Business Plan 2017/18 - NHS Resolution · PDF fileNHS Resolution Business Plan 2017/18 6 In...

Advise / Resolve / Learn

Business Plan 2017/18

2Advise / Resolve / Learn

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Contents

Contents

Welcome from our Chair & Chief Executive 4

Part 1 Overview 8

1.1 Who we are and what we do 9

1.2 The environment we work in 10

1.3 Some of our achievements in 2016/17 12

Part 2 Our goals for 2017/18 14

Part 3 Measuring our performance 26

Part 4 Our people 30

4.1 Structure 31

4.2 Developing a high performing team 33

Part 5 Our resources 34

5.1 Estates 41

5.2 IT 41

Part 6 Governance 42

6.1 Audit, risk and assurance 43

6.2 Procurement 44

6.3 Raising concerns and whistleblowing 44

6.4 Data security 44

Conclusion 46

NHS Resolution Business Plan 2017/18

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Our plans are informed by:

• Consultation in 2016 on the future of our main indemnity scheme, the Clinical Negligence Scheme for Trusts (CNST).

• Our report on the consultation sets out a programme to enhance CNST to better support the work of our NHS Trust members in improving patient safety whilst ensuring a fair distribution of the costs of claims across the service.

• Discussion with system partners such as NHS Improvement on the contribution that we can make in supporting financial planning, providing a platform for learning from harm and acting as a financial lever for improvement. The indemnity schemes are now closely aligned with the financial planning

process with prices for 2017/18 issued in October 2016, two months early.

• Testing of our approach to learning from harm with an economic evaluation of the ‘Sign up to Safety’ incentive scheme and national events and publications focused on high claims areas. We have extended the reach of our data into national work such as that of Getting it Right First Time (GIRFT) whilst increasing triangulation at a local level and expanding scorecard coverage to injuries sustained by employees and members of the public.

We have evolved over our 20 year history and the most significant changes have come about in more recent years, such that we now deliver advice and services to the NHS which are about much more than litigation. Whilst court proceedings remain inevitable for intractable cases or those involving points of principle, we believe that resolution is possible in many cases without formal and costly litigation. The services we provide through the Family Health Services Appeal Unit (FHSAU) and the National Clinical Assessment Service (NCAS) have even less to do with litigation but share the objective of acting independently, impartially and fairly to reach the right result in a situation where conflicting views and interests may be at play. This recognition of a single shared objective was the genesis of our new name – NHS Resolution.

Welcome from our Chair and Chief ExecutiveWelcome to our Business Plan for 2017/18 which sets out our plans for the coming financial year and delivers the first part of our Five Year Strategy, ‘Delivering fair resolution and learning from harm’, under our new name, NHS Resolution. It marks a different approach to delivering compensation and a shift upstream to support candour and learning to address the rising costs of harm in the NHS.

http://www.nhsla.com/CurrentActivity/Documents/Report%20on%20the%20Clinical%20Negligence%20Scheme%20for%20Trusts%20(CNST)%20Consultation%20-%20Final.pdf

http://www.nhsla.com/CurrentActivity/Documents/NHS%20Resolution%20-%20Our%20strategy%20to%202022%20-%20FINAL.pdf


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Welcome

Ian Dilks / Chair Helen Vernon / Chief Executive

The financial challenges currently facing the NHS mean that we must take every opportunity to save money and remove unnecessary expenditure. We must continue to apply our expertise to add value in areas which would see significant cost without our involvement and look for opportunities to increase the impact we have.

Without our interventions in 2016/17 to negotiate claims values, defend claims where there was no liability and challenge excessive legal costs, we estimate that the costs of claims to the NHS would have been at least double1. Significant costs would have accrued to the service as a result of the suspension of practitioners due to performance concerns and millions of pounds of legal costs expended on protracted contractual disputes.

Tackling the rising cost is not something we can do alone and although we see the work that we do as an important part of the solution, there is much that is not within our control and needs to be delivered by others. Collaborative working is therefore essential to the way in which we will get things done. We are also committed to learning from experience elsewhere, including other countries who are confronting the same issues.

We were delighted to welcome two new Non-Executive Directors (NEDs) to our Board in 2016/17. Dr Mike Durkin, National Director for Patient Safety, NHS Improvement joined us as an Associate NED. We are looking forward to utilising Mike’s knowledge and experience and to working more closely with NHS Improvement.

Mike Pinkerton joined us after five years as Chief Executive of Doncaster and Bassetlaw Hospitals NHS Foundation Trust. In addition to his wide experience of the NHS secondary care system, Mike brings his first-hand experience of the challenges facing the leadership of a major trust. We therefore start the year ahead with an enhanced Board with the experience to support the organisation in working effectively as a part of the NHS system.

1Estimated using the last damages and cost reserves for claims closed without payment plus estimated savings through successful damages and costs negotiations


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In our strategy to 2022, we identify four priorities:

Our Business Plan sets out our planned activity for 2017/18 to deliver the first stage of our Five Year Strategy, focused on these four priorities. It is a challenging programme of work which involves some changes in how we do things as much as what we will

do and how we will work with others. An ambitious plan is required to meet the significant financial challenge of rising costs and we are confident that the skill and expertise of our staff and partners will see us deliver against our aims in the coming year.

Priority Where we would like to be in 2022

Resolution

• Resolving disputes in a fair and cost-effective way with formal litigation reduced.

• Ensuring disputes can be resolved in an open culture that promotes learning and creates and environment where the injured person, their family and healthcare staff are all supported.

• Using alternative dispute resolution methods at all stages to avoid unnecessary conflict.

Intelligence

• Utilising innovative technology to routinely provide meaningful data and analysis on claims, concerns and appeals, to support learning and prevent harm.

• Making the best use of data held within the health system in order to improve the ‘risk based’ pricing of our indemnity schemes and incentivise improvement.

• Triangulating our data and intelligence with others in a consistent way which supports effective benchmarking and uses shared data to drive changes that improve outcomes.

Intervention

• Identifying, supporting and signposting solutions that are known to reduce harm by improving patient and staff safety.

• Operating ‘upstream’ and supporting NHS trusts to positively influence both the number of disputes and the associated costs.

• Influencing, evidence based changes to the legal environment.

Fitness for purpose

• Having the right skills and resources in place to deliver our services.

• Maximising the use of digital channels with a new single website, intranet and extranet which enables us to operate more effectively and securely with our customers and suppliers.

• A learning organisation that continuously improves and delivers services with the most effective use of our resources.

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Welcome


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Part 1Overview

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Part 1 | Overview

We provide the following core services to our customers:

1. The Claims teams deliver unrivalled expertise in handling both clinical and non-clinical claims to members of our indemnity schemes

2. NCAS provides bespoke advice, support and interventions in relation to concerns about the performance of doctors, dentists and pharmacists.

3. FHSAU offers an impartial tribunal service for the fair handling of primary care contractor disputes.

These teams are supported by the following departments:

1. The Safety and Learning team supports members to better understand their claims risk profiles to target their safety activity while sharing learning across the system.

2. The Finance and Corporate Planning directorate provides finance, human resources/organisational development, corporate governance and business development expertise.

3. The IT and Facilities team enables the organisation to deliver its services effectively.

4. The Membership and Stakeholder Engagement team works at a corporate level to improve our customer-focused approach to delivery.

Each core service area has built up a solid foundation over the years, demonstrating expertise which we are now bringing together under a single umbrella name of NHS Resolution. It is our ambition to:

• harness the synergies in skills and knowledge across our core service areas;

• continue to collaborate with the wider health system to inform policy making and deliver solutions in partnership;

• provide our customers with a more integrated service offering delivering fair outcomes for patients and staff through the timely and efficient resolution of disputes;

• help our customers implement processes that seek to avoid disputes arising or ensure that they’re resolved earlier;

• better support the system, organisations and individuals to learn when disputes arise and take proactive action to reduce harm by improving patient and staff safety;

• make best use of the levers within our control to incentivise the right behaviours at a system, organisation and an individual level;

• engage with customers to develop our integrated service;

• update our digital presence to provide more cost-effective and streamlined ways to access our services; and

• capitalise on opportunities to streamline our processes to make more effective use of resources.

Our purpose statement

To provide expertise to the NHS on resolving concerns fairly, share learning for improvement and preserve resources for patient care.

Our values

Professional – being an organisation which operates to the highest possible professional standards.

Expert – being the centre of expertise for resolving claims, disputes and concerns about performance.

Ethical – having high standards and doing the right thing.

Respectful – dealing with customers, colleagues, patients and the public in a considerate and sensitive way.

1.1 Who we are and what we do


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We will ensure that, while we deliver and develop our services, we work in a collaborative way with key system partners so as to complement existing work and avoid unnecessary duplication.

The rising cost of clinical negligence claims to the acute and secondary care sector is our primary focus. The projected expenditure for CNST in 2017/18 is £1.95 billion (before the effect of the change to the ‘Ogden’ discount rate is taken into account) representing a 17.5% increase compared to last year. The CNST provision also rose to £50.8 billion as at 31st March 2016 (from £25.6 billion in 16/17) representing the amount of money that would have needed to be set aside to meet all known and outstanding clinical claims as at the reporting date. These rising costs are placing significant pressure on the public purse. CNST expenditure is funded directly by member contributions and the claims provision feeds directly into the government’s balance sheet.

These increases have largely been driven by factors outside of our direct control. The increase in the provision reported in our 2015/16 accounts was largely driven by a change in the HM Treasury discount rate. The more recent change to the ‘Ogden’ discount rate will have a further significant impact. However, there has been significant growth in both the frequency and severity of liabilities being reported to the CNST scheme in recent years. The increasing frequency reflects in part increased treatment activity, but also changes in the legal environment. The increase in severity has been influenced by increasing damages for high value claims, such as in birth injury claims, where there are often complex and long-term care needs, as well as increases in claimant legal costs.

Irrespective of these pressures, the clinical negligence liability will continue to grow for some years to come, due to the structural aspects of the liability.

A significant element of the liability relates to the ongoing costs of providing lifetime care for those who suffered brain damage at birth which are met on an annual basis, which we often refer to as a ‘periodical payments’. Every year results in additional ongoing costs.

Our primary focus is therefore, reflected in the Business Plan and Five Year Strategy, to reduce the rate of growth in the claims costs and the incidence of harm to address the burden of clinical negligence on the NHS.

Patients should be entitled to pursue claims for fair compensation when things go wrong. However, court proceedings are not the only route to resolving concerns about healthcare. There are alternative ways to achieve fair resolution that don’t have to involve a costly legal process.

1.2 The environment we work in

Given the current challenges faced by the healthcare system, it is crucial that we work with our Arm’s Length Body (ALB) colleagues and other partners in the health service and civil justice system to ensure the service is able to maximise the resources available for delivering patient care.

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We will use our expertise and knowledge across all of our functions to support our customers to manage risk, drive improvement and resolve concerns when they first arise as well as provide support with advice and guidance, to contribute to the prevention of harm in the first place.

2017/18 will see us take an important step forward with the introduction of an early notification team for certain maternity incidents which supports the work following the Better Births report, the Department’s ‘Halve It’ ambition and other key activity such as the Royal College of Obstetricians and Gynaecologists’ (RCOGs’) Each Baby Counts campaign. Introducing this approach will allow us to:

• provide support to families and member staff in the difficult post-incident period;

• work within the system to ensure that opportunities to learn are not lost;

• capture robust data that can be used to incentivise better outcomes through price;

• offer services to help maintain/repair the ongoing treatment relationship; and

• resolve compensation claims in a more efficient and less adversarial way.

We will also use the early notification data to develop a joint target with NHS Improvement to reduce avoidable brain injury and ensure there is an optimum response to an incident.

While the cost of clinical negligence claims will be our primary focus, our core service teams will also continue to deliver value in their respective areas – for example the way performance concerns are resolved in the NHS and the way in which primary care contract disputes are managed. We will also ensure that all teams remain fully up to date with new developments and that our products respond to the same, whilst offering regular training events to raise awareness and share best practice.

Our primary focus is therefore... to reduce the rate of growth in the claims costs and the incidence of harm to address the burden of clinical negligence on the NHS.

Part 1 | Overview


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1.3 Some of our achievements in 2016/17

Undertook a consultation on the pricing structure of our CNST and used this to inform changes to our

methodology.

Issued notices to members of our indemnity schemes on charges for

2017/18 two months early to fit with the NHS financial planning

timetable.

Achieved ISO27001 certification demonstrating that we follow international best practice in

relation to our information security management systems. Achieved accreditation against Investors in

People, a world recognised standard in people management excellence.

Improved our IT systems to maximise the financial benefits of fixed recoverable costs for lower

value employers’ and public liability claims.

Raised the profile of the organisation by being represented on a number of ALB senior forums,

and worked in partnership with a range of Royal Colleges and

charities.

Fully implemented the link adviser model to build a more focused and tailored relationship and to develop

knowledge about individual organisations and the way

in which they work.

Worked with trusts to help them understand their claims profile and areas for action through a range of publications and events together

with the provision of annual scorecards on both clinical and

non-clinical claims.

Piloted an in-house litigation team, providing direct legal support to the

NHS with the aim of reducing the cost of outsourcing litigated cases

while taking best advantage of the skills and experience of our legally qualified staff.

Established a mediation panel and re-tendered for

our legal services panel contracts, leveraging our purchasing power to

secure the best value and highest quality services for the NHS, in

externally provided legal advice.

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Part 1 | Overview

Evaluated the impact of the Sign up to Safety

incentive funding scheme which allocated funds to organisations that successfully bid for money to reduce

harm in key areas.

Ran five events, related to our work supporting the Sign up

to Safety campaign, which brought together successful

and unsuccessful bidders to share learning in the areas of maternity, missed fractures

in A&E and human factors.

Successfully bid for a Darzi Fellow who is now supporting us with key aspects of work focused on

maternity.

Provided expert input into a number of policy initiatives

including the potential introduction of fixed recoverable costs for clinical

negligence and the proposal for a Rapid Resolution and Redress scheme as recommended by the

Better Births review.

Reviewed our Back on Track service and relaunched this as our Professional Remediation

Service.

Used our expertise and data to support quality

improvement initiatives such as the GIRFT initiative.

This involved working in partnership with the GIRFT team to provide specialty based score cards in

orthopaedic surgery and maternity.

Defended a judicial challenge to a decision made under the

NHS Pharmaceutical and Local Pharmaceutical Services Regulations

2013. The Court rejected the challenge on all grounds providing

further evidence of the robust FHSAU decision making.

Delivered training events to support NHS England in making

decisions under the NHS Pharmaceutical and Local

Pharmaceutical Services Regulations 2013. Over 40 delegates attended

the sessions where we shared our experience of determining

appeals to improve local decision making through

best practice.

Created new Membership and Stakeholder Engagement and

Business Development functions to help ensure that we evolve as an organisation in a way that benefits our customers in the most effective

way.


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Part 2Our goals for

2017/18

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Our aims

• To continue to provide cost-effective dispute resolution services for appeals, claims and cases.

• To challenge the legal environment, reducing litigation and increasing the use of alternative dispute resolution.

• To reduce the unnecessary costs attached to claims and inform policy initiatives designed to achieve this outcome.

• To extend the reach of NCAS into organisations that are currently not utilising our services.

What we will continue to do in 2017/18

Deliver transparent and robust resolution in the field of primary care contract management with decisions routinely published on our website.

Deliver effective management of requests for advice while raising awareness of NCAS’ work, services and expertise in the resolution of concerns about performance.

Deliver expert management of compensation claims while undertaking targeted initiatives to reduce costly litigation. This will include evaluating a recent low-value pilot with a claimant solicitor firm on why people claim to help develop future initiatives.

Effectively deploy alternative dispute resolution through the claims mediation service.

Ensure delivery of efficient and high quality services from key suppliers that we use to deliver claims resolution so as to provide even greater value to our customers. This will include:

• concluding the 2017 legal panel tender and actively managing the new panel over the period of the framework; and

• taking forward service improvement initiatives with other key suppliers such as our costs and mediation panels, advisers, experts and counsel.

Strategic Priority 1 – Resolution

Part 2 | Our goals for 2017/18


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How will we know we have succeeded? By when?

Each core service directorate to maintain or improve its customer satisfaction survey score.

2017/18 customer satisfaction survey

Successfully mediate at least 50 cases through the Claims mediation service.

By the end of Quarter 4

Reduce liability costs by 20% for high value maternity claims received via the early notification process where an admission of liability is made.

From 2018/19 onwards

Reduce the time from incident to admission of liability for high value maternity claims received via the early notification process by one year.


Reduce the open claims book. By the end of Quarter 4

Reduce the number of ‘frustration’ claims i.e. claims which are only pursued because there has been a failure to address the matter appropriately at an earlier stage.

Baseline in 2017/18 to set a target from 2018/19 onwards

What we will aim to transform in 2017/18 Why?

Identify and, where appropriate, investigate potential high value maternity claims as part of the new early notification process.

Improve the experience for families and healthcare staff.

Reduce the costs associated with resolving high value maternity claims.

Scope if the approach can be extended to other high cost claim areas.

Provide customers with training/guidance on local dispute resolution and effective delivery of candour through the Faculty of Learning.

Build capacity and capability at local level.

Reduce the number of ‘frustration’ claims.

Map, reengineer and, where appropriate, automate processes to help improve efficiency and reflect the changing demands on core service areas. This will include the notification and triage processes as well as improvements to how we handle claims and cases.

To continually improve our services to deliver value for money.

Evaluate our existing mediation offering to develop a corporate, integrated mediation service. This will provide a corporate umbrella for our mediation work and allow formal expansion into other areas such as NCAS-delivered mediation services.

To make best use of alternative dispute resolution to reduce costs.

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Our aims

• To understand and respond to the drivers of cost and our customers’ needs.

• To help the system, organisations and individuals identify and address issues.

• To share what we know to inform policy development.

• To ‘diagnose’ the issues driving costs and use this to devise and signpost interventions.


Support operational staff to capture accurate data by providing them with data quality training as well as the appropriate support tools and systems.

Make best use of available data sources to identify, investigate and act to combat claims fraud in the NHS.

Use our data and expertise to drive quality improvement activity. This will include:

• providing members with expert analysis of their claims data through both the extranet and claims scorecards;

• supporting members to better understand their scorecards to prioritise their safety activity;

• helping to shape the new national incident reporting and learning system;

• supporting the work of the GIRFT initiative; and

• ongoing membership of key initiatives including the Maternity Transformation Programme Board.

Provide expert input into ongoing policy development discussions including:

• the potential introduction of fixed recoverable costs for clinical negligence claims;

• the proposed introduction of a Rapid Resolution and Redress scheme for certain types of maternity claim;

• work to deliver fairer law for patients;

• building a dynamic model with actuarial input to help model policy; and

• the work to develop Maintaining High Professional Standards.

Maintain our information systems to ensure that we’re sharing data and intelligence safely and in compliance with data protection requirements (internally and externally) so as to deliver our strategic objectives.

This includes preparing the organisation for some of the policy developments in this area, such as the General Data Protection Regulations and the National Data Guardian/Caldicott developments.

Explore the use of innovative technology to understand the opportunities to think about our approach to data analysis in a different way.

Embed the Link Adviser model to further develop a more focused and tailored relationship and to develop knowledge about individual organisations and the way in which they work.

Provide a web-check service to allow NHS users to undertake pre-employment checks for Performers Lists Regulations and Healthcare Professional Alert Notices.

Establish new and continue to use existing stakeholder reference groups to improve the quality of the services we provide as well as to identify other opportunities for improvement.

Publish key decisions, statistical and other data routinely on our website while making sure that all associated guidance documentation is kept up to date.

Strategic Priority 2 – Intelligence



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Capitalise on our earlier involvement in maternity incidents by working with key system partners and clinical leaders to routinely capture learning to drive system, organisational and individual improvement.

We will employ dedicated maternity expertise to help us to achieve these goals.

Reduce the incidence of severe harm in maternity by improving outcomes for mothers and babies.

Reduce the cost of responding to harm in maternity.

Lay the foundations to support Rapid Resolution and Redress, if it proceeds after consultation.

Initiate a programme of work to move to a more diagnostic data analytics approach that will allow us to:

• routinely triangulate our data with existing data sources;

• routinely contribute robust data into the wider system;

• improve the pricing of our indemnity schemes to incentivise safer care, becoming more predictive;

• identify opportunities to offer members targeted support; and

• provide members with effective benchmarking data and buddy networks.

Identify opportunities for improvement at a system, organisational and individual level.

Allow us to incentivise the right outcomes using the right data.

Help organisations to work collaboratively to improve outcomes.

Use the findings from the pilot of a triangulated score card (pulling together complaints, incidents and claims data) to inform future development of the approach.

Support members to better understand their overall risk profile.

Undertake deep dives into the following priority areas for 2017/18:

• Learning from inquests

• Mental health

• Ambulance service claims

• Further analysis of maternity claims linked to the ‘Early Notification’ team outputs

Deliver support in key areas to help improve safety and reduce harm.

Share findings with relevant partners to help develop interventions.

Identify and exploit opportunities to capture more useful data to help baseline our current performance.

Better data to measure the impact of future improvement activity.

Improve the platform that enables NHS users to complete pre-employment checks for Performers Lists Regulations and Healthcare Professional Alert Notices.

Streamline process for organisations undertaking pre-employment checks.

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How will we know that we have succeeded? By when?

Every organisation and member to have an identified NHS Resolution adviser, claims manager and safety and learning lead to support effective information sharing and contribute to the identification of ’early warning’ signals.


Capture learning data on 95% of maternity incidents reported via the early notification process and share this with key system partners.

By end of Quarter 4

FHSAU decisions to be published on our new corporate website within first two weeks of each month.

From Quarter 3 onwards

Share findings of deep dive exercises with relevant partners.

By end of Quarter 4

Agree Memoranda of Understanding with key system partners including Care Quality Commission (CQC), NHS Improvement and RCOG to help inform the development of more specific, shared objectives over time.

By end of Quarter 2

We will... explore the use of innovative technology to understand the opportunities to think about our approach to data analysis in a different way.



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Our aims

• To work in partnership with other ALBs, NHS trusts, patients and healthcare staff to improve the way in which the NHS responds to incidents.

• To provide the system with access to a range of intervention services that uses our expertise to support improvement.

• To inform and implement policy initiatives effectively.

• To play a unique role in incentivising safety improvement, using the indemnity schemes as both a platform for learning and a lever for change.


Use our expertise to provide customers with access to educational events, publications and training programmes including on-site training.

Support members to effectively comply with the duty of candour and ensure that demonstrable learning has been implemented by providing access to guidance and specific interventions.

Partner with national and regional bodies to collectively work to improve safety and support effective service delivery. This will involve working with organisations such as the CQC, NHS Improvement, NHS England, Health Education England and the Royal Colleges to improve safety and reduce harm.

Shape future initiatives by using the learning received from the recent review of the effectiveness of the Sign up to Safety funding scheme.

Implement the programme of improvements to CNST set out in our response to the CNST Pricing Consultation. This includes:

• reviewing options for using our funding levers effectively to incentivise members to improve patient care with a particular focus on linking CNST maternity price to improved outcomes so as to reduce harm;

• modelling the ability to segment the risk pool further; and

• reviewing the data that informs exposure measures and whether or not the exposure/experience weighting is effective.

The ultimate aim is to refine the pricing approach to incentivise members to improve safety and reduce claims.

Deliver NCAS assessments and interventions that are robust and represent international best practice.

Strategic Priority 3 – Intervention

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Use our earlier involvement in maternity incidents to develop interventions that add value, including:

• delivering/signposting materials to support families and staff involved in such incidents;

• providing staff with access to peer support;

• working with and sharing intelligence with key system partners to support the development of quality improvement tools; and

• using the additional data to inform the work to link CNST maternity price to safer outcomes.

To help families and staff at a difficult time.

To improve maternity outcomes and reduce future harm and cost through interventions, effective incentives and joint working.

Ensure the claims process does not act as a barrier to learning.

Scope a Faculty of Learning that will bring together all of our internal and external training offerings into one accessible repository.

The Faculty will be responsible for signposting and delivering an expanding suite of solutions, delivered directly or in partnership with key system partners.

Year one will focus on:

• effective delivery of candour;

• effective local dispute resolution;

• support to trust boards with the management and governance of performance concerns; and

• learning from inquests.

To share our expertise and solutions under one easy to access umbrella.

Streamline associated processes for accessing solutions including registration/payment.

To develop solutions based on qualitative feedback and case experience.

Empower customers to deal with difficult issues.

Reduce the number of frustration claims.

Scope and deliver an NCAS evaluation, research and development programme which will include a longitudinal study of factors for success in remediation.

Identify process improvement opportunities including the increased use of technology.



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Peer support delivered to any member of staff involved in maternity incidents who requests it.


Implement the next phase of improvement to the pricing methodology for the CNST maternity membership.

Quarter 3 onwards

Deliver:

• clinical engagement events;

• five leaflets;

• a trust board training programme;

• one further training event for NHS England from the Appeals Unit; and

• two training events for Pharmaceutical Contractors .

By the end of Quarter 4 with positive feedback received on content

Monitor effective compliance with the duty of candour and demonstrable evidence of learning.

Pilot capture for all early notification cases and then review for 2018/19

We will... use our expertise to provide customers with access to educational events, publications and training programmes including on-site training.

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Our aims

• Ensuring we have the right skills and resources in place to deliver our services.

• A learning organisation that continuously improves and delivers services with the most effective use of our resources.


Maintain and upgrade the IT infrastructure and operational processes to meet our needs, streamline process and reduce our running costs.

Monitor cyber security threats and implement proactive security measures while keeping the Board and Audit and Risk Committee apprised of emerging threats and our ability to deal with them.

Maintain and, where possible, improve upon our information governance and security practices. This will include work to apply even greater control over our data to ensure its confidentiality, security and integrity even after transmission to a third party.

Learn from the Investors in People framework and develop a continuous improvement programme from the audit findings.

Ongoing implementation of the staff engagement action plan in conjunction with our Staff Engagement Group.

Improve quality assurance processes in key areas including the claims function and NCAS.

Review our regulations/directions to ensure that our core services remain relevant to new models of care delivery.

Implement necessary changes to ensure that we can deliver effective services.

Use the findings of the 2016/17 customer satisfaction survey to implement an action plan to implement changes to our services.

Strategic Priority 4 – Fitness for Purpose



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Roll out of the new FHSAU and NCAS case management systems to staff.

Streamline operational process.

Align core teams onto one common case management platform.

Develop a forward investment strategy for our IT systems to best support our overall strategy. This will include reviewing our core operational systems as well identifying new corporate systems that are required to deliver our strategy.

Plan our future IT requirements alongside the organisational strategy.

Start migrating our IT services to the Cloud to deliver greater efficiencies and reduce risk.

Increased agility to respond to challenges.

Reduce our exposure to risk and associated cost.

Migrate disaster recovery systems to the Crown hosting data centre platform and then, in 2018/19, move our live IT systems to this platform.

Provide the necessary agility to adapt to environmental changes and improve our system resilience.

Implement changes necessary to move to a new name.Establish and grow awareness of the new NHS Resolution identity to deliver our strategic priorities.

Develop a workforce strategy that supports the delivery of the NHS Resolution Five Year Strategy.

Build a highly motivated and skilled workforce to deliver our strategy.

Pilot a member and stakeholder account engagement approach to inform how such an approach will help deliver each of our strategic priorities.

To shape our future plans to deliver a more customer focused service, informed by user feedback.

Launch a single organisational intranet.Streamline processes and support effective internal communication.

Launch a new single website and use this to effectively deliver products and services.

Improve our ability to engage with stakeholders while streamlining processes.

Implement a new digital customer journey with associated new products and engagement channels.

Improve the customer journey.

Review the extranet to agree a future development plan which best supports the organisational strategy – for example whether to incorporate claims scorecards as an interactive dashboard tool as well as opportunities for improving the NCAS customer journey.

Understand customer needs to inform future development.

Develop work experience opportunities and an apprenticeship programme for appropriate areas of the business.

Further embrace the benefits of a diverse workforce.

Deliver next phase in income generation and efficiency plans to deliver reductions in Grant-in-Aid funding.

To effectively use public funds to deliver value-adding services.

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Successful migration of the following services to the Cloud:

• mobile device management;

• Skype/telephone system; and

• internet proxy services.


Retain our ISO27001 certification. By the end of Quarter 4

Improve staff satisfaction scores in 80% of categories. Quarter 3 onwards

Improve staff satisfaction with core systems year-on-year from 2018/19.

Baseline in 2017/18 to measure from 2018/19

Evidence of increasing scores on 50% of the areas covered by annual customer satisfaction surveys year on year.


Deliver Grant-in-Aid target for 2017/18 period. By the end of Quarter 4

We will... maintain and upgrade the IT infrastructure and operational processes to meet our needs, streamline process and reduce our running costs.



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Part 3Measuring our

performance

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We have reviewed our key performance indicators to ensure that these provide an appropriately balanced view of quality, cost and delivery taking into account regular customer feedback.

Claims key performance indicator targets are not published as this information could affect our ability to manage claims effectively.

Descriptions of how success is measured in the claims management area are therefore included together with details of how we will measure our success against each of our strategic objectives for 2017/18.

Resolution Area Target

Response time to a letter of claim. Claims Internal

Closure rate. Claims Internal

Claims closed with no damages payment. Claims Internal

Time to resolution. Claims Internal

Repudiated claims converting to a damages payment. Claims Internal

Reduction in the number of cases proceeding to litigation. Claims Internal

Reduction in the open book of claims. Claims Internal

FHSAU ‘first step’ letters sent out within seven days of receiving the appeal or dispute.

FHSAU 90%

FHSAU appeals or disputes where at least 14 days’ notice of an oral hearing is given.

FHSAU 100%

FHSAU appeals where the decision maker agreed with recommendation of case manager.

FHSAU 80%

Time to resolve FHSAU appeals and disputes - internal input only. FHSAU 15 weeks

Time to resolve FHSAU appeals where external input is required. FHSAU 25 weeks

Time to resolve FHSAU disputes where external input is required. FHSAU 33 weeks

Positive outcome of quality audits for FHSAU appeals and dispute files. FHSAU 90%

Part 3 | Measuring our performance


28

Intervention Area Target

Positive feedback from trusts visited on recognition of products. S&L At least 60%

Response rate to Members following a request for contact within five working days.

S&L 95%

NCAS education events rated by participants at least four out of five for effectiveness/impact.

NCAS 90%

Requests for advice from NCAS responded to within two working days (or within an alternative timeframe requested by the employing/contracting organisation).

NCAS 90%

Clinical advice reports produced/issued to the General Dental Council within 10 working days.

NCAS 98%

Assessments and other interventions delivered within target timeframe. NCAS 92%

Assessment and other intervention reports produced/issued within target timeframe.

NCAS 90%

Percentage of exclusions/suspensions critically reviewed in line with the following timescales:

Stage 1: after initial four weeks.

Stage 2: at three months.

Stage 3: at six months.

NCAS 90%

Decisions on referrals for assessments and other interventions communicated to the referrer within 11 working days of receipt of all referral information.

NCAS 90%

Intelligence Area Target

Percentage of members visited that have accessed their scorecard and provided positive feedback on it.

S&L 80%

Healthcare Professional Alert Notices issued/released (where justified) within target working days.

NCAS 90%

Healthcare Professional Alert Notices revoked (where justified) within seven working days.

NCAS 90%

29

Fit for purpose Area Target

Indemnity scheme financial spend. FinanceWithin 5% of target

Undertake annual customer satisfaction survey to inform service development.

Membership and

Stakeholder Engagement

Complete in 2017/18

Target for participation in our customer satisfaction survey to ensure engaged customer base.

Membership and


60%

Evidence of increasing scores covered by annual customer satisfaction survey year on year.

Membership and


Increasing scores in

50% of areas covered

Overall approval rating in the 2017/18 customer satisfaction survey. All 55%

Downtime (unavailability between 7am – 7pm) of any IT system. ITNo > 5%

of working month

Downtime (unavailability between 7am – 7pm) for the extranet and claims reporting services.

ITNo > 2.5% of working

month

Workstation audits to be carried out monthly to ensure compliance with our security policies and standards.

ITCompletion of

10 audits

Part 3 | Measuring our performance


30

Part 4Our people

31

We made the following appointments in 2016/17:

• Dr Mike Durkin appointed as an Associate Non-Executive Director.

• Mike Pinkerton appointed as a Non-Executive Director.

In addition to the Chief Executive, the Executive Directors (Board members) are Joanne Evans, Director of Finance and Corporate Planning, Denise Chaffer, Director of Safety and Learning and Vicky Voller, Director of NCAS.

4.1 Structure

Part 4 | Our people

ChairIan Dilks

Associate Non Executive Director

Mike Durkin

Non Executive DirectorProfessor Keith Edmunds

Non Executive DirectorAndrew Hauser (unpaid)

Non Executive DirectorMike Pinkerton

Chief ExecutiveHelen Vernon

WTE 7.00

BudgetPay £356,088

Non-pay £13,645

WTE 10.00

Head of Family Health

Services Appeal Unit

(FHSAU)

Lisa Hughes

Budget

Pay£416,636

Non-pay£554,052

WTE 47.30

Director of National

Clinical Assessment

Service (NCAS)

Vicky Voller

Budget

Pay£3,075,341

Non-pay£1,347,312

Director of Finance & Corporate Planning

Joanne Evans

Budget

Pay£1,957,462

Non-pay£1,424,834

WTE 34.30

Director of Claims

Alan Hunter

Budget

Pay£8,125,079

Non-pay£138,158

WTE 150.01

Technical Claims

Director

John Mead

Budget

Pay£1,429,997

Non-pay£46,298

WTE 18.90

Director of Membership

& Stakeholder Engagement

Ian Adams

Budget

Pay£778,477

Non-pay£197,970

WTE 14.30

Director of Safety

& Learning

Denise Chaffer

Budget

Pay£721,254

Non-pay£42,835

WTE 10.00

Head of IT & Facilities

Sean Walker

Budget

Pay£845,091

Non-pay£3,396,966

WTE 14.00

Executive Directors


32

33

Part 4 | Our people

2017/18 will see us continuing our work to both develop and retain a high performing team that is capable of delivering against our strategic objectives.

Our priority will be to develop a workforce strategy that identifies the key skills and capabilities to deliver our organisational strategy. We will align our policies, procedures, training and support to our staff to ensure that we have a well-equipped and highly motivated workforce. We recognise the benefits that a diverse and engaged workforce can bring, and are firmly committed to ensuring that NHS Resolution is seen as an excellent employer.

In 2016/17 our planned staffing level was 271.9 full time equivalent (FTE) posts.

Over the year we averaged 242.3 FTEs due to vacancies, some of which were filled by the use of temporary staff whilst recruitment exercises were undertaken.

For 2017/18 our plan is to increase our staffing level to 305.8 FTE. The increases will primarily be in the Claims area to deliver the new arrangements for early notification of serious incidents in maternity, support the development of business intelligence and analysis of claims data, and deliver improvements to the resolution of disputes.

4.2 Developing a high performing team

Our priority will be to develop a workforce strategy that identifies the key skills and capabilities to deliver our organisational strategy.


34

Part 5Our resources

35

We are funded primarily by income received from our Members in respect of the CNST, the Liabilities to Third Party Scheme (LTPS) and the Property Expenses Scheme (PES).

We also receive £139m of Grant-in-Aid funding from the Department of Health (DH) for that element of our administrative and programme spend which relates to the management of DH liabilities and the services provided by NCAS and the FHSAU.

Government funding by scheme (£000’s) 2017/18

DH Clinical Liabilities (£100,000)

Existing Liabilities Scheme (£29,000)

DH Non-clinical Liabilities (£9,000)

Administration (£6,832)

Ex-Regional Health Authority (£1,000)

Part 5 | Our resources


36

Expenditure Budget (£000’s) 2017/18

We are committed to delivering savings against our Grant-in-Aid funded administration costs in 2017/18 and beyond.

We have created a business development team that will be tasked with leading business improvement projects to identify and deliver efficiency savings across the business.

Our administration costs represent 1.17% of our overall expenditure.

Clinical Negligence Scheme for Trusts (£1,935,672)

DH Clinical Liabilities (£100,000)

Liabilities for Third Parties Scheme (£45,520)

Existing Liabilities Scheme (£29,000)

DH Non-clinical Liabilities (£9,000)

Administration (£25,140)

Property Expenses Scheme (£3,847)

Ex-Regional Health Authority (£1,000)

37

Grant-in-Aid funding £000’s

Programme

DH clinical liabilities 100,000

Existing Liabilities Scheme 29,000

DH non-clinical liabilities 9,000

Ex-Regional Health Authority 1,000

Total Grant-in-Aid funding – programme 139,000

Administration

Administration 6,832

Total revenue resource limit 145,832

Programme income £000’s

Clinical Negligence Scheme for Trusts 1,949,000

Liabilities for Third Parties Scheme 49,200

Property Expenses Scheme 3,900

National Clinical Assessment Service 1,248

Total programme income 2,003,348

Current annual budget 2017/18



38

Programme expenditure £000’s



Property Expenses Scheme 3,847

National Clinical Assessment Service 1,248

Scheme administration 17,060

Total programme expenditure 2,003,348

Net expenditure 145,832

(Under)/overspend revenue resource limit (0)

Ring fenced depreciation and impairments

Depreciation 700

Total revenue resource outturn 146,532

Grant-in-Aid expenditure £000’s

Programme





Total Grant-in-Aid expenditure – programme 139,000

Administration

Administration 6,832

Total Grant-in-Aid expenditure 145,832

39

Provisions £000’s





Property Expenses Scheme 936



Total Annually Managed Expenditure 5,300,000

Annually Managed Expenditure resource limit [to be confirmed]

Capital £000’s

Capital expenditure [to be confirmed]

Total capital expenditure [to be confirmed]

Annually Managed Expenditure (AME)

NHS Resolution’s annually managed expenditure, or AME, represents the estimated change in the provisions made for legal claims for each of the schemes that we operate.

These estimates do not include any additional budget requirements relating to the recent ‘Ogden’ discount rate change. Further work is required to calculate the likely impact of this before budgets can be adjusted.

Capital expenditure relates primarily to IT equipment and software replacement and development.

AME is more difficult to explain or control, as it is spent on programmes which are demand-led such as welfare, tax credits or public sector pensions. It is spent on items that may be unpredictable or not easily controlled by and are relatively large in comparison to other government departments.


40


We successfully relocated 64 staff in 2016/17 to ensure that our London-based services were delivered from under one roof.

Whilst this involved acquiring additional space in Victoria, we reduced our overall working space in London.

We will continue to keep our estates requirement under careful review in 2017/18. We will take steps to accommodate our proposed workforce strategy at the same time as taking full advantage of the efficiencies that can be delivered through remote working.

We will continue to make effective use of shared meeting room space with our ALB partners at the same time as making use of our legal panel firms’ nationwide meeting room space.

5.1 Estates

41

Cyber security

Cyber security remains a business priority for us. In 2016/17, we reviewed our cyber security defences and endpoint security to ensure that we were maintaining alignment between ever evolving security threats and our security capabilities. During 2017/18, we will complete the following work in this area:

• Undertake a Distribute Denial of Service resilience test and develop an action plan.

• Deliver an ongoing programme of software patch management to a defined and agreed standard.

• Undertake a further review of end point security to look into the feasibility of ‘artificial intelligence’ or machine learning technology for a more proactive rather than reactive approach to cyber security.

• Increase staff awareness.

• Deliver a planned programme of ongoing penetration test.

• Complete an annual social engineering test.

We will continue to keep our Board apprised of emerging threats and our capability to deal with them.

Information Systems Development

We will look to fundamentally change the way in which we approach our 2017/18 IT systems development work through our newly created business development function.

We will complete our virtualisation work and integrate our IT systems into one common network thereby reducing our running costs. We will exploit the benefits of the Crown Hosting Data Centre platform to begin our ‘Journey to the Cloud’, which will act as an enabler for us to be more agile in dealing with disaster events and emerging circumstances such as relocation to more challenging/reduced accommodation.

There will be an ongoing programme of work for the streamlining of internal and external business processes as well as more focused work on improving our external facing communication tools, such as the website, to support our strategic aims and meet the needs of our stakeholders.

In previous years we have adopted a ‘recondition and re-use’ approach to our desktop estate to keep costs to a minimum. This approach will change in 2017/18 to allow us to be more flexible with regards to our accommodation needs. We will begin work that will enable us to supply our staff with a single lightweight and dock-able workstation running the Windows 10 operating systems. Additionally, we will cease our use of the Blackberry service in favour of the further utilisation of IOS based smartphones. This work is likely to be completed by 2018/19. These changes will enable our staff to work in the most adaptable and agile way.

5.2 IT



42

Part 6Governance

43

Delivery of our Business Plan is dependent upon the effective management by ourselves and others of the following risks:

• Sufficient resource being available to deliver our services and the challenging degree of change envisaged.

• Externally driven changes which may change the volume or value of claims we receive and so increase or reduce the costs to the indemnity schemes and create operational challenges in volume and uncertainty in the payment profile.

• Changes in policy or expectations of our purpose, services or delivery which may supersede our plans and/or cause a re-prioritisation of resource.

• Unforeseen changes in the health service either structurally or in the profile of and response to harm.

• Changes in the priorities of others whose actions are integral to the delivery of our Business Plan.

We place effective identification and control of risk at the heart of good decision making.

Our supportive risk management framework ensures:

• integration of risk management into activities across the organisation as well as policy making, planning and decision making processes;

• chances of adverse incidents, risks and complaints are minimised by effective risk identification, prioritisation, treatment and management;

• risk management is an integral part of our culture and encourages learning from incidents; and

• a risk management framework is maintained, which provides assurance to the Board that strategic and operational risks are being managed.

Risks will be monitored and escalated to the appropriate risk register and managed in line with our appetite for risk.

In delivering our strategic priorities, utilising the Strategic Risk Register enables the Senior Management Team to mitigate threats and exploit opportunities.

We will work collaboratively with DH and the wider ALB network to take forward work on identifying any risk interdependencies between organisations.

We will work with our internal audit supplier to develop a comprehensive annual internal audit plan which will offer insight and assurance that existing internal controls are adequate and suggest improvements where required.

6.1 Audit, risk and assurance

Part 6 | Governance


44

We comply with Public Procurement Regulations in relation to procurement.

We will review and revise our Procurement Policy and Procedure to ensure they meet regulation and are accessible to all staff.

We will ensure any procurement is considered in terms of business need and is the most economically advantageous for the NHS.

We recognise that all of our customers entrust us with confidential, personal and sensitive information.

We are committed to ensuring that we safeguard this information by maintaining our data security controls as part of our ISO27001 certified information security management system.

We will continue to ensure that we learn from our incident reporting and implement improvements where these are necessary.

We also want to work with our partners in the healthcare system to learn from the information that we hold.

This will require us to share information and we will do so with appropriate regard to information governance and follow best practice in data sharing.

We are committed to ensuring that our staff are able to raise concerns without fear of blame and then listening to and acting on their concerns. As part of this we are reviewing our policy to ensure it remains fit for purpose.

We are also working with the National Guardian for speaking up freely and safely within the NHS, to identify areas for joint working, including incorporating messages about supporting those raising concerns into our training materials and publications.

In 2017/18 we will continue with this programme, including continuing to work collaboratively with other national stakeholders, hearing directly from those practitioners and clinical staff who have raised concerns, considering how our services can be improved to support them and offering remediation and return to work plans for doctors, dentists and pharmacists.

6.2 Procurement

6.3 Raising concerns and whistleblowing

6.4 Data security

45

Part 6 | Governance


46

Conclusion

47

Conclusion

Our Business Plan for 2017/18 represents the first step on an ambitious journey to successfully deliver our Five Year Strategy, ‘Delivering fair resolution and learning from harm’, while maintaining and improving the core services that our customers expect of us.

We will regularly report progress in our delivery to the Board and our DH Sponsorship team. We will also continue to seek feedback from key stakeholders, including our scheme members and staff, so that we’re continually challenging our own performance and adapting our plans, where necessary.


Resolution

Contact us

We would like to hear from you.

If you have any comments or questions on our Business Plan 2017/18, please get in touch by email at:

[email protected]

Alternatively, you can write to us at:

NHS Resolution151 Buckingham Palace RoadLondonSW1W 9SZ

You can read more about our work at:

www.resolution.nhs.uk

Follow us at @NHSResolution

Published April 2017

Business Plan 2017/18 - NHS Resolution · PDF fileNHS Resolution Business Plan 2017/18 6 In...

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