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NHS Resolution – Board meeting (Part 1) Tuesday 12th March 2019 10:00 – 15:30 Post-Board session 15.30 – 16.30 Venue: DAC Beachcroft, 100 Fetter Lane, London EC4A 1BN

Agenda

Item Time Description

Note

Review

Approval

Presenter

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 23rd January 2019 Approval Chair

1.4 Review of actions from Board meetings Note Chair

2 Operational Items

2.1 10.10 Chief Executive’s report Note Chief

Executive

2.2 10.25 Performance review Note Chief

Executive

3 Management proposals requiring Board input or

approval

3.1 No items to consider

4 Liaison with key stakeholders

4.1 10:40 MSE Report Note DoSE

5 Key Developments

5.1 10.50 Post-LASPO review Note TCD

6 Oversight of key projects

6.1 No items to consider

7 Board Committee Reports and Minutes

7.1 11.00 Audit & Risk Committee Minutes 11.10.18 Note ARC Chair

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8 Other matters requiring Board approval

8.1 11.05 RemCo Annual Report and Terms of Reference Approval Chair

9 11.15 Any Other Business

10 Date and Venue for next meeting

10.1 Wednesday 22nd May 2019 at 10.00am – venue to be

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) 23rd January 2019 10:00 – 15:30 Room G-1, Ground Floor, 151 Buckingham Palace Road, London

Present

Ian Dilks Chair

Keith Edmonds Non-Executive Director

Mike Pinkerton Non-Executive Director

Charlotte Moar Non-Executive Director

Nigel Trout Non-Executive Director

Sam Everington Non-Executive Director (Associate Board Member)

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

Ian Adams Director of Membership & Stakeholder Engagement

Simon Hammond Director of Claims Management

David Gurusinghe Acting Director of Claims Management

Lisa Hughes Head of Primary Care Appeals

Catherine O’Sullivan Governance and Risk Manager

Julia Wellard Executive Assistant (Minutes)

Apologies

Joanne Evans Director of Finance & Corporate Planning

Cheryl Lynch Representative of DHSC Sponsor Team

1 Administrative matters

1.1

Chair’s opening remarks and apologies The Chair opened the meeting by welcoming Simon Hammond, who joined NHS Resolution as new Director of Claims on 7th January, and Lisa Hughes, Head of Primary Care Appeals. Apologies for absence were received from Joanne Evans, Director of Finance and Corporate Planning.

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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 14th November 2018

The minutes of the Board meeting held on Wednesday 14th November 2018 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:

Finance performance report – Director of Finance to make the Finance performance report more comprehensible to people who do not have a finance background. It was considered that the January finance report required further review.

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.

The following actions were closed:

Claims Management performance – Director of Membership and Stakeholder Engagement to arrange for a narrative to be produced on the number of new claims and what the information is showing for Board to use in discussions with stakeholders. This is linked to the next point on Claims Management and is reflected in the current papers.

Claims Management performance report – Acting Director of Claims Management to provide an explanation of what lies beneath claims numbers.

Primary Care Appeals performance report – Chief Executive to ask the Head of Primary Care Appeals to confirm what the difference is between the new and old KPIs and whether they need approving by the Board. The new KPIs do need approving by the Board as reflected in the current papers. The KPIs have now been split between those cases that take longer than 15 weeks as they require legal advice and four weeks have been added.

Appeals Unit panel appointments – Chief Executive to liaise with Head of Governance and Head of Primary Care Appeals whether panel members should be included on our website and the register of interests. It was considered that this required a review of the procedure across the organisation which was underway.

Policies – Head of Governance to look at how review periods for policies are determined and whether they are all three years. The historic basis of time periods is not clear and varies from 2-3 years but we have developed a process document on policy development which will be referred to SMT and will provide guidance on consistency of review periods.

Code of Conduct – Head of Governance to diarise a review of the Code of Conduct after one year to consider how useful and effective it is as it was considered not an easy read. Head of Governance has referred this to the Head of HR who is the policy owner to review content once the next review period is

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due.

DPA Policy – Head of Governance to check the date of SMT approval and that the DPA policy does not need JNC approval. The date of SMT approval was 31 October 2018. Not all policies require JNC approval. Where policies do not affect staff terms and conditions, but are a statement of the legal framework, JNC may note them but are not required to be consulted.

2 Operational items

2.1 Chief Executive’s Report

The NHS Long Term Plan The NHS Long Term Plan which was published on 7th January focuses on improving services outside hospitals and a move towards joined-up preventative and personalised care for patients with an ambition to establish integrated care systems throughout the country by 2021. We are working on integrating the NHS Long Term Plan into our own Business Plan as well as refreshing our five year strategy which should include closer working with NHS England and NHS Improvement. Letter to trust CEOs The Chief Executive circulated a New Year letter to Chief Executives of acute, foundation and community trusts highlighting the following:

the recent reductions in total contributions to both the Clinical Negligence Scheme for Trusts and Liabilities to Third Parties Scheme;

thank members for their support of NHS Resolution and the work to help reduce the cost of claims;

describe the likely overall upwards trajectory of the CNST contribution;

highlight some key publications; and

publicise the imminent launch of our customer survey. The letter also made reference to work we are taking forward with our clinical fellow in Emergency Care this year. The Chair has also sent out similar correspondence to all Chairs of member organisations. The Board noted the Chief Executive’s Report.

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 on 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 November 2018 was presented. It was considered the report continued to be difficult to read and needs to be clearer and more comprehensible to members and the public and the Chief Executive, Director of

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Finance and Charlotte Moar will meet to discuss. Action: CE/DoF/CM

In terms of PIDR, it was noted that we are yet to receive confirmation of the PIDR budget for the current year from DHSC. Claims Performance Analysis was undertaken on claims by tranche and graphs showing the month on month volatility in claims volumes were presented. There are a number of external factors influencing claims trends, in particular the impact of the Legal Aid, Sentencing and Punishment of Offenders Act 2012 (LASPO) which resulted in claims being notified to us before the introduction of costs recoverability reforms, and new firms entering the clinical negligence market to pursue claims as a result of the introduction of fixed fees in other areas of personal injury law. Analysis was also undertaken on matters notified under CNST and LTPS in the financial year 2018/19 to 30th November 2018. Under CNST, this identified that Casualty/A&E claims accounted for 13.1% of new claims, followed by orthopaedic surgery at 11.5%, obstetrics at 10.2%, and general surgery at 8.8%. If the pattern continues, Casualty/A&E will be the largest specialty by volume of claims received in 2018/19. This provides further justification for our strategic decision to deep dive Casualty/A&E claims in 2019/20 with the assistance of clinical expertise. Claims received by NHS Resolution in 2018/19 will, due to the incident to claim creation time-lag, relate to a range of previous incident years. This means that most of the Casualty/A&E claims received in this financial year will relate to incidents that occurred in the 2017/18 and prior financial years and are not, therefore, reflective of care standards in 2018/19. A&E is a clear headline for us and it was considered that this was an interesting piece of work that we should deep dive to understand what it means i.e. whether it relates to more visits to A&E or performance which needs feeding back to the system and it would be helpful for the information to be used externally with stakeholders Board members considered that the level of detail in the claims report had improved and would like to see more on what the claims data are showing i.e. as identified above on A&E, which would provide the vehicle for influencing Chief Executives and Directors of Finance in trusts as to where they could concentrate efforts to reduce claim costs. The clinical fellow who will be working on A&E is a consultant and will also be working across the system with NHS Improvement and NHS England around how this can be taken forward. It was noted that it would be helpful to have updates on how the A&E work is being taken forward in the claims report but it would also be helpful to see what else is coming through the data which needs specific focus and what we are going to do about it. Board members were asked to provide specific comments or questions to the Director of Claims and Acting Director of Claims on what they would like to see in the claims report on a routine basis to understand what is happening overall and whether there are any specific issues which need a deep dive which can be discussed at an informal Board meeting.

Action: All Board

It was suggested that it would be interesting to see the long term trend in new claims in terms of high value claims against low value claims which can then be analysed by specialty and linked across to reserving and pricing.

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Primary Care Appeals performance All KPIs for the reporting period have been fully met save for the KPI for the average number of weeks taken to resolve appeals and disputes (oral hearing) which proved problematic to arrange due to the availability of parties during the summer. A list of existing and new KPIs was presented for Primary Care Appeals and the Board approved the changes. 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 November 2017 to October 2018. There was a noted increase in agency workers for the period with a total of 46 engaged which is mainly as a result of a rise in activity within the IT and Facilities department in order to support the roll-out and delivery of a number of key projects within the department, in particular the Windows 10 project. Sickness absence for the reporting period remains relatively low and the organisation continues to report below the national average rate. There continues to be a large proportion of sickness attributed to anxiety, stress, depression and other psychiatric illnesses, and the HR and OD team are continuing to do more work in this area to analyse the information. This is not a huge issue and they are being managed appropriately with three cases concerning non-work related matters and others being a combination of both work and personal matters. There was some concern that of the 12 people that were reported as having anxiety and stress, five had left and whether there was anything the organisation needed to be worried about but there was nothing of significant concern which needed addressing. It was also noted that the Exit Policy mentions that exit interviews are only given to staff who had left voluntarily and the Head of HR will look into this as this should not be the case.

Action: HoHR

In terms of leavers, it was noted that there had been 35 leavers in the reporting period with four leaving due to incompatible working relationships and whether there is any learning to be taken forward for managers. However it was noted that the incompatible working was not necessarily with the line managers but with colleagues and it is not always possible to resolve these issues. Managers undertake training in dealing with difficult conversations as well as receiving development on leadership skills.

In terms of employee relations, since the last reporting period, there have been nine new cases which are being managed to resolution in a timely manner and on an informal basis where possible with mediations being taken forward before they become formal.

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Following the staff survey, the HR and OD team continue to implement and deliver a number of workstreams to support the delivery of the strategy including a mentoring scheme and leadership programme There are six Mandatory and Statutory Training (MAST) courses which all staff are required to comply with and compliance has improved since last summer from 60% to 90%. It was proposed that the Non-Executive Directors (NEDs) should be required to complete the information governance and equality and diversity training, however, NEDs can submit certificates for completion of these courses which they have undertaken within other organisations. It was considered that NEDs are not required to complete fire safety and health and safety management as they are almost always accompanied by other NHS Resolution staff which therefore mitigates any potential risks. However, it was pointed out that some NEDs have attended the office to work and therefore do not consider themselves as guests. This will be kept under review. The Board therefore approved the approach in relation to MAST for NEDs. It was encouraging to note that we now are able to provide fraud and bribery awareness training to new starters which has been developed by our Local Counter Fraud Specialist (LCFS). Renewals on this training will be provided by multiple annual drop in sessions which all staff will be invited to attend and compliance monitored in the same way as MAST requirements. In terms of the staff survey, a question was asked whether we benchmark ourselves against other equivalent bodies and whether others are doing well and how we can learn from them. It was considered that the range of activities that the organisation is taking forward for staff in terms of development etc speaks of a positive culture in the organisation. The Senior Management Team are also taking forward some specific work on equality and diversity and Roger Kline has agreed to facilitate that session. One of the HR and OD objectives relating to developing an Equality, Diversity and Inclusion (E,D&I) Agenda mentions that the next step is that there is to be a facilitated session on E,D&I with SMT in early 2019 and this is around broadening our agenda rather than dealing with a specific issue which has been raised. A report has been produced on Race Equality and Ethnicity Pay and one of the three recommendations as part of the implementation plan is for the organisation to voluntarily publish its race data in accordance with the Workforce Race Equality Standards (WRES) along with other ALBs. The report will be considered as wider development of our E,D&I agenda and, as mentioned above, a facilitated session is to be run for SMT and other key stakeholders across the organisation. The general view is that we support the proposals to introduce ethnicity pay reporting internally. The Race Equality and Ethnicity Pay Report will be used as a basis for the sessions with Roger Kline. The Board thanked the Head of HR and his team for the report which the Board noted.

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2.4

2018 Gender Pay Gap Report NHS Resolution is required to publish its gender pay gap (GPG) data by March 2019 in accordance with recent requirements set out in the Equality Act 2010. A report was provided on the organisation’s GPG data which shows that there has been a positive reduction in the organisation’s mean gender pay gap over the last 12 months. Work has been undertaken by the team looking at starting salaries following an issue raised at SEG and there has also been an internal audit around recruitment. We have a fair, transparent and open recruitment process but there have been some issues around whether we have been consistently applying Agenda for Change conditions appropriately. We are therefore looking at whether we are implementing best practice in our recruitment process and it was suggested that we could benchmark ourselves against those organisations who do really well in meeting the right standards. Reference was made to Roger Kline’s The “Snowy White Peaks” of the NHS report which is a survey of discrimination in governance and leadership and the potential impact on patient care in London and England and the SMT will look into this. The Board noted the Gender Pay Gap 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 new website has been fully operational since 17th October 2018 and has seen a high increase in visits with longer viewing times, more pages being viewed and return visits. In terms of the most popular areas of the website, the top most visited pages relate to the Maternity Incentive Scheme and the article on Darnley vs Croydon with visits on average lasting for approximately three and a half minutes. There is a remarkable improvement with the number of users doubled in the last three months compared with the previous website which reflects the improved functionality of the site and increased access of relevant information. There has been considerable engagement by the Safety and Learning team, in particular the Conversations on Consent event which was held on 28th November in Ipswich and this event is being repeated. There have also been a number of joint events between the Safety and Learning

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team and the Practitioner Performance Advice team. Michele Golden has joined the Safety and Learning Team from CQC as new Deputy Director of Safety and Learning. The Board noted the Communications and Stakeholder Engagement Report.

5 Key Developments

5.1

Legal Update Civil Liability Act 2018 The Civil Liability Act 2018 received Royal Assent on 20th December and introduces a new basis for setting the Personal Injury Discount Rate (PIDR). XX v Whittington Hospital NHS Trust (Court of Appeal, 19.12.2018) This claim demonstrates the propensity of higher courts to extend the scope of liability to increase damages in personal injury litigation. The case relates to a claimant developing cancer of the cervix following failure to detect signs of cancer from both smear tests and biopsies. The claimant required chemo-radiotherapy which led to infertility and severe radiation damage to parts of her lower body. Liability was not disputed and at a quantum trial in the High Court in 2017, the judge limited the claimant’s recovery of damages for the cost of surrogacy arrangements and the claimant appealed againt this element of the ruling. The Court of Appeal decided that it would be appropriate to award damages for commercial surrogacy, including fees payable to the birth mother, on the basis that the arrangement was being taken forward in California where it was lawful to do so and it would be inappropriate to deprive the claimant of damages when she personally proposed no wrongdoing. The first instance judgment was overturned and the recovery of full commercial surrogacy costs was approved. As a consequence of this ruling, it is likely that NHS Resolution will see further claims of this type and given the important issues of principle involved we are therefore contemplating an appeal to the Supreme Court. It was suggested that we should look at obtaining costings from Surrogacy UK rather than settling on the American costs. The TCD confirmed that the first instance judgment endorsed settlement on UK costs. The Board noted the legal update.

6 Oversight of Key Projects

6.1

There was nothing to report.

7 Board Committee Reports and Minutes

There were no committee reports and minutes to note.

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8 Other matters requiring Board attention

8.1

Policies for noting/approval The following policies have been updated to reflect a consistent approach with other recently updated HR policies, including the addition of a contents page, standard equalities statement and an equality impact assessment tool.

8.1.1

Work Placement Policy and Procedure Key changes to the policy are:

Contents page added

EQIA added

Approval for applications changed to appropriate Director

Timescales removed A question was raised on how we advertise for placements and they are advertised to everyone and the Head of HR will ensure that this is explicit in the policy.

Action: HoHR The Board noted the Work Placement Policy and Procedure.

8.1.2

Dress Code and Appearance Policy Key changes to the policy are:

Three yearly review

Updated introduction and monitoring section

Include equality assessment form

The Board noted the Dress Code and Appearance Policy.

8.1.3

Drugs and Alcohol Policy Key changes to the policy are:

Three yearly review

Update Section 5 Legislation - GDPR

Revised sections 7 – EAP link.

Include equality assessment form

The Board noted the Drugs and Alcohol Policy.

8.1.4

Exit Process and Exit Interviews Procedure Key changes to the policy are:

Table of Content added

Section 7 - GDPR – use of data

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Section 8 – provision of factual reference

Flowchart

The Head of HR to ensure that the policy includes that all leavers should receive an exit interview.

Action: HoHR The Board noted the Exit Process and Exit Interviews Procedure.

8.1.5

Agency Workers Key changes to the policy are:

Contents page added

EQIA include

Introduction added

Purpose and scope added

IR35 compliance added

WSG approval added

ID & Right to Work checks added

Induction added

Internal vacancies added

Exit process added The Board noted the Agency Workers Policy and Procedure.

9 Any Other Business

9.1

There was no other business.

10 Date and Venue for next meeting

10.1 The next Board meeting is scheduled for Tuesday 12th March 2019 at 10.00am, venue tbc.

Signed ……………………………………………………….……… Date ………………………………………………………………….

Board Actions – January 2019 Part 1

Action Ref No. Date of Board

Meeting Part 1 or

Part 2

Reference

Action

Date action due

Officer responsible RAG rating

Status of action

18.10 16.5.18 Part 1 Claims Management

Performance

DoMSE to arrange for a narrative to be produced on the number of new claims and what the information is showing for Board to use in discussions with stakeholders.

January Board DoMSE CLOSED

As this narrative might be a useful external publication and support work arising from the cross-government strategy, the CE and MSE team are considering how this can be taken forward.

18.22 14.11.18 Part 1 Finance performance

Report

DoF to make the Finance performance report more comprehensible to people who do not have a finance background.

January Board DoF CLOSED

Following the January Board meeting, it

was considered that this needed further

work.

18.23 14.11.18 Part 1 Claims Management

Performance Report

ADoC to provide an explanation of what lies beneath claims numbers.

January Board ADoC CLOSED completed

18.24 14.11.18 Part 1 Primary Care Appeals

Performance Report

CE to ask the HoPCA to confirm what the difference is between the new and old KPIs and whether they need approving by the Board.

January Board CE CLOSED

KPIs require Board approval. KPIs

have been split and those that take

over 15 weeks because they require

legal advice have h ad four weeks

added.

18.25 14.11.18 Part 1 Appeals Unit Panel

Appointments

CE to liaise with HoG and HoPCA whether panel members should be included on our website and Register of interests.

ASAP CE/HoG CLOSED This should be the same procedure

across the organisation.

18.26 14.11.18 Part 1

Learning from suicide

related claims: A thematic

review of NHS Resolution

data

DoS&L to bring a report back to Board in 6-9 months on what has happened since the report was launched.

September 2019 Board

DoS&L Not yet due

18.27 14.11.18 Part 1 Policies HoG to look at how review periods for policies re determined and whether they are all three years.

ASAP HoG CLOSED

The historic basis of time periods is not

clear and varies from 2-3 years but we

have developed a process document

on policy development which will be

referred to SMT and will provide

guidance on consistency of review

periods.

18.28 14.11.18 Part 1 Code of Conduct

HoG to diarise a review of the Code of Conduct after one year to consider how useful and effective it is as it was considered not an easy read.

ASAP HoG CLOSED

HoG has referred this to the policy

owner [Michael Humphries] to review

content once the next review period is

due.

18.29 14.11.18 Part 1 DPA Policy HoG to check the date of SMT approval and that the DPA policy does not need JNC approval.

ASAP HoG CLOSED

The date of SMT approval was 31

October 2018. Not all policies require

JNC approval. Where policies are not

about affecting staff terms and

conditions, but are a statement of the

legal framework, JNC may note the

policy but are not required to be

consulted on it.

19/01 23.1.19 Part 1 Finance Performance

CE/DoF/CM to meet to talk through how the Finance performance report can be made more comprehensible to members and the public.

For March meeting

CE/DoF/CM

This has happened and the finance

report has been changed to reflect

feedback

19/02 23.1.19 Part 1 Claims Performance

All Board to feedback to DoC/ADoC what they would like to see in the claims performance report on a routine basis, and whether there are any specific issues which need a deep dive which can be discussed at an informal Board meeting.

ASAP All Board For further discussion following GAD

Board education session.

19/03 23.1.19 Part 1 Exit Policy

HoHR to ensure that the Exit Policy includes that all leavers should be invited to have an exit interview before the leave the organisation.

ASAP HoHR

To be closed. The current policy is clear

that is applies to all staff and workers.

This includes those on fixed-term

contracts and agency workers.

19/04 23.1.19 Part 1 Work Placement Policy

and Procedure

HoHR to ensure that the policy is explicit in explaining how placements are advertised.

April 2019 HoHR

Policy will be updated to reflect how

placements will be advertised although

like the recruitment to substantive roles

this is likely to vary depending on the

specific requirements. Policy to be

updated by April 2019.

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Chief Executive’s Report Board meeting (Part 1) 12th March 2019

NHS Resolution and the Parliamentary and Health Services Ombudsman (PHSO)

NHS Resolution and the PHSO have been taking forward work to collectively support

organisations to be more effective in handling incidents which may escalate into a complaint

and/or compensation claim. In order to give clarity on our respective roles we published joint

guidance at the end of January which can be found here: Joint guidance NHS Resolution

and PHSO

The guidance includes recognition of the overlap which may occur when the PHSO makes

an award in respect of injury or damage that falls under one of our schemes, and explains

the circumstances under which we might reimburse a trust, wholly or partly, when an award

has been met. It also highlights that such awards can in some circumstances be set off

against damages claims, to prevent double recovery.

We hope that the guidance will become a useful resource for NHS complaints and claims

managers, and for our own staff, and that it addresses an area of overlap which is frequently

raised by them

GP Indemnity On 31st January NHS Resolution was confirmed as the scheme operator (as well as administrator) of the new state backed scheme for general practice – the Clinical Negligence Scheme for General Practice (CNSGP). The scheme will commence on 01 April 2019. CNSGP forms part of a wider package of changes to GP contractual arrangements, through which NHS England and the British Medical Association (BMA) have agreed a five-year GP contract framework from 2019/20. The state backed indemnity scheme is a crucial element of the new contract and is a clear commitment to addressing the concerns raised by GPs in recent years. The scheme aims to provide a more sustainable system of indemnity for general practice. It is also expected to contribute to improving retention and recruitment, remove the administrative burden of organising personal clinical indemnity cover, and support new models of care by providing a more streamlined way for general practice clinicians to be indemnified for their NHS work across multidisciplinary teams. We will work with the Department of Health and Social Care (DHSC), NHS England, the Medical Defence Organisations (MDOs), GP representatives and others to make the transition to the state scheme as seamless as possible for those working in general practice. We recently published a webpage which provides information on the new scheme together with a contact address for queries.

https://resolution.nhs.uk/resources/information-for-nhs-trusts-on-the-respective-roles-of-the-parliamentary-and-health-service-ombudsman-and-nhs-resolution/https://resolution.nhs.uk/resources/information-for-nhs-trusts-on-the-respective-roles-of-the-parliamentary-and-health-service-ombudsman-and-nhs-resolution/

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Response submitted to draft patient safety strategy On 15 February 2019, we submitted our consultation response to the draft patient safety strategy proposed by NHS Improvement. In our response, we highlighted the need for any patient safety measures to be aligned with the top five areas that result in high value claims. We also invited support to further develop incentive schemes, and drew attention to key priorities in our business plan that are opportunities for further collaboration. We have since met with the NHSI patient safety team to take forward some of the ‘asks’ contained within our consultation response, including work to further define the scope of our thematic work on emergency claims.

The Board is asked to note the Chief Executive’s report.

https://engage.improvement.nhs.uk/policy-strategy-and-delivery-management/patient-safety-strategy/user_uploads/developing-a-patient-safety-strategy-for-the-nhs-14-dec-2018-v2.pdfhttps://engage.improvement.nhs.uk/policy-strategy-and-delivery-management/patient-safety-strategy/user_uploads/developing-a-patient-safety-strategy-for-the-nhs-14-dec-2018-v2.pdf

Board meeting – Part 1 12th March 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.

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Performance Report Board meeting (Part 1) 12th March 2019

Finance Executive Summary

Departmental Expenditure Limit (DEL) budgets

Year to date net expenditure on all budgets is £140m underspent which now includes

an agreed PIDR budget of £369m.

Indemnity scheme budgets, excluding the PIDR impact, are underspent against

budget by £134m. The last position reported to Board based on November data was a

£130m underspend.

£308m has been spent on the additional costs of PIDR year to date, £3m more than

we were forecasting by this point in the financial year.

Administration costs are £1.4m underspent. We expect this to reduce to £1.2m by

year end as we continue to fill vacancies and progress work to set up the expanded

accommodation in Leeds.

Capital expenditure at the end of January is £818k against a budget of £1,509k for the

full year, including additional funding for the expanded Leeds office. We are currently

expecting this to be fully spent.

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.

Discussions have been held with DHSC and HM Treasury to provide an update on the

potential effect of in year trends on a limited range of factors that affect the value of

scheme liabilities, and a range of scenarios to inform this year’s budget.

A budget of £10.6bn has been agreed for this year for the Parliamentary Spring

Supply Estimate, an increase from £7.7bn in the Main Estimate, which was based on

forecasts in the 2015 Spending Review. This budget allows for uncertainty in the

valuation until the full actuarial review has been completed.

The approach and scenarios were reviewed by the Chair of the Audit and Risk

Committee and Chief Executive before submission to DHSC. DHSC Finance made

the final selection for the Spring Supply Estimate and DHSC have confirmed that they

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are content that NHS Resolution has discharged its responsibilities in relation to

supporting them in forecasting the year end position.

Department Expenditure Limit (DEL) Position

The income and expenditure for the year to January 2019 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 underspend at January 2019 is £140m. There is a favourable variance on Income as a result of additional contributions from new independent sector members joining CNST, and 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 to minus 0.75%. The indemnity schemes are underspent by £130m at the end of January; which includes the agreed budget of £369m relating to expenditure due to the change in Personal Injury Discount Rate (PIDR). The table above shows forecast full spend against budget for Member Funded Schemes and DHSC Funded Schemes. However, given the year to date position, we do expect that there will be an underspend on the baseline expenditure budget as a result of continued favourable trend in the settlement of claims, and have reported to DHSC that it could be in the range of £100m to £150m. Claimant legal costs have been one area where we have started to see improved trends. The findings set out in the paper later in Part 1 Board on the government’s post implementation review of the Legal Aid, Sentencing and Punishment of Offenders Act 2012 (LASPO) may be partial contribution to such trends. Administration costs are currently underspent by £1.4m, but budget holders are reporting an increase in the rate of expenditure towards year end as recruitment activity progresses, and in anticipation of preparing the Leeds office for occupation.

3

Detailed Indemnity Schemes Expenditure at January 2019

Budget Actual Variance

£'000 £'000 £'000

Ex-RHA 833 1,059 (226)

ELS 30,543 30,990 (446)

DH Clinical Liability 101,381 77,242 24,139

DH Non-Clinical Liability 8,427 4,851 3,576

CNST 1,907,895 1,806,490 101,405

PES 9,540 6,377 3,163

LTPS 38,468 38,881 (412)

Total 2,097,088 1,965,889 131,199

Year to Date

The table above shows a breakdown of expenditure by scheme at January. This includes baseline expenditure of £1.658bn and PIDR expenditure of £308m. Across all schemes the damages and claimant costs budgets are underspent by £143.3m (10%), defence costs and periodic payment budgets are overspent by £8.3m (2%) Annually Managed Expenditure (AME) Position The budget for Annually Managed Expenditure (AME) is the change in the value of the liability in the accounts between the start and end of the financial year. Some work has been completed to update the AME budget for Parliamentary Spring Supply, drawing on trends observed in claims so far this year. We provided DHSC a range of options of where AME might land based on the work completed so far. DHSC submitted a forecast of £10.6bn to HMT which included a 7% allowance for impacts of changes to methodology and assumptions, excluding the impact of adopting segmentation on the basis of specialty. We have had confirmation that HMT have approved the updated AME budget of £10.6bn. It is important to note that this is not a complete review of all key assumptions (this piece of work takes place from December to March), and therefore creates some risk and uncertainty in relation to being able to accurately forecast AME budget requirements at this stage.

Capital Budget Position

This annual capital budget is £1,509k. The forecast is to utilise the full budget by the end of

the year.

4

Prompt Payment Policy and Reporting of Performance

The number of invoices paid within 30 days remains below the target of 95% at 85%. We have reviewed our processes to improve performance in this area, and changes have been implemented which has increased performance year on year, but we are unlikely to achieve the target until the update to the financial accounting system is implemented later in the year.

5

Claims Executive Summary This paper reports the number of claims for compensation and reports of potential claims received by NHS Resolution under our indemnity schemes. 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 new notifications received under our two principal schemes in

the financial year 2018/19 to 31st January 2019 compared with the corresponding period in 2017/18.

Scheme 2017/18 2018/19 Rate of

change

Clinical Negligence Scheme for Trusts

(CNST ) 8,779 8,751 -0.32%

Liabilities to Third Parties Scheme

(LTPS) 2,901 2,833 -2.34%

The graph below shows the month on month volatility in claims received under CNST and LTPS year-

on-year since 2005/6

We refer to previous board reports for commentary on the external factors which have a direct impact

on the number of claims received.

6

The graph below shows in greater detail the claims received over the last three financial years and

year to date.

CNST

We received 8751 new matters, down by 0.32% against the same period in 2017/18.

There appears to be a strong volatility around claims reported in CNST over the last 18 months. This

may be being fuelled by market conditions such as the change in the PIDR.

The overall pattern is more stable than the preceding periods and claims volumes generally appear to

be plateauing.

The charts below shows claims received to date during the current financial year split by value and

speciality. Only the top 4 categories are shown. This excludes EN and incidents.

47

9 9

4

0

5

10

15

20

25

30

35

40

45

50

Obstetric A & E Paediatric Orthopaedic

Claims received by value (%)

7

The continuing trend is A&E represents the highest volume of claims received but only accounts for

9% of the overall value. Obstetric claims account for only 9.7% of claims volume but represent 47%

of value.

Commentary on Trends

Overall this quarter we have seen a drop in the number of claims but this is negligible which supports

a hypothesis that claims volumes are largely stable, mirroring the previous year results. We do not

anticipate a large volume spike in either direction in the remainder of the financial year.

LTPS

We received 2833 new matters, down 2.34% against the same period in 2017/18.

Commentary on Trends

We are seeing a continual downward trend in LTPS cases since the peak in 2011/12. The latest

downward trend shows the lowest number of new claims received since 2006/07.

We expect the number of new claims received to remain stable, with minor spikes. .

8

Practitioner Performance Advice Case advice service

All performance quoted to 31/01/19 A total of 769 new requests for advice were received from April – January 2019. The number of new requests for advice as at January 2019 indicates an increase of 1.5% compared to the same period last year. Chart 1: New requests for advice – year to date

Chart 2: New requests for advice – month on month

9

Chart 3: New requests for advice – by sector (YTD)

Chart 4: New requests for advice – by profession (YTD)

* 34 General requests for advice cases are not included in the practitioner figures for FY18/19YTD.

Healthcare Professional Alert Notices (HPANs) In January 2019 there were 18 active HPANs. In January 2018 there were 16 active HPANs. 100% of Healthcare Professional Alert Notices were issued within 7 working days from decision to issue during April 2018 to January 2019. The percentage is based on a total of 26 HPAN requests in this period. 100% of Healthcare Professional Alert Notices were revoked within 7 working days of decision to revoke in April 2018 to January 2019. The percentage is based on a review of 24 HPANs all of which were revoked within the target timeframe during this period.

10

Chart 5: Healthcare Professional Alert Notices – year to date

External education and learning 100% of education events delivered during April 2018 – January 2019 were rated at least 4 out of 5 for effectiveness/impact by participants.

WORKSHOPS Activity summary in FY18/19 up

to 31 January 2019 Activity summary in FY17/18 up

to 31 January 2018

Total: 49 25

- In-house - Public - Bespoke

30 15 4

12 10 3

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. The increase in demand of workshops is attributed to improved marketing and communication which has strengthened the profile of our events and it is expected to continue to increase as we launch our revised educational material.

Exclusions in England (secondary care only)

93.1% of exclusions in England (Secondary Care) were reviewed within the target timeframes. The above figure is based on seven exclusions not having been reviewed within the reporting period. The delays in reviewing the exclusions that did not meet the KPI were due to the employer’s non-availability; however, in all cases where the KPI was not met, the exclusions have now been reviewed.

11

Assessment and Interventions (A&I) The table below shows the current live activity for the assessment and interventions services.

Area Activity summary for the FY18/19 (up to 31 January 2019)

Assessments and interventions

Full performance assessments • 9 assessment reports issued and 2 partial assessments completed • 1 assessment report being prepared Professional Support and Remediation action plans • 31 action plans issued • 3 action plans being prepared

Other interventions

15 assessment of behavioural concerns reports issued

6 assessments of behavioural concerns being planned or report being prepared

1 occupational health assessment report issued

8 assisted mediation completed

1 assisted mediation being planned

Key performance indicators

Service Measure to report % FY 18-19 YTD up to

31 January 2019 % FY 18-19 YTD up to

30 November 2018

Advice Service

90% of requests for advice responded to within 2 working days (or within an alternative timeframe requested by the Employing/Contracting O)

100%

100%

Healthcare Professional Alert Notices (HPANs)

90% of HPANs issued/released (where justified) within 7 working days 90% of HPANs revoked (where justified) within 7 working days

100% 100%

100% 100%

External education and learning

90% of education events rated by participants at least 4 out of 5 for effectiveness/impact

100%

100%

Exclusions and suspensions

90% of all exclusions/ suspensions critically reviewed (where due)

93%

95%

12

Primary Care Appeals Primary Care Appeals - Performance against Key Performance Indicators 2018-19

Target Indicator

Dec 2018

(Dec 2017)

Jan 2019

(Jan 2018)

90% % of "first step" letters sent out within 7 days of receiving the appeal or dispute

100% (100%)

100% (100%)

100% % of appeals or disputes where 14 or more days notice of hearing has been given

NA (100%)

100% (NA)

80% % of appeals where Decision Maker agreed with recommendation of Case Manager

88% (100%)

89% (71%)

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 - Internal input only

7* (13)

12 (12)

19 weeks

The average number of weeks taken to resolve appeals and disputes – additional input

18 (17)

10 (16)

25 weeks

The average number of weeks taken to resolve appeals and disputes - Oral Hearing

18 (36)

24 (24)

33 weeks

The average number of weeks taken to resolve disputes – CMR valuation input required

31 (NA)

37** (NA)

Excludes 20 APMS disputes delegated to NHS Resolution under special Directions. * the average number of weeks for this KPI is particularly low because we had a small number of applications to change pharmacy opening hours over the Christmas period. In order to ensure these were completed before Christmas where possible, and with the agreement of parties, we truncated the process. ** this was one case and it missed target given it was a particularly complex case requiring additional circulations. Due to a determination in a different case, we became aware that the parties to this case were using the wrong Directions. Therefore we sent out to parties again allowing them to amend their representations to take into account the alternative Directions.

13

Safety and Learning Agreed KPIs – 2018/19 Board – March 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 ‘Getting it Right First Time’ (GIRFT) with clarification requested on scorecard data and the differences in relation to the GIRFT data. Forty 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. All email responses completed within the time scale target apart from one. This KPI compliance is 97.5%. 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

London 16 April- Chelsea and Westminster NHS Hospital Maternity event. Delegates attended from all over the London region.

1

London 26 April Learning from Claims ‘sector scorecard’ North West London NHS Trust Transformation for Musculoskeletal (five member trusts, six CCGs and GIRFT). This was a short task and finish project led by CEO Hillingdon. Claims data supported service improvements in individual trusts and business case for fracture service across sector.

2

London Datix event 9 May – Birmingham24 May Leeds 4 and 20 July London – working in partnership with Datix to share the learning of Local Incident Reporting Provider project back to members – audience of governance and quality leads.

3

South 31 May- Bristol Mental Health Trusts met to share scorecards data, discuss safety solutions and challenges, heard from Dr Oates on emerging themes from deep dive into mental health data.

4 (&11)

North 5 June- Leeds.

5

14

Hosted by DAC Beachcroft, several Trusts from mental health and acute sectors gathered for round table discussions. Dr Oates delivered a presentation on her work reviewing

North 20 June- Harrogate Hosted by Hempsons, the Mental Health Clinical Fellow presented a case study and discussion workshop. Discussed work involved for upcoming report.

6

Midlands and East 20 June- Birmingham A regional event was held by Datix attended by several regional trusts. The Safety and Learning team presented the work of NHS Resolution and the safety and learning team at both events.

7

South 26 June- Portsmouth South Region external reference group held. The focus of the event was on learning from Incidents with a presentation from Healthcare Service Investigation Branch( HSIB) panel and members on good practice

8

North 27 June- Leeds A regional event was held by Datix attended by several regional trusts. The Safety and Learning team presented the work of NHS Resolution and the safety and learning team at both events.

9

North 4 July- Newcastle Hosted by DAC Beachcroft in Newcastle, a number of Trusts from mental health and acute sectors gathered for round table discussions. Alice Oates delivered a presentation on her work reviewing suicide and attempted suicide claims.

10

National Event 5 July- London Mental Health Matters- a variety of speakers, from multi agencies including the Police and Arms Length Bodies, presented information on mental health issues.

11

North 10 August- Manchester Clinical Commissioning Group Engagement hosted by Hempsons. These are a series of regional events lead by the Safety and learning team in collaboration with panel firms.

12

South September 19- Bristol Clinical Fellow presentation of report ‘Learning from suicide related claims’ to 10 regional mental health trusts.

13

South September 26- Winchester South Region External Reference Group. Presentations from Healthcare Safety Investigation Branch and DAC Beachcroft.

14

South October 1 - Exeter South West Quality Improvement Network. Working collaboratively with NHS England and NHS Improvement delivered an event to support quality improvement.

15

South October 16 - Reading. NHS England regional event for responsible officers. The director of safety and learning facilitated a workshop in collaboration with Practitioner Performance Advice

16

North: October 22 – Newcastle Round table discussion, hosted by DAC Beachcroft, on effective use of the scorecards, representation from seven north east trusts.

17

15

London: October 26 - Learning from suicides through claims. - 55 delegates and 20 different trusts

18

North: November 21 – Liverpool Clinical Commissioning Group Engagement hosted by Hill Dickinson. These are a series of regional events lead by the Safety and Learning team in collaboration with panel firms.

19

National event: November 28 – Ipswich Conversation on Consent Nadine Montgomery (Montgomery v Lanarkshire health board 2015) gave a personal account of her own experience which provided a unique insight into the patient perspective. Delegates engaged in conversations on the complexities of consent.

20

North: December 3 - Leeds Round table discussion, hosted by DAC Beachcroft, on effective use of the scorecards, representation from seven north east trusts.

21

National event: January 31 – London Ambulance staff matter: improving Safety at the frontline attendees of all ten England ambulance trusts represented. Various work streams and new models of working shared for trusts to implement.

22

London: February 2 - Safety & Learning workshop with Barking, legal and HSIB

23

The Safety and Learning Team has an over achievement of this KPI- compliance is currently over 100% in the last quarter of financial year.

Products 3. Eight safety and learning products to be made available for members in 2018/19.

Products to date:

Product Product number of 8

Consent leaflet: This was trailed in Resolution Matters in March and was delivered in readiness for sharing at the first major platform at the Royal College of Nursing Congress in May, followed by Bristol Patient Safety Conference in May. Several members have expressed an appetite for sessions focussed on consent.

1

Case Stories: Two Case stories were shared at the Mental Health national safety and learning event on 5 July.

2 & 3

Maternity Pressure Ulcer leaflet: This leaflet is currently being updated with current claims figures and NHS Resolution branding. It is expected to be published in the Autumn 2018

4

Neonatal Jaundice leaflet: This leaflet is currently being updated with current claims figures and NHS Resolution branding. Now completed and published Autumn 2018

5

The Assaults leaflet: This product is currently in draft and collaboration is being coordinated with the Health and Safety Executive (HSE); NHS England; Royal College of Nursing (RCN) and Unison. It is expected to be published in May 2019.

6

Learning from Suicide-related claims: 7

16

The full report from our clinical fellow is also available in a summary leaflet which emphasises the nine recommendations made in the report. This has been very well received by members at recent events.

Teaching Video: A community district Nurse experience and learning of being involved in a claim.

8

The percentage compliance of the KPI (currently achieved. 8 products of 8) ** This KPI compliance is 100%.

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 planning the schedule of 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%.

Membership and Stakeholder Engagement

report

Board meeting (Part 1)

Tuesday 12 March 2019

Agenda item: Part 1

Title of paper: Membership and Stakeholder Engagement activity report,

October to December 2018

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, December 2018 to February 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.

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Membership and Stakeholder Engagement report Board meeting (Part 1) [12 March 2019]

A: Corporate communications/media relations Publications Resolution Matters (1 February 2019) Included articles relating to:

A second year of the maternity incentive scheme

An update on the Clinical Negligence Scheme for General Practice (in particular that NHS Resolution will operate the scheme).

A joint statement for claims and complaints managers in Trusts to outline how our services inter-relate and interact with the Parliamentary and Health Service Ombudsman

Changes to Practitioner Performance Advice assessments

A note about our extranet refresh

The announcement of a new Leeds office

Our case of note: XX v. Whittington Hospital NHS Trust (Court of Appeal 19/12/2018)

Resources from the Early notification scheme – specifically targeting staff support including details of the available support for staff and two case studies looking at: Understanding the risk of maternal and neonatal hyponatraemia and Learning lessons in maternity from a recent Supreme Court ruling (Darnley).

Details about our new Director of Claims Management

An overview of our event: Ambulance staff matter

Details of our 2018/19 customer survey Evaluation Sent to 5,173 contacts with 454 people clicking on links, we had an overall 33.53% click rate and an average of 3.17 clicks per person for this campaign. The top five links utilised were:

Topic Unique opens

CNSGP 143

NHS Resolution and the Parliamentary Health Service Ombudsman 111

A second year of the maternity incentive scheme 92

Case of note 86

Introducing Simon Hammond 72

https://nhsresolution.createsend1.com/t/i-l-nhjoyd-l-q/https://nhsresolution.createsend1.com/t/i-l-nhjoyd-l-a/https://nhsresolution.createsend1.com/t/i-l-nhjoyd-l-a/https://nhsresolution.createsend1.com/t/i-l-nhjoyd-l-f/https://nhsresolution.createsend1.com/t/i-l-nhjoyd-l-f/

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Direct marketing Resolution Matters (1 February 2019) http://createsend.com/t/i-068BE0C91A1AD1342540EF23F30FEDED Customer survey warm-up email (10 January 2019) An email sent to a range of customers to provide advanced warning of our annual survey from Helen Vernon http://createsend.com/t/i-CF8DAB316AD645722540EF23F30FEDED Followed by the invitation (18 January 2019) the invitation at director level http://createsend.com/t/i-0604EE79B762AEB22540EF23F30FEDED Followed by a first reminder (29 January 2019) send at director level http://createsend.com/t/i-DCA688AF3A46628A2540EF23F30FEDED Followed by a second reminder (6 February) sent on behalf of Helen Vernon http://createsend.com/t/i-DCA688AF3A46628A2540EF23F30FEDED With tailored correspondence to chief executives and chairs to highlight a reduction in the total contributions to the CNST and to the Liabilities to Third Parties Scheme. These emails also drew attention to the rising costs of clinical negligence, some recent publications and the impending customer survey New Year Letter (sent on 11 January 2019) Ian Dilks contacted CNST member chairs http://createsend.com/t/i-D7A0D9F8950CC5B12540EF23F30FEDED New Year Letter (sent on 9 January 2019) Helen Vernon contacted CNST member chief executives http://createsend.com/t/i-BC36EE5FDF8E44D02540EF23F30FEDED External promotion and awards We are delighted that in a joint submission with our design agency, Studio North, we have been shortlisted for two awards by Transform Awards Europe in the categories of Best naming strategy1 and Best brand consolidation2. The awards focus on recognising brand development and rebranding projects, recognising excellence and reward innovation in branding across Europe. The winners will be announced on 28 March in London. The awards website explains: “The awards recognise best practice in corporate, product and global brand development work, with categories that focus on strategy, execution, content and evaluation. More than that, it is a platform for organisations to tell their stories and to discuss reputational change. Companies and agencies entering the Transform Awards have their work benchmarked against their peers and stand out amongst their competitors, rewarding excellence across the whole brand development process.”

1 Best naming strategy: this award honours innovation in naming. It is for the most appropriate new name for a new brand, rebrand or brand extension or where an organisation can demonstrate a clear and well thought through naming strategy.

2 Best brand consolidation: this award is for the most effective alignment of individually branded elements and sub-brands of an organisation.

http://createsend.com/t/i-068BE0C91A1AD1342540EF23F30FEDEDhttp://createsend.com/t/i-CF8DAB316AD645722540EF23F30FEDEDhttp://createsend.com/t/i-0604EE79B762AEB22540EF23F30FEDEDhttp://createsend.com/t/i-DCA688AF3A46628A2540EF23F30FEDEDhttp://createsend.com/t/i-DCA688AF3A46628A2540EF23F30FEDEDhttp://createsend.com/t/i-D7A0D9F8950CC5B12540EF23F30FEDEDhttp://createsend.com/t/i-BC36EE5FDF8E44D02540EF23F30FEDEDhttp://www.transformmagazine.net/awards/europe/http://www.transformmagazine.net/awards/europe/the-shortlist/

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Media relations: 28 December 2018 – 14 February 2019 Media enquiries per month December (whole month): 10 January: 26 Up to 19 February: 6 Media highlights In January, we publicised plans for the new Clinical Negligence Scheme for General Practice, or CNSGP. This was part of the announcement on General practice indemnity which was included in Investment and evolution: A five-year framework for GP contract reform, agreed by NHS England and the British Medical Association. We made an announcement on our website: NHS Resolution to launch a new indemnity scheme for general practice NHS Resolution is delighted to be launching an indemnity scheme for General Practice for clinical incidents occurring on or after 1st April 2019. NHS Resolution to launch a new indemnity scheme for general practice Through the Chair, in February we secured a print interview with the outgoing legal editor at The Times, who met with Helen Vernon and Ian Dilks. They discussed how we handle clinical negligence claims and the current legal system. It was an opportunity to dispel myths around so-called ‘delay, deny, defend’ behaviour and to highlight our role in the wider healthcare system around learning from harm. When it comes to NHS negligence, prevention is better than cure (The Times, Frances Gibb, Thursday 7 Feb 2019) When every penny spent on the NHS feels precious, there is mounting concern at the huge rise of the cost of clinical negligence. The National Audit Office (NAO) found in September 2017 that over the previous ten years spending on the clinical negligence scheme for hospital trusts had quadrupled to £1.6 billion, and the number of successful claims paying out damages had more than doubled, to 7,300. In June that same year the Medical Protection Society, which insures doctors, noted that NHS clinical negligence costs had risen 72 per cent in five years and could reach £2.6 billion by 2022, yearly costs that equate to the cost of training 6,500 doctors. The cost of clinical negligence claims is rising faster than NHS funding. It is a challenge that lands at the door of NHS Resolution (NHSR), the body charged with handling claims. Ian Dilks, the chairman, and Helen Vernon, the chief executive, accept that the sums are unsustainable When it comes to NHS negligence, prevention is better than cure (note paywall)

https://www.england.nhs.uk/wp-content/uploads/2019/01/gp-contract-2019.pdfhttps://www.england.nhs.uk/wp-content/uploads/2019/01/gp-contract-2019.pdfhttps://resolution.nhs.uk/2019/01/31/nhs-resolution-to-launch-a-new-indemnity-scheme-for-general-practice/https://www.thetimes.co.uk/article/when-it-comes-to-nhs-negligence-prevention-is-better-than-cure-v075xp3pj

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B: Stakeholder engagement Customer survey 2018-19 Invitations to participate in this year’s survey were sent out in mid-January. Response rates were initially lower than expected, so to boost the response rate we have extended the closing date until 26 February. During the week commencing 18 February we sent out a final reminder and made targeted telephone calls to try to ensure the broadest range of responses. Participation at national conferences Better Births: Three Years On, 7 March 2019 Our Early Notification team will staff an exhibition stand promoting our work on maternity. Speaker slots at external conferences and events

NHS Complaints Summit - HC-UK event, 14 January 2019 Julienne Vernon presented at this event to a group of NHS staff.

Improving Patient Safety & Care 2019 Conference, 6 February 2019 Denise Chaffer presented on our role in relation to learning from claims, promoting improvements in safety to reduce harm and claims as well as how best to support patients, carers and staff in developing a culture of learning and accountability and not blame.

Capsticks Emergency Medicine Seminar, 11 February 2019 Denise Chaffer presented on learning from claims to around 35 delegates.

International visit On 6 March we’ll be involved in hosting a delegation from the South African Ministry of Health and Ombudsman’s Office for a one-day technical session. They are coming to London as part of the FCO funded Better Health Programme and want to find out more from us about reducing the cost of claims.

C: Events In progress Panel conferences The Winter panel conference, with a technical claims focus, will be held on 28 February 2019 at Hill Dickinson’s London office. The summer panel conference will be held at Kennedys on Monday 24 June. Conversations on Consent 2, July, Bristol Due to the success of the first consent event in Ipswich in November, a second event is being planned for July in Bristol. Venue sourcing and confirmation of previous speakers is under way before a date is confirmed.

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Maternity event, summer 2019 Initial work has started to scope out the feasibility of a national maternity event aimed at lead obstetricians and midwives from all our members who provide maternity services Delivered Ambulance event, 31 January 2019 Working closely with safety and learning, Hill Dickinson and Weightmans, the event, chaired by Sir Graham Meldrum, chair of the West Midlands Ambulance Trust, was well delivered and received positive feedback from 65 ambulance trust delegates. Speakers came from a variety of ambulance trusts, NHS England, NHS Improvement, NHS Employers and Unison. Training and education Finding the words training event Two more Finding the words sessions are planned for March 2019, one in Birmingham and the other in London. Practitioner Performance Advice training Up until the end of February we have managed logistical arrangements for 51 Practitioner Performance Advice income-generating training events. These numbers are higher than the corresponding period last year. We have seen a spike in requests for training courses to be delivered before the end of the financial year and for Q1. We will be running two bespoke courses in Q4 for the MDO Defence Medical Services and a further one in April. We have begun marketing our primary and secondary public courses for Q1. Primary Care Appeals training We have managed logistics for a one-day workshop on 4 March designed for those working at NHS England involved in determining applications for inclusion in the pharmaceutical list and appeal decisions. The workshop explains regulatory tests and learning from Appeals’ experience of handling appeals.

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D: Digital communications This reporting period has seen the launch of our annual customer survey and announcement of the Clinical Negligence Scheme for General Practice (CNSGP). As expected, we are starting to see our numbers level out after the exponential growth following the launch of the new website.

www.resolution.nhs.uk

Dec-Feb18

Feb-Apr18

Apr-Jun18

Jun-Aug18

Aug-Oct18

Oct-Dec18

Dec-Feb19

Users 4,536 4,475 6,314 7,130 9,002 18,828 19,811

Sessions 5,960 5,714 8,265 9,516 11,866 26,343 28,571

Page views 13,232 13,326 17,392 20,410 23,698 83,614 81,133

Page per session

2.22 2.33 2.10 2.14 2.00 3.17 2.84

Avg. session duration

1.40 mins

1.38 mins

1.30 mins

1.40 mins

1.28 mins

2.25 mins

2.07 mins

% New sessions

67.80% 79.70% 77.90% 78% 78.3% 80.3% 78.1%

Bounce rate 52.62% 49.40% 56.99% 56.06% 60.19% 50.35% 52.76%

http://www.resolution.nhs.uk/

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Top content December 2018 to February 2019

Top content for this reporting period focuses on our maternity incentive scheme and a combination of our different clinical negligence schemes. There is healthy engagement with the new CNSGP content we have added since the announcement, with users spending higher than average amounts of time on this page. This is the first time that the CNST Rules have been viewed so frequently by users. This suggests that people may potentially be looking for further information on the CNSGP. CNSGP-specific information, including Scheme Rules and related FAQs will be added to the website prior to the launch of the new scheme in April.

Content

Page views

Unique page views

Avg. time on page

Entrances

Maternity incentive scheme 2,829 2,318 0.51 mins 1,839 Maternity incentive scheme Y2 1,594 1,246 3.26 mins 473 CNSGP (main page) 1,070 865 2.26 mins 625 CNST Rules 845 610 1.45 mins 356 Advice for claimants 761 623 3.05 mins 243

Twitter statistics

Twitter statistics over this reporting period show good engagement with tweet impressions and mentions continuing to be relatively high in comparison to last year.

Jul18 Aug18 Sep18 Oct18 Nov18 Dec18 Jan19

Tweets 17 17 32 27 31 9 27 Profile visits 997 1,652 2,298 1,288 1,734 1,905 2,559 New followers 35 80 90 62 65 89 45 Tweet impressions

27.9K 30.9k 58k 32.3k 39.9k 32.9k 38.7k

Mentions 805 199 199 163 174 197 339

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Safety and Learning report Board meeting (Part 1) [March 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 – 20 National engagements Ambulance staff matter national conference 31 January 2019 London - Following the initiative of NHS Resolution panel firms to support national sharing and learning events, this was the sixth national event the Safety and Learning team have delivered with support from MSE. The content was designed to reflect the non-clinical claims in ambulance trusts which developed a focus on frontline staff safety and support. Speakers from across the NHS, Legal Services and a union presented the work undertaken to reduce violence, aggression and harm of ambulance staff. The event was attended by 92 people representing NHS Resolution, all ten ambulance trusts in England, one Welsh trust, nine panel firms and speakers.

2. Regional engagement - Seven Regional Engagement events across Safety and

Learning and Early Notification team with an additional 11 visits to members. 5 February 2019 - Safety & Learning workshop - To engage with clinicians, Safety & Learning leads and claims staff across several London trusts highlighting the work the Safety and Learning team (audience 30+).

. 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.

December 20 NHS Resolution and the Early Notification scheme presentation at National Association of Ambulance Medical Directors. Our Director of Safety and Learning and Clinical Fellow in Obstetrics shared a presentation on claims related to ambulance trusts, with a focus on maternity services and the Early Notification scheme.

January 29 the National Obstetric Clinical Fellow, on behalf of Director of Safety and Learning, attended the Strategic leaders meeting to network and work collaboratively with midwifery senior leaders working in ALBs. The aim was to enhance joint working and reduce duplication across the system.

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3. Individual trust visits - The Safety and Learning and Early Notification team have collectively visited 11 individual Trusts. Claims scorecards and leaflets were shared with specific focus areas or further visits discussed. Breakdown: London: 3; South: 3; Midlands and East: 0; North: 4 Early Notification 2 in London

4. Internal - The lunch and learn sessions Workstation Posture and Mindful Movement were both repeated to allow access to more staff members, as previous sessions were oversubscribed. The Workstation Posture session provided insight into the issues that can arise from prolonged sitting at desks. It provided guidance on avoiding these problems and suggested exercises for those that have developed aches/pains. Mindful Movement provided an introduction to mindfulness through a focus on body position and movement. Many attendees valued the opportunity to pause and recognise their thoughts and emotions, and how these might influence their actions.

Safety and Learning Engagement January/February 2019

The table below provides a summary of direct engagements made by NHS Resolution’s Safety and Learning team with member trusts and others. Some of the visits will include colleagues from claims, Early Notification, Practitioner Performance Advice teams or finance to support the content as requested. These data do 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 (12/12/2018 - 07/02/2019):

Engagement January February

London 2 1

Midlands & East 0 0

South 3 0

North 4 0

Early Notification team 4 0

Independent health care provider 0 0

ALBs 4 0

Conference & regional event (i.e. trust attendance) 93 230

Non-governmental 3 0

Panel 5 1

Royal colleges 2 1

Others 7 0

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Safety and Learning Engagement January/February 2019

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Member trust visits e.g. site visit, request to present to trust staff

Depicted by trust number per region

Independent heath care providers Independent members

Conferences and regional events (NHS Resolution led and ones where NHS Resolution in attendance).

National events numbers where NHS Resolution has a stand or clusters of engagement with membership. It may be difficult to capture trust numbers within this format but reports on these 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 and Social Care

e.g. Care Quality Commission, NHS Improvement, NHS England and NHS Blood and Transplant

Non-governmental and third sector Charities ,associations and organizations 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 guidance representing NHS Resolution at meetings

e.g. Royal College Midwives, Royal College Nursing, Royal College of Anaesthetists, Royal College of Physicians, Royal College of Radiologists, Royal College of Obstetrics and Gynaecology

Others e.g. CCGs, Patients, families individual experts, networks and communities Future finance group, Safer Needles Network

Board meeting 12 March 2019

Agenda item: 5.1

Title of paper: Post-Implementation Review of LASPO

Responsible Director/Lead: John Mead

Summary of paper:

A précis of the review so far as it relates to issues affecting NHS Resolution.

Board action requested:

The Board is asked to note the position.

Potential risks:

Retention of recoverability of ATE premiums in clinical negligence cases and the present arrangements for

costs budgeting increase NHS expenditure on litigation.

Equality, diversity & inclusion:

Not directly relevant.

Has the patient and public interest been taken into account?

It is in the interests of patients as a whole, and the public generally, that NHS spending on litigation is minimised.

__________________________________________________________________________________

Board Report – Part 1

Government Post-Implementation Review of the Legal Aid, Sentencing and

Punishment of Offenders Act 2012 (LASPO)

1) Introduction

This Act, part of which introduced many of the reforms to recoverability of costs in civil

litigation proposed by Sir Rupert Jackson, was implemented on 1st April 2013.

Published on 7th February 2019 following a call for evidence by the Ministry of Justice in

2018, the review assesses the impact of these changes and concludes in broad terms

that their objectives have been met.

2) Detail

The following summary covers only those aspects of LASPO which are relevant to NHS

Resolution’s activities.

Non-recoverability of success fees from defendants

By far the most important reform from our perspective. Nearly all respondents

accepted that LASPO had reduced the costs of civil litigation. Research by

academics, to which we contributed a considerable amount of data, concluded

that these costs have reduced by c.10% for clinical negligence cases and c.8%

for other types of personal injury claim. The former figure must be regarded as

provisional because of the long tail in clinical negligence litigation.

After the Event (ATE) Insurance

Whilst recoverability of premiums has been ended in most types of case, it is still

possible for claimants to recover premiums relating to the cost of liability expert

reports in clinical negligence claims. This is an anomaly which is opposed by

defendants, and contrary to Sir Rupert’s recommendation.

In the two financial years 2016/17 and 2017/18 NHS Resolution paid £63M in

post-LASPO ATE premiums. It is difficult to obtain information on the calculation

of ATE premiums and therefore the basis of charging is obscure to both

defendants and government.

Qualified One-Way Cost Shifting (QOCS)

Introduced to obviate the need for ATE insurance in most personal injury cases,

this arrangement means that a defendant winning at trial is unable to recover

costs from an unsuccessful claimant other than in a few exceptional cases (e.g.

if the claimant has been guilty of fundamental dishonesty). This reform is