Best Practice & Research Clinical Obstetrics & Gynaecology
2Assessing and credentialing standards of care: the UK Clinical Negligence Scheme for Trusts (CNST, Maternity)
Section snippets
What is CNST and why was it set up?
The NHSLA is a Special Health Authority which was established on 20 November 1995 to indemnify NHS bodies against claims for clinical negligence and to administer CNST. The NHSLA is not an insurance company; it manages CNST, a mutual risk pool which is run on a pay-as-you-go basis whereby each year sufficient money is collected from trusts to cover the payments made during that year on claims arising from incidents since 1st April 1995. In April 2002, responsibility for managing all clinical
Current CNST maternity clinical risk management standards
The assessment is divided into eight risk areas or standards, each of which comprises a number of criteria. The standards, which are designed to be measurable and achievable, are: organization; learning from experience; communication; clinical care; induction, training and competence; health records; implementation of clinical risk management; staffing levels. The standards cover a range of both reactive and proactive risk management systems and processes, and each standard is set at three
Contribution setting and discounts
Each trust's CNST contribution is determined using actuarial techniques based upon a range of factors, such as size and type of trust, specialities practised, claims experience, numbers of staff etc. Since April 2003 CNST contributions have been split between maternity services and all other clinical activities. The contribution calculation for maternity includes the number of births, and a trust will earn discounts from each part of the contribution (maternity and ‘other’) in accordance with
The future of CNST risk management
Trust assessments against the CNST General Clinical Risk Management Standards ended on 31 March 2006. New acute standards incorporating organizational, clinical, and health and safety risks have been developed to replace both the CNST general assessment and Risk Pooling Scheme for Trusts (organizational and non-clinical risk) assessment and have recently been piloted. Separate standards and assessments are being retained for maternity services, and starting in 2007/08 the process of revising
Summary
Based on the need to reduce significant clinical negligence costs, the CNST Maternity Clinical Risk Management Standards have provided trusts with a framework to assist in achieving effective systems and processes to manage clinical risks in maternity services. This broad approach has involved establishing continuous proactive and reactive risk management initiatives to provide lessons to be learned and acted upon, affording the potential to improve patient safety and service provision.
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