process established for responding to concerns about any licensed medical practitioner’s1 fitness to practise, which is supported by an approved responding to concerns policy that includes arrangements for investigation and intervention for capability, conduct, health and fitness to practise concerns. Action from last year: To review the disciplinary and capability policies for compliance with Maintaining High Professional Standards in the modern NHS (MHPS) Comments: During the year the responsible officer with colleagues in HR have reviewed the existing disciplinary, capability and appraisal policies and have suggested minor amendments to them to refer appropriately to MHPS and revalidation in circumstances where a doctor’s employment is reliant on them maintaining a license to practise Action for next year: None
4. The system for responding to concerns about a doctor in our organisation is subject to a quality assurance process and the findings are reported to the Board or equivalent governance group. Analysis includes numbers, type and outcome of concerns, as well as aspects such as consideration of protected characteristics of the doctors3. Action from last year: None required Comments: This is covered by the quality assurance process for the organisation’s disciplinary and capability policies Action for next year: None
5. There is a process for transferring information and concerns quickly and effectively between the responsible officer in our organisation and other responsible officers (or persons with appropriate governance responsibility) about a) doctors connected to your organisation and who also work in other places, and b) doctors connected elsewhere but who also work in our organisation4. Action from last year: None required
4This question sets out the expectation that an organisation gathers high level data on the management of concerns about doctors. It is envisaged information in this important area may be requested in future AOA exercises so that the results can be reported on at a regional and national level. 4 The Medical Profession (Responsible Officers) Regulations 2011, regulation 11: http://www.legislation.gov.uk/ukdsi/2010/9780111500286/contents page 11
Comments: Human Resources maintains a record of all doctors employed by NHS Resolution. The responsible officer utilises the templates included in the NHSE guidance “Information flows to support medical governance and responsible officer statutory function” to share information with other responsible officers.
Action for next year: None
6. Safeguards are in place to ensure clinical governance arrangements for doctors including processes for responding to concerns about a doctor’s practice, are fair and free from bias and discrimination (Ref GMC governance handbook). Action from last year: None required Comments: This is covered by the organisation’s Equality, Diversity and Inclusion Policy. The organisation has on-going oversight of all employee relation matters via the Workforce Strategy Group (WSG) which includes ethnicity/gender monitoring of both individuals and line management. High-level ER information is included in the HR&OD Board twice yearly board reports. Action for next year: Consider an explicit reference to reporting on the processes for responding to concerns in the next review of the Equality, Diversity and Inclusion Policy in September 2020
Section 5 – Employment Checks 1. A system is in place to ensure the appropriate pre-employment background checks are undertaken to confirm all doctors, including locum and short-term doctors, have qualifications and are suitably skilled and knowledgeable to undertake their professional duties. Action from last year: Formalise pre employment checks of licensed medical practitioners Comments: The regulations give the RO responsibilities in relation to pre-employment checks of any licensed medical practitioner to be employed by the organisation. During the year this process has been formalised with the HR team to ensure connections to the appropriate responsible officer are clear and lines of communication with that responsible officer are established Action for next year: To work with the Director of Claims Management to consider any action required to ensure the process of securing expert witnesses is compliant with the RO regulations
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Section 6 – Summary of comments, and overall conclusion
Please use the Comments Box to detail the following: Although NHS Resolution, as a designated body, has a very small number of connected doctors, the nature of its business means that it has relationships with and holds information on a large number of doctors. It is therefore important that it meets the key requirements for compliance with regulations and key national guidance, The actions identified in the last annual report to the board in May 2018 have all been progressed and the disciplinary and capability policy and procedures have been strengthened to now explicitly address the specific requirements for the recruitment, appraisal and revalidation of doctors. The following actions have been identified to further strengthen the arrangements in NHS Resolution including: New Actions:
To secure a peer review of the organisation’s medical appraisal and revalidation processes to review the appraisal policy to make explicit reference to the requirements of medical appraisal and revalidation for doctors To work with the Director of Claims Management to consider any action required to ensure the process of securing expert witnesses is compliant with the RO regulations to consider an explicit reference to reporting on the processes for responding to concerns in the next review of the Equality, Diversity and Inclusion Policy in September 2020
Overall conclusion: The contents of this report demonstrate that NHS Resolution is compliant with The Medical Profession (Responsible Officers) Regulations 2010 (as amended in 2013).
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Section 7 – Statement of Compliance:
The Board / executive management team of NHS Resolution (NHS Litigation Authority) has reviewed the content of this report and can confirm the organisation is compliant with The Medical Profession (Responsible Officers) Regulations 2010 (as amended in 2013).
Signed on behalf of the designated body
Official name of designated body: NHS Resolution (NHS Litigation Authority)
Name: Ms Helen Vernon Signed: ______Role: Chief Executive Date: 11 September 2019
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Official
Dr Mike Prentice Revalidation Lead NHS England Quarry House Quarry Hill Leeds LS2 7UE
PA Contact Details: [email protected] Tel: 0113 825 3052 18 July 2019 Our Ref: 504 Publications Approval 000740 Dr Sally Pearson Responsible Officer NHS Litigation Authority
Dear Dr Pearson
Medical Revalidation Annual Organisational Audit (AOA) Comparator Report for: 504 - NHS Litigation Authority
I am writing to thank you for submitting a return to the NHS England 18/19 Annual Organisational Audit (AOA) exercise.
Please find enclosed a report setting out your response to the exercise. The report also compares your organisation’s submission with that of other designated bodies across England, both in a similar sector and nationwide.
The 2018/19 slimmed down version of the AOA was designed to concentrate primarily on the quantitative measures of previous AOAs, the number of doctors with a prescribed connection and their appraisal rates. In this the sixth year of the AOA, I am pleased to report a continuing upward trend in the overall appraisal rate. This is extremely reassuring and I would like to thank you once again for your continued work. There is emerging evidence that creating the right environment for doctors to reflect on their clinical practice through appraisal is one which enables them to thrive and develop professionally. This benefits the patients that they look after and allows doctors to have confidence in their professional practice.
1 As well as revising the AOA, a review of reporting the other important aspects of the responsible officer function (monitoring of practice, responding to concerns, and identity/language checks) have moved to the annual Board report. The Board report, combined with the annual Statement of Compliance, has been re-designed to support a conversation within the designated body to review all the responsible officer’s obligations and to agree an action plan for areas where further development is identified. Assurance of the totality of the designated body’s work on the responsible officer’s duties will therefore be provided to the higher level responsible officer through both completion of the AOA and the statement of compliance, as signed off by the designated body’s Board or equivalent management body.
Board-level accountability for the quality and effectiveness of appraisal rates is extremely important and this report, along with the resulting action plan, should be ` presented to your board, or an equivalent management body. It is also good practice to include the report in an NHS organisation’s Quality Account.
If you need support in improving any element of your revalidation systems, your local revalidation team (contact details below) can help you. Your higher level responsible officer Professor Steve Powis Your local revalidation team’s lead contact Carla Glanville Your local revalidation team’s contact details [email protected]
This letter has been sent to the responsible officer recorded in the AOA return at 31 March 2019. If you are no longer the responsible officer, please pass this report on to the new responsible officer immediately, or to the Chief Executive of the organisation. If there are any changes to notify, or you have any queries, please contact your local revalidation team.
Please note that for transparency and openness, your submitted AOA return will be shared with your higher level responsible officer and some elements of the return will be shared with the appropriate regulatory bodies.
A more detailed report including the anonymised results of all organisations involved in this AOA exercise will be published in the autumn.
I would like to take this opportunity to thank you for providing the required assurance to your higher level RO, and to NHS England.
Further information on revalidation can be found at www.england.nhs.uk/revalidation
Yours sincerely
Doctor Mike Prentice Revalidation Lead NHS England cc: Your higher level responsible officer cc: Your local revalidation team’s lead contact
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YOUR ANNUAL ORGANISATIONAL AUDIT Analysis is based on the total of 862 returns from designated bodies (DBs) to the 2018/19 Annual Organisational Audit (AOA) exercise for the year ending 31 March 2019
The following information is presented as per your own AOA submission.
Name of designated body: NHS Litigation Authority Name of responsible officer: Dr Sally Pearson Sector: Special health authorities (NHS Litigation Authority, NHS Improvement, NHS Blood and Transplant, etc)
Prescribed connection to: NHS England (National Office)
Please note: a) In some instances, data was not suitable for comparative reporting. In these cases your own response may be reported, but comparative data is not. An explanation is given for this within the report. If you require further information on these areas, please contact your local revalidation lead: Carla Glanville at [email protected]. b) Only the questions asked are presented below. Please refer to AOA 2018/19 for the full indicator definitions if required.
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2018/19 AOA indicator Your Same sector: All sectors: organisation’s SECTION 1: The Designated Body and the Responsible Officer response DBs in sector: 4 Total DBs: 862 Your No. of DBs in all organisation’s No. of DBs in same sector and (%) that said ‘Yes’ sectors and (%) that response said ‘Yes’
A responsible officer has been nominated/appointed in compliance 1.4 Yes 4 (100.0%) 851 (98.7%) with the regulations.
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2018/19 AOA indicator Your Same sector: All sectors: SECTION 2: Appraisal organisation’s response DBs in sector: 4 Total DBs: 862
Number of doctors with whom the designated body has No. of doctors Total no. of doctors Total no. of doctors 2.1 a prescribed connection as at 31 March 2019 (in organisation) (in SAME sector) (across ALL sectors)
2.1.1 Consultants 0 57 53177 2.1.2 Staff grade, associate specialist, specialty doctor 0 6 12543 2.1.3 Doctors on Performers Lists 0 0 47422 2.1.4 Doctors with practising privileges 0 0 1870 2.1.5 Temporary or short-term contract holders 0 1 22314 2.1.6 Other doctors with a prescribed connection to this designated body 1 1 7128 2.1.7 Total number of doctors with a prescribed connection 1 65 144454
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2018/19 AOA indicator Your Same sector: All sectors: organisation’s SECTION 2 (cont): Appraisal response DBs in sector: 4 Total DBs: 862
Completed appraisals (1)
Your Number of doctors with whom the designated body has a organisation’s Same sector ALL sectors 2.1 prescribed connection on 31 March 2019 who had a completed response and (%) appraisal rate appraisal rate annual appraisal between 1 April 2018 – 31 March 2019 calculated appraisal rate 2.1.1 Consultants N/A 93.0% 93.7% 2.1.2 Staff grade, associate specialist, specialty doctor N/A 100.0% 88.2% 2.1.3 Doctors on Performers Lists N/A N/A 95.2% 2.1.4 Doctors with practising privileges N/A N/A 92.7% 2.1.5 Temporary or short-term contract holders N/A 0.0% 81.8% 2.1.6 Other doctors with a prescribed connection to this designated body 1 (100%) 100.0% 87.9% 2.1.7 Total number of doctors who had a completed annual appraisal 1 (100%) 92.3% 91.5%
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2018/19 AOA indicator Your Same sector: All sectors: organisation’s SECTION 2 (cont): Appraisal response DBs in sector: 4 Total DBs: 862
Approved incomplete or missed appraisal (2)
Your Number of doctors with whom the designated body has a organisation’s prescribed connection on 31 March 2019 who had an response and (%) Same sector ALL sectors 2.1 Approved incomplete or missed appraisal between 1 April calculated appraisal rate appraisal rate 2018 – 31 March 2019 appraisal rate
2.1.1 Consultants N/A 5.3% 4.2%
2.1.2 Staff grade, associate specialist, specialty doctor N/A 0.0% 8.6% 2.1.3 Doctors on Performers Lists N/A N/A 4.2%
2.1.4 Doctors with practising privileges N/A N/A 5.1%
2.1.5 Temporary or short-term contract holders N/A 100.0% 13.6%
2.1.6 Other doctors with a prescribed connection to this designated body 0 (0%) 0.0% 10.5% Total number of doctors who had an approved incomplete 2.1.7 or missed appraisal 0 (0%) 6.2% 6.4%
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2018/19 AOA indicator Your Same sector: All sectors: organisation’s SECTION 2 (cont): Appraisal response DBs in sector: 4 Total DBs: 862
Unapproved incomplete or missed appraisal (3)
Number of doctors with whom the designated body has a Your organisation’s prescribed connection on 31 March 2019 who had an response and (%) Same sector ALL sectors 2.1 Unapproved incomplete or missed annual appraisal between 1 calculated appraisal appraisal rate appraisal rate April 2018 – 31 March 2019 rate 2.1.1 Consultants N/A 1.8% 2.2% 2.1.2 Staff grade, associate specialist, specialty doctor N/A 0.0% 3.2% 2.1.3 Doctors on Performers Lists N/A N/A 0.6% 2.1.4 Doctors with practising privileges N/A N/A 2.2% 2.1.5 Temporary or short-term contract holders N/A 0.0% 4.6% 2.1.6 Other doctors with a prescribed connection to this designated body 0 (0%) 0.0% 1.6%
Total number of doctors who had an unapproved 2.1.7 0 (0%) 1.5% 2.1% incomplete or missed annual appraisal
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2018/19 AOA indicator Your organisation's response SECTION 3:
The last Annual Board report was signed off on: 16/05/2018 00:00:00 3.1 The last Statement of Compliance was signed off on: 06/08/2018 00:00:00
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2018/19 AOA indicator Your organisation’s response SECTION 4: Comments
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