Governance structures - NHS Resolution

The purpose of this page is to summarise the principal Governance Structures for NHS Resolution (the operating name of NHS Litigation Authority) including both how it is accountable to the Secretary of State for Health and internal governance arrangements. Where appropriate reference is included to enabling legislation and relevant guidance.

Role of NHS Resolution

NHS Resolution plays an important role in the health care system by administering on behalf of the Secretary of State for Health the NHS indemnity (the Schemes), established under s.71 of the National Health Service Act 2006 and associated regulations. This enables the Secretary of State for Health to set up schemes to help the NHS and providers of NHS care to pool the costs of any “expenses arising from any loss of or damage to their property, and liabilities to third parties for loss, damage or injury arising out of the functions of the bodies concerned”. NHS Resolution also undertakes other activities in order to promote the highest possible standards of patient care and reduce the risk to staff and other third parties visiting Scheme members’ property.

NHS Resolution also undertakes other activities through the Practitioner Performance Advice service (formerly the National Clinical Assessment Service) which is an advisory service to support the resolution of concerns about the professional practice of doctors, dentists and pharmacists. Practitioner Performance Advice provides expert advice, support and assessment interventions and training.

In addition, NHS Resolution through the Primary Care Appeals service (formerly the Family Health Services Appeal Unit) is responsible for ensuring a prompt and fair resolution of appeals and disputes between primary care contractors and NHS England. Primary care contractors include GPs, dentists, opticians and pharmacists. Primary Care Appeals also maintains a database of primary care contractors who have had restrictions placed upon their inclusion on Performers Lists and has a responsibility for providing information to NHS England on checks made against the restrictions database.

Role of the Principal Accounting Officer (PAO) – Department of Health and Social Care (DHSC)

The Permanent Secretary, as the Principal Accounting Officer (PAO) of the Department of Health and Social Care (DHSC), is accountable to Parliament for the proper stewardship of the resources allocated to the Department. The PAO is also required to provide assurance that the individual organisations within the system are performing their functions and duties effectively and have the necessary governance and controls to ensure regularity, propriety and value for money. The PAO does this through the appointment by the PAO of the Chief Executive as the Accounting Officer of the NHS Resolution. The PAO has also appointed a Senior Departmental Sponsor (SDS) to act as NHS Resolution’s designated, consistent point of contact within the Department, The SDS acts as the link at executive level between NHS Resolution and the senior officials of the Department, and also with ministers. The SDS is currently the Director General for Acute Care and Workforce. The SDS is supported by a Departmental sponsor team, who are the principal day-to-day liaison between the Department and NHS Resolution. The SDS is responsible for ensuring that each organisation is sponsored effectively and in line with the Department’s sponsor standards. The mechanisms in place to provide this assurance include:

Annual objective setting and review process for the Chair
Accountability from the Accounting Officer through the annual governance statement
Setting and agreeing framework agreements between NHS Resolution and DH
Agreeing the annual business plan and corporate plan
Quarterly and annual accountability reviews;
Triennial reviews

Chief Executive and Accounting Officer (AO)

The AO may be called to Parliament to account for the performance of the NHS Resolution in administering the schemes and the other functions of the NHS Resolution and for the stewardship for the funds entrusted to it.

The AO is required to sign the Governance Statement annually. The AO is supported in that role by the Board and the NHS Resolution’s internal audit team which together provide oversight of the effective working of internal controls and provide assurance to the AO.

The responsibilities of the AO are to ensure that the day-to-day operations and management of NHS Resolution is run on the basis of the standards (in terms of governance, decision-making and financial management) set out in Managing Public Money including seeking and assuring all relevant financial approvals.

The principles set out in Managing Public Money are reflected in NHS Resolution’s Standing Financial Instructions which govern the day-to day operation of NHS Resolution. The responsibility for ensuring that the Standing Financial Instructions are met is delegated by the AO to the Director of Finance and Corporate Planning, and to the Finance and Corporate Governance teams. The Director of Finance and Corporate Planning also acts as the Senior Information Risk Owner (SIRO) and Data Protection Officer.

Role of the Board

The composition and conduct of the Board is guided by Standing Orders (most recently issued in March 2023). NHS Resolution is led by a Board consisting of a Non-Executive Chair, at least three but no more than five Non-Executive members, one of whom chairs the Audit and Risk Committee, and at least three but no more than five Executive members, holding the offices of Chief Executive Officer, Chief Finance Officer, and such other executive appointments as decided by the NHS Resolution Board. Other, non-voting, associate board and non-board members may also attend the Board at the discretion of the Chair.

See NHS Resolution’s Board current members here.

NHS Resolution is governed by its Board and the Chair of the Board is responsible to the Secretary of State. The role of the Board is to establish and take forward the strategic aims and objectives of the NHS Resolution consistent with its overall strategic direction and within the policy and resources framework determined by the Secretary of State. Its role is described in the corporate governance code for central government. This includes holding the executive management team to account ensuring the organisation is able to account to Parliament and the public for how it has discharged its functions, and that decision-making is informed by information covering the full range of corporate, financial, clinical, information and research governance. The Board ensures that effective arrangements are in place to provide assurance on risk management, governance and internal control.

The Chair is responsible for ensuring that the NHS Resolution’s affairs are conducted with probity, and that NHS Resolution’s policies and actions support it in the discharge of its functions and duties efficiently and effectively and meet NHS Resolution’s objectives, including those set out in its business plan. In addition, the Chair has the following leadership responsibilities:

leading the process to formulate the Board’s strategy;
developing and maintaining a high performing board and ensuring high standards of governance within the organisation;
ensuring that the Board, in reaching decisions, takes proper account of guidance provided by the responsible minister or the Department;
working with the Board to promote the efficient and effective use of staff and other resources, and ensure adherence to high standards of regularity and propriety; and representing the views of the Board to the general public.

The Board has determined that it will:

Operate as a unitary Board, except in any areas specifically reserved for certain directors, and in a way that achieves the right balance between the role of the Board as a whole and the role of the Executive team.
Carry out its activities transparently, subject to any commercial considerations and the need to protect patient and personal sensitive information. It demonstrates this by proactively publishing on its website key information on areas including pay, diversity of the workforce, performance, the way it manages public money and the public benefits achieved through its activities. The publication of its Annual Report and Accounts also plays a role in this process.
Own the process for developing strategy in conjunction with and in response to the needs of key stakeholders, with a particular focus on the medium to longer term.
Approve (annual or longer term) plans for the implementation of strategy.
Monitor the performance of the organisation against agreed plans.
Be responsible for the overall system of control, ensure key risks are identified and appropriate mitigating actions are taken.
Ensure compliance with relevant NHS and wider Government regulations and requirements, including the provision of excellent services and good value for money.
Set the tone and culture for the organisation and lead by example.
Review, endorse and adopt, in support of the AO, the Annual Report, financial statements and statement to be given by the AO.
Collectively and individually represent the interests of the NHS Resolution in other communities as appropriate.
Periodically review its own performance.

All Board members will have regard to their duties as set out in corporate governance in central government departments and adhere to the code of conduct for board members of public bodies. All Board members must comply with the rules on handling conflicts of interests which are set out in the code of conduct above and as set out in the standing orders.

Committees

The following Committees and management structures are established to enable the Board and the AO to discharge their responsibilities and to ensure that internal controls are in place to safeguard and steward financial and resource controls.

Committees of the Board

1.1 Audit & Risk Committee (ARC)

The Audit & Risk Committee is chaired by a Non-Executive director and includes 2 lay members. It meets at least four times a year. The full terms of reference for the Audit and Risk Committee is accessible from the link. ARC receive information about the internal control system to receive assurances that it is indeed effective, and consequently reports to the AO and the Board on their assessment. The ARC reviews the NHS Resolution’s strategic risk register, the results of internal and external audit work and the annual audit plan with reference to the Strategic Risk Register for approval by the Accounting Officer. It also receives and reviews reports from the Reserving and Pricing Committee, the Operations Risk Review Group and the Information Governance Group (IG). The IG group is Chaired by a Senior Information Risk Owner and includes the Caldicott Guardian who work together to ensure that both patient and other personal information are handled in line with best practice in government and the wider public sector.

1.2 Remuneration and Terms of Service Committee (RemCo)

The RemCo is chaired by the NHS Resolution Chair. It is a Non-Executive Committee of the NHS Resolution Board, which determines its membership and terms of reference. The Remuneration Committee’s full terms of reference is accessible from the link to view. The RemCo role includes the determination of the remuneration, benefits and terms of services of all posts covered by the Executive Senior Managers’ Pay (ESM) Framework.

1.3 Reserving and Pricing Committee (RPC)

The RPC is chaired by the AO and has responsibility for the development of methodologies for both reserving and pricing, and the production of robust estimates of provisions for financial reporting, and cashflow forecasts and pricing for financial planning. ARC receives reports from RPC on reserving matters to form a view about the key estimates in the accounts when making a recommendation to the Board and the AO on the signing of the accounts. A Non-executive is a member of the RPC. The purpose of the RPC is to provide assurance to the Board that the case reserving methodology and practice, as well as modelling methodologies, assumptions and outputs are appropriate. The responsibilities include setting and reviewing the reserving methodology for each scheme and to agree and sign off on key assumptions used in each reserving and cash flow projection exercise. The RPC also recommends to the Board reserves for accounting purposes and total collect amounts for each scheme. The RPC Terms of Reference is accessible from the link to view.

1.4 People Committee

The People Committee is chaired by a Non-Executive Director and includes Executive and Non-Executive members of the Board. Read the People Committee’s terms of reference in full. The People Committee’s scope includes oversight and assurance of NHS Resolution’s people and organisational development strategies and associated workstreams. This will provide an appropriate dedicated forum and more time to discuss people related activities.