Clinical Negligence Scheme for Trusts


The Clinical Negligence Scheme for Trusts (CNST) handles all clinical negligence claims against member NHS bodies where the incident in question took place on or after 1 April 1995 (or when the body joined the scheme, if that is later). Although membership of the scheme is voluntary, all NHS Trusts (including Foundation Trusts) in England currently belong to the scheme.

From 1st April 2013, independent sector providers of NHS care have been able to join CNST and cover under CNST was extended to include the cost of representation at inquests.

The costs of the scheme are met by membership contributions. The projected claim costs are assessed in advance each year by professional actuaries. Contributions are then calculated to meet the total forecast expenditure for that year. Individual member contribution levels are influenced by a range of factors, including the type of trust, the specialties it provides and the number of “whole time equivalent” clinical staff it employs. Claims history is also taken into account meaning that members with fewer, less costly claims pay less in contributions.

When a claim is made against a member of CNST, the NHS body remains the legal defendant. However, we take over full responsibility for handling the claim and meeting the associated costs. Until April 2002, trusts handled claims within their chosen excess themselves. Such claims were then “called-in” and all CNST claims are now handled centrally regardless of value.


Scheme frequently asked questions

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