Clinical Negligence Scheme For Trusts Research Articles

Medicolegal claims in general surgery: a 10-year retrospective review of claims against the NHS in England.

Every year 12,000 medicolegal claims are brought against the NHS in England at a cost of £8 billion-6.7% of the NHS England budget. In 1,000 of these claims the primary speciality is General Surgery. The aims of this paper were to examine 10 years of claims against General Surgery Departments in NHS England, identify the common causes and injuries, review the associated cost and suggest strategies for improvement. Data regarding medicolegal claims made against NHS General Surgical Departments in England from 2010 to 2020 were obtained from the Clinical Negligence Scheme for Trusts. A retrospective review was undertaken to examine the number of claims, cost of claims closed with and without damages, primary causes and primary injuries. A total of 10,027 claims were made between 2010 and 2020. Of these, 9,377 were closed in that time, with cost totalling £851,558,930. Of claims closed, an average of 608 per year were closed with damages and 329 without damages. Claims with damages resulted in more than forty-five times greater cost per claim compared with those closed without damages. Overall, cost increased by over 50% between 2010 and 2020. Common causes included 'failure/delay in treatment', 'intraoperative problems' and 'failure/delay in diagnosis'. Common injuries included 'additional/unnecessary operation(s)', 'unnecessary pain', 'fatality' and 'bowel damage/dysfunction'. Medicolegal expenditure represents a serious concern for the NHS, worsening each year. This retrospective review highlights the rising cost along with the most common causes and primary injuries. Action is required at every level of the NHS to improve surgical care, consent and communication with our patients, and by doing so minimise poor outcomes and their resultant medicolegal consequences.

Legal implications of pressure injuries: experience of a tissue viability nurse expert.

NHS Resolution manages the Clinical Negligence Scheme for Trusts, and aims to reduce the cost of litigation in terms of clinical negligence claims. To achieve this, potential clinical negligence claims are screened to assess whether to defend the claim or to provide an out-of-court settlement. Nurse experts from all nursing specialties are engaged to review all documentation and patient records to offer an opinion on the viability of a claim. This article describes the processes involved in assessing tissue viability clinical negligence claims, providing examples of evidence that guided decisions and advice on how nurses can protect their organisation from costly litigation.

Responding to the tsunami of clinical negligence claims

Annual spending on the Clinical Negligence Scheme for Trusts has quadrupled in ten years, from £0.4 billion in 2006–2007 to £1.6 billion in 2016–2017. Here, Roger Kirby discusses what the recent tsunami of clinical negligence claims means for the medical profession.

PM.55 Developing and Defining Auditable Standards of Care For Obstetric Women Admitted to ITU: Completing the Audit Cycle

There are many reports and recommendations in maternity care with some confusion and lack of clarity. Standards are available from confidential reports in maternal deaths, Clinical Negligence Scheme for Trusts,...

Management of shoulder dystocia: a re-audit

Shoulder dystocia is an obstetric emergency with raised neonatal morbidity including brachial plexus injury. With much litigation the Clinical Negligence Scheme for Trusts (CNST) advise minimum standards for documentation.

Risk management in obstetrics

Risk management is an integral part of clinical care in the UK in 2011. It is vital that all clinicians, managers and commissioners understand the underlying principles and how it works in practice. It is a useful tool in driving forward the quality of patient care combining as it does evidence based medicine (pro-active risk management) and response to incidence and complaints (re-active risk management). The risk management team will be responsible for ensuring that guidelines are up to date, national reports are responded to, training of all staff is in line with national recommendations and there is a good system for responding to, investigating and learning from all incidents, complaints and claims. This review will describe some of the principles of risk management, the current standards and assessments of the clinical negligence scheme for trusts (CNST) and includes two case reports to illustrate how risk management works in practice.

An analysis of successful litigation claims in children

IntroductionAll National Health Service (NHS) Trusts in England are covered by the Clinical Negligence Scheme for Trusts (CNST). The NHS Litigation Authority (NHSLA) is the body that handles the claims...

Improvements in patient safety as a result of preparing for a CNST assessment: observation at district general hospital

BackgroundPatient safety is the utmost concern for clinicians and the Trust. CNST (clinical negligence scheme for Trusts) is designed to ensure high quality is embedded in organisational governance, patient care...

A ‘modified’ CHAPs tool – an effective system for handover of care between medical staff in a maternity unit setting

Effective communication is central to promoting patient safety and reducing the number of serious clinical incidents. CNST (Clinical Negligence Scheme for Trusts) Maternity Standard 4-criterion 8 requires a maternity service...

Clinical Negligence Scheme for Trusts (CNST)

Clinical negligence claims have been steadily increasing worldwide and these can pose a serious threat to the financial viability of healthcare organizations, threatening their very existence. They may also encourage ‘defensive’ practice, lack of transparency, avoidance of provision of ‘high risk’ services such as obstetrics and orthopaedics, to avoid potential clinical negligence claims. In the U.K., costs of clinical negligence claims have been steadily increasing. Hence, the NHS Litigation Authority (NHSLA) was established in 1995 as a Special Health Authority to administer an ‘insurance policy’ (called Clinical Negligence Scheme for Trusts or CNST) to participating trusts. The aim is to provide a scheme for NHS organizations to fund the cost of clinical negligence claims. Although the participation in this scheme is voluntary, currently all the trusts in England are enrolled in this scheme. As at 31 March 2008, the NHSLA estimates that it has potential liabilities of £12.1 billion, of which £11.9 billion relate to clinical negligence claims.

Implementation of guidelines on oxytocin use at caesarean section: A survey of practice in Great Britain and Ireland

Objective Caesarean section is one of the most commonly performed major operations on women worldwide. Operative morbidity includes haemorrhage, anaemia, blood transfusion and in severe cases, maternal death. Various clinical guidelines address oxytocin use at the time of caesarean section. We previously reported wide variation in practice amongst clinicians in the United Kingdom in the use of oxytocin at caesarean section. The aim of this current study was to determine whether the variation in approach is universal across the individual countries of Great Britain and Ireland and whether this reflects differences in interpretation and implementation of clinical practice guidelines. Study design We conducted a survey of practice in the five individual countries of Great Britain and Ireland. A postal questionnaire was sent to all lead consultant obstetricians and anaesthetists with responsibility for the labour ward. We explored the use of oxytocin bolus and infusion, the measurement of blood loss at caesarean section and the rates of major haemorrhage. Existing clinical guidelines from the National Institute for Clinical Excellence (NICE), the Royal College of Obstetricians and Gynaecologists (RCOG) and ALSO (Advanced Life Support in Obstetrics) were used to benchmark reported practice against recommended practice for the management of blood loss at caesarean section. Results The response rate was 82% (391 respondents). Use of a 5 IU oxytocin bolus was reported by 346 respondents (85–95% for individual countries). In some countries, up to 14% used a 10 IU oxytocin bolus despite recommendations against this. Routine use of an oxytocin infusion varied greatly between countries (11% lowest–55% highest). Marked variations in choice of oxytocin regimens were noted with inconsistencies in the country-specific recommendations, e.g. NICE (which covers England and Wales) recommends a 30 IU oxytocin infusion over 4 h, but only 122 clinicians (40%) used this. Conclusions Clinicians’ approach to the use of oxytocin at the time of caesarean delivery varies between countries. Even in countries with on-site visits to ensure guideline implementation (e.g. Clinical Negligence Scheme for Trusts in England), deviations from guideline recommendations exist. These variations may reflect a lack of robust evidence and the need for future research in this area.

Independent midwives: working without professional indemnity insurance

This paper highlights the issue of independent midwives practising without professional indemnity insurance. The paper explains the history of the provision, decline and now absence of insurance for midwives who practise independently. Despite the government's commitment to professional indemnity insurance cover for all health professionals working independently and not covered by the Clinical Negligence Scheme for Trusts, an exception has been made for independent midwives. The paper questions how the government can maintain its commitment to choices for maternity care yet permit midwives to care for pregnant women and attend at the birth of a baby without requiring insurance. There is no mandatory requirement to insure by the Nurses and Midwives Council (NMC). Without a mandatory requirement to insure the only advice given to midwives by the NMC is that they should inform their patients of the insurance position. The way in which information should be given is not stated and the practice is not consistent. Little information on the implications of lack of insurance is provided to parents considering retaining an independent midwife for the birth of their child. This situation leaves parents and children exposed to a situation where there is a clinical negligence claim no possibility of obtaining damages from an uninsured Defendant of limited personal means.

Providing a quality service

It is looking increasingly likely that the Clinical Negligence Scheme for Trusts (CNST) is going to set the standard for midwifery staffing at a ratio of 1 midwife to 28 births. Overall I think this is a good thing; we only have to look at the example of our obstetric colleagues to see that CNST can drive changes in the workforce. Further to this the Healthcare Commission Report Towards Better Births (2007) quite clearly showed that the better performing trusts were those with better midwifery staffing.

Clinical audit on documentation of medical records at a teaching hospital in London, United Kingdom

Objective To compare current practice in paediatric units of St. George’s Hospital, London, with the Clinical Negligence Scheme for Trusts (CNST) guidelines and service standards for documentation of medical records and identify desirable changes. Method Fifty Bed Head Tickets (BHTs) from 2 paediatric medical units at St. George’s Hospital, London were audited using a questionnaire. Proforma used on admission and daily records were audited. Results In admission proforma, recording of parents’ ages was 24%. In history section, birth history and developmental milestones were noted in 74% of records. In examination section, the most poorly filled parts were ‘endocrine’ at 6% and ‘skeletal system’ at 38%. Differential diagnosis and treatment plan were complete in 90% of notes. All entries by doctors and nurses were legibly written and signing and dating of entries had been done in over 80% while writing time of entry and printing of name had been done only in 40% and 38% respectively. A daily entry by a doctor was noted in 98% of BHTs. A consultant had reviewed 56% of the children who had been in-ward.

Awareness and Politics of Venous Thromboembolism in the United Kingdom

Because of travelers’ thrombosis, hard campaigning, and lobbying, the awareness of venous thromboembolism is markedly improving within the United Kingdom. The present improvements relate directly to championing of the cause by a charity and British politicians. This article summarizes the story of the awakening, which had occurred since 2000. “Education, education, education.” Tony Blair, British Prime Minister, 1997 to 2007. In September 2000 the death of a 28-year-old woman, Emma Kristofferson, who collapsed and died from a pulmonary embolism after leaving a 20-hour flight from Sydney to Heathrow airport provoked a media furor. Since that time there have been numerous articles in the British press about travel & deep vein thrombosis (DVT), such that the average informed member of the public is aware of the initials DVT but relates risk to travel. The words “economy class syndrome” and “travelers thrombosis” have entered common parlance. A Lifeblood commissioned MORI poll of more than 2000 people in the UK in 2006 showed that more than 50% of the population could associate leg pain and swelling with the word thrombosis. The issue of travelers’ thrombosis was also picked up by the House of Commons Science and Technology Committee in their report on Air Travel and Health in 2001,1 and after hearing evidence from experts they demanded the airlines provided more information. John Smith MP, Labor member for the Vale of Glamorgan, was elected chairman of an all-party group set up to investigate the causes of flight-related deep vein thrombosis (DVT) and campaigned to increase awareness.2 Despite the growing recognition since 2000 that the risks of developing travelers’ thrombosis are very low for the healthy traveling public, the press interest in this has been sustained. In 2002 frustrated with the lack of awareness and understanding among health professionals and the general public …

Who do I sue? Liability for the treatment of NHS patients by outside providers

The following paper was presented by John Grace QC at the AVMA conference in Glasgow on 29 June 2007. Many practitioners have expressed concern at the difficulties they have encountered in locating the correct Defendant when their client has received NHS treatment in a private hospital or a foreign country or when treated by overseas medical teams flown in. This article examines the different situations which may arise and considers a practical solution to claims which arise in England where the CNST (Clinical Negligence Scheme for Trusts) apply. It should be noted that the CNST does not apply in Wales or Scotland.

Stepping out: the changing role of e‐resources librarians

Stepping out: the changing role of e‐resources librarians

Clinical Negligence Scheme for Trusts (CNST)

Clinical Negligence Scheme for Trusts (CNST)

Learning resource for professionals offering antenatal and newborn care

Learning resource for professionals offering antenatal and newborn care

Achieving Level Three of the Clinical Negligence Scheme

This article discusses my experience, from a theatre nurse's perspective, of meeting Level Three of the Clinical Negligence Scheme for Trusts (CNST). As the practice development sister for Theatres, Day Unit and Endoscopy and as a member of the CNST group, it is my responsibility to gather evidence for my areas.