NHSLA schemes - Timeline Key internal and external events from 1995-2009.

NHSLA schemes - Timeline

Key internal and external events from 1995-2009

© Det Norske Veritas AS. All rights reserved Slide 22nd October 2009

Timeline: 1995

Standards

Willis and the Medical Protection Society (MPS) worked on the development of risk management standards

Assessments

5% discount offered to all trusts who could provide ‘any’ documentary evidence of risk management.

NHSLA Reform

NHSLA formed

Schemes established - only Clinical Negligence Scheme for Trusts (CNST) at this stage

Willis appointed to develop clinical risk management standards

Willis team consists of a manager and two assessors

NHS Reform

NHS Executive appointed Willis and the MPS to develop clinical risk management standards and manage Cat A claims

Internal events Assessment team External events


Timeline: 1996

Standards

CNST Standards launched (only Level 1 at this stage)

Assessments

Very subjective assessment process

No guidance manual

NHSLA Reform

Chief Executive appointed

NHSLA framework published (overall aim being to promote the highest possible standards of patient care and to minimise the suffering resulting from any adverse incidents)

One further assessor appointed



Timeline: 1997

Standards

CNST Level 2 Standards developed and tested

Guidance manual developed with minimal external input

Contract for risk management services was put out for tender and awarded to Willis

Team size remained as before


Regulation and national papers

The New NHS - Modern - Dependable (DH 1997) published. The proposals included the concept of clinical governance; a new independent body -Commission for Healthcare Improvement (CHI); National Service Frameworks; and the National Institute of Clinical Excellence (NICE).

Nolan report published. This built on the 1992 Cadbury report which had identified principles of good governance in organisations, integrity, openness and accountability - clinical governance entered the NHS language.

NHS Reform

The announcement of the concept of Primary Care Groups, Primary Care Trusts and NHS Direct


Timeline: 1998

Standards

CNST Level 3 Standards developed and tested

Team size remained as before



A First Class Service: Quality in the New NHS (DH 1998)

Human Rights Act 1998

Data Protection Act 1998

NHS Reform

First scheme member mergers took place

NHS Direct established

Investigations

Bristol Royal Infirmary Enquiry into children’s heart surgery at Bristol which reinforced the issue of consent


Timeline: 1999

Standards

Risk Pooling Scheme for Trusts (RPST) assessors worked with the Controls Assurance team to produce the core risk management standards

A mental health standard was developed and included within the CNST General Standards

A maternity standard was developed and included within the CNST General Standards

The CNST team expanded to one manager and five assessors

The RPST team was appointed and included one manager and three assessors


Towards Safer Childbirth (RCOG 1999)

HSC 1999/065 Clinical Governance in the New NHS (DH 1999)

Standards

Controls assurance statements introduced for the first time which required boards to sign off assurances for internal controls and risk management in addition to financial controls.

NHS Reform

National Institute for Clinical Excellence (NICE) established

Commission for Health Improvement (CHI) established



Timeline: 2000

Standards

New CNST Standards were launched in response to the Bristol investigation and national confidential enquiries

RPST Standards were launched

Work began on a separate assessment process for maternity services

Assessments

First RPST assessments carried out

First PCT assessments in respect of CNST carried out

NHSLA Reform

The first NHSLA risk manager was appointed

The CNST team expanded to one manager and eight assessors

The RPST team size remained as before

Standards

CNST was recognised by CHI as the national standard for clinical governance

NHS Reform

NHS Walk-in Centres

Abolition of NHS Executive

Investigations

“Dirty Hospitals” became a news headline which led to CNST developing an infection control standard

Redfern report published (organ retention at Alder Hey Children’s Hospital)

Shipman investigation


External events


An Organisation with a Memory (DH expert group 2000)

White Paper - The NHS Plan

White Paper - Reforming the Mental Health Act

Freedom of Information Act 2000


Timeline: 2001

Standards

Infection control added to the CNST Standards

The CNST and RPST assessors initiated joint project work on the development of combined ambulance standards

Work on a theatre pathway commenced

Assessments

Annual mandatory assessments were introduced for those trusts that had not achieved Level 1 of the CNST Standards

Contract for risk management services was put out for tender and awarded to Willis

Management of CNST and RPST teams merged in recognition of national move towards convergence of clinical and non-clinical risks

One manager for both teams with nine CNST assessors and five RPST assessors


Health and Social Care Act 2001

Building a Safer NHS for Patients (DH 2001)

Doing Less Harm (DH 2001)

White Paper - Shifting the Balance of Power within the NHS

HSC 2001/005: Governance in the new NHS (DH 2001)

Standards

Minimising the burden of assessment became a priority for the NHS, and the NHS Reviews Co-ordination Group was established

Hospital "star" system of league tables

The CNST Standards were included in trust performance ratings (star ratings)


External events

NHS Reform

National Patient Safety Agency (NPSA) established

Dr Foster established

Investigations

Kennedy Report on Bristol cardiac surgery


Timeline: 2002

Standards

The CNST General Standards were reviewed against the RPST Standards to identify and remove any areas of duplication

Revised RPST Standards were introduced

Assessments

Informal visits introduced for the first time

NHSLA Reform

All trusts in existence were members of CNST

One manager for both teams with eight CNST assessors and six RPST assessors

NHS Reform

Commission for Healthcare Audit and Inspection (CHAI) was established. It subsumed the existing Commission for Health Improvement (CHI), the value-for money-responsibilities of the Audit Commission and those of the National Care Standards Commission (NCSC).

28 Strategic Health Authorities (SHAs) replace health authorities

First Primary Care Trusts (PCTs) established

PCTs take over commissioning

NHS foundation trusts proposed


External events


Assurance: The Board Agenda (DH 2002)

Standards

New Department of Health controls assurance risk management standard introduced. This was based on the RPST risk management standard and was drafted by the RPST team.


Timeline: 2003

Standards

Separate CNST Maternity Standards and assessment formally introduced

Standalone PCT Standards introduced (covering clinical and non-clinical risk)

Three managers for the CNST team with ten assessors

Three managers for the RPST team with seven assessors


The Health and Social Care Act 2003

NHS Reform

The Health and Social Care Act 2003 established Monitor

Investigations

Confidential Enquiry into Maternal and Child Health (CEMACH) was established in 2003 through the amalgamation of the Confidential Enquiry into Stillbirths and Deaths in Infancy (CESDI) and the Confidential Enquiry into Maternal Deaths (CEMD)



Timeline: 2004

Standards

Separate standards developed designed to address the specific risks faced by ambulance trusts and PCTs, and bring together the requirements of the CNST and RPST

Assessments

RPST assessments suspended for all scheme members pending a review of the NHSLA risk management standards and assessment process to take place during the year

Concept of improvement periods introduced

Three managers for the CNST team with twelve assessors

Three managers for the RPST team with nine assessors

NHS Reform

The Healthcare Commission (HCC) took over the role of the Commission for Health Improvement (CHI) and also assumed some of the responsibilities of the National Care Standards Commission (NCSC) and the Audit Commission, as well as a number of additional functions.

Concordat between bodies inspecting, regulating and auditing health or social care established

First foundation trusts established


External events


Standards for Better Health (DH 2004)


Timeline: 2005

Standards

CNST Mental Health & Learning Disabilities Standards introduced

Final year of CNST General Standards

Assessment team fully combined with assessors now known as NHSLA assessors

Six managers for the team with 21 assessors

Procedure for Dealing with Abusive, Threatening or Aggressive Behaviour towards Assessors introduced

Regulations and national papers

Creating a Patient Led NHS - Delivering the NHS Improvement Plan (DH 2005) allowed patients to choose to receive care from Independent Sector Treatment Centres

Mental Capacity Act 2005

Investigations

Review of maternity services provided by North West London Hospitals NHS Trust (Northwick Park Hospital)



Timeline: 2006

Standards

NHSLA Acute Standards introduced

Team size remained as before Standards

The annual health check replaced the 'star ratings' assessment system and looked at a much broader range of issues than the targets used previously. It sought to make much better use of the data, judgements and expertise of others to focus on measuring what matters to people who use and provide healthcare services. Trusts had to declare their compliance with the core standards set out in Standards for Better Health, published by the Department of Health in 2004.

NHS Reform

SHAs reduced to 10, PCTs reduced 152


External events


Health Act 2006


Timeline: 2007

Standards

NHSLA Ambulance, MH&LD and PCT Standards introduced

Concept of template documents introduced

Scheme member handbook developed

Assessments

Independent organisations assessed for the first time

Contract for risk management services was put out for tender and awarded to DNV

Four managers for the team with 20 assessors


Framework for Action (Lord Darzi 2006)

Safer Childbirth (RCOG 2007)

Mental Health Act 2007

Investigations

Saving Mothers’ Lives (CEMACH 2007)



Timeline: 2008

Standards

Revised CNST Maternity Standards introduced

Assessments

Post assessment questionnaire introduced

Three managers for the team with 17 assessors


The Health and Social Care Act 2008 established a single, integrated regulator for health and adult social care - the Care Quality Commission (CQC) to replace the Healthcare Commission, the Commission for Social Care Inspection and the Mental Health Act Commission

High Quality Care For All: NHS Next Stage Review (DH 2008)

Investigations

Investigation into Mid Staffordshire NHS Foundation Trust



Timeline: 2009

NHSLA Reform

Additional support visits introduced

Four managers for the team with 14 assessors


NHS Constitution (Department of Health 2009)

NHS Reform

Care Quality Commission (CQC) introduced


The future?

NHSLA schemes - Timeline Key internal and external events from 1995-2009.

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