What we know

There are many organisations and initiatives in the healthcare system which have the express aim of improving safety. We are not a patient safety body now, nor are we aspiring to be one. However, in order to move upstream to manage risk and costs, we need to influence providers. There are three channels for doing so; the membership channel, actions with commissioners and actions with regulators. The challenge is to turn good ideas for improvement into practice, to demonstrate collective impact and to ensure that our efforts complement and support each other.

We have a unique relationship with the healthcare system with every provider trust in England being a member of our indemnity schemes. This creates a platform for sharing solutions coupled with the financial leverage that the pricing of the indemnity schemes provides. There are some significant gaps in the continuum between incidents and claims.

We have learned from our recent consultation that trusts would welcome more support in responding effectively and transparently when concerns are raised.

Commissioners have responsibilities for improving the quality of services and there is potential for us to work together in using the levers and opportunities we have. We are not a regulator but as we get closer to the incident and overcome the obstacle of time-lag, we can take a greater role in informing the regulators where we find concerns, whilst providing a supportive role for improvement.

Our aims

  • To work in partnership with NHS trusts, patients and healthcare staff to improve the way in which the NHS responds to incidents.
  • To inform and support the implementation of policy initiatives in order to deliver the policy intention.
  • To play a unique role in incentivising safety improvement, using the indemnity schemes as both a platform for learning and a lever for change.

What we will do in year one

  • We will extend our involvement closer to the incident and in the case of brain injury at birth, will ask trusts to report incidents to us without delay and scope a joint objective for the reduction of harm in this area with NHS Improvement.
  • We will review these incidents to establish whether an appropriate investigation has been undertaken and the family involved and kept informed, to offer peer support to healthcare staff involved, preserve the records, undertake an early investigation into legal liability and share learning from the event (working with others such as the Royal College of Obstetricians and Gynaecologists).

Over five years we will

  • Use the data obtained through the early reporting of brain injury at birth to inform the pricing of the indemnity scheme and the value of the provision.
  • Use the platform of membership to develop and share a range of products and training tools, courses, workshops, events and webinars in areas such as candour, the inquest process and the effective management of complaints and claims, drawing on the expertise of our panel firms and the National Clinical Assessment Service (NCAS). We will look for educational partners to accredit our courses.
  • Investigate the options for using levers within our control effectively at a system, organisation and individual level to support the early prevention of incidents, claims and disputes and incentivise members to improve patient care.
  • Inform and support implementation of initiatives to change legal practice to obtain the best outcome for patients including legal costs reform to improve the claims process, ‘Safe Space’ and ‘Rapid Resolution and Redress’.
  • Encourage increased disclosure through the NCAS process with increased levels of referrers disclosing to the referee and greater information on diversity.
    Work with the National Whistleblowing Guardian and others to support healthcare staff to speak up freely and to develop a culture where it is normal to raise issues about safety, without fear of subsequent legal processes.
  • Develop a range of tailored assessment and intervention products, including assisted mediation, for managing concerns about practitioner performance.

We will know we have succeeded when

  • We are capturing all maternity incidents which will result in a multi-million pound claim within three months, removing the time-lag which currently exists between such an incident and the eventual claim.
  • We have increased visibility of the liability relating to these incidents and are able to facilitate learning and interventions.
  • We are successfully delivering the change envisaged in policy initiatives which we have informed and we are able to demonstrate the benefits for example a reduction in claimant legal costs in areas where fixed costs are applied.
  • Providers take action and are able to demonstrate improvements in safety in response to price incentives delivered under the indemnity schemes.
  • Good ideas which are shared via the platform of the indemnity schemes are implemented.
  • Litigation is no longer seen as a barrier to safety.