Gail Naylor, Director of Nursing & Midwifery. Safety and Quality Committee

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1 Report to Trust Board of Directors Date of Meeting: 24 June 2014 Enclosure Number: 5 Title of Report: Author: Executive Lead: Responsible Sub- Committee (if appropriate): Executive Summary: Clinical Negligence Scheme for Trusts Gail Naylor, Director of Nursing & Midwifery Gail Naylor, Director of Nursing & Midwifery Safety and Quality Committee As part of the ongoing work to improve risk management across the maternity service, the Trust has been independently reviewed against the CNST Maternity Clinical Risk Management Standards level 1 in order to provide assurance to the Trust Board and its stakeholders that the Maternity Service is operating at CNST Maternity level 1. The review is currently being completed with a full detailed report available by Friday 20 th June. However, enough work has been completed by close of business on 17 th June to enable confirmation that the Maternity Service is operating at CNST level 1 and will pass the independent assessment with a high score (see initial report at Appendix 1). The full CNST Maternity Level 1 report will be presented to Trust Board and other key committees in June/July The Maternity Service is already working to a detailed CNST level 2 (Practice) and level 3 (Performance) action plan with frequent reporting on progress to key Maternity Service and Trust committees. Board Assurance Framework Reference: 2.3, 2.4 Risk Rating (high, Medium. 1

2 medium, low risk) and any recommended changes to risk rating: Compliance, legal and national policy regulatory requirements: Financial Implications: Achievement of higher standards of risk management within maternity should lead to a reduction in clinical negligence claims and an overall safer service for patients. Clinical negligence claims affect the insurance premium of the Trust. Actions required by the Board: To approve: To note: For information: Discussion and decision Where the Board is made aware of key points but no decision required For reading and consideration and for discussion by exception only The Trust Board is requested to NOTE the initial outcome of the independent review. Data quality: Source: Denise Woods Validated by: Gail Naylor, Director of Nursing Date: 24/06/2014 2

3 APPENDIX 1 Independent Review of the Maternity Service at North Cumbria University Hospitals NHS Trust NHS Litigation Authority Clinical Negligence Scheme for Trusts Maternity Clinical Risk Management Standards 2013/2014 Level 1 - PASS Summary Briefing Paper Denise Woods 17 th June

4 CONTENTS Page EXECUTIVE SUMMARY: 1. Introduction 3 2. Conclusion 3 3. Next Steps 3 4. Outline of the Current Assessment at level The Standards and Assessment Process 4.2 Level Outline of the Standards Framework Appendix CNST Clinical Risk Management Standards ( ) Dashboard 5 4

5 Executive Summary: 1. Introduction The purpose of this review is to formally measure the North Cumbria University Hospitals NHS Trust Maternity Service against the CNST Maternity Clinical Risk Management Standards level 1 and to provide assurance to the Trust Board and it s stakeholders that the Maternity Service is operating at CNST Maternity level Conclusion The review is currently being completed with a full detailed report available by Friday 20 th June. However, enough work has been completed by close of business on 17 th June to enable confirmation that the Maternity Service is operating at CNST level 1 and will pass the independent assessment with a high score. 3. Next Steps The full CNST Maternity Level 1 report will be presented to Trust Board and other key committees in June/July. The Maternity Service is already working to a detailed CNST level 2 (Practice) and level 3 (Performance) action plan with frequent reporting on progress to key Maternity Service and Trust committees. 4. Outline of the Current Assessment at level The Standards and Assessment Process These are designed to: improve the safety of women and their babies; provide a framework within which to focus risk management activities in order to support the delivery of quality improvements in patient care, organisational governance, and the safety of women and their babies; assist in the identification of risk; contribute to embedding risk management into the maternity service's culture; focus maternity services on increasing incident reporting whilst decreasing the overall severity of incidents; encourage awareness of and learning from claims; reflect risk exposure and enable maternity services to determine how to manage their own risks; encourage and support maternity services in taking a proactive approach to improvement; provide information to the organisation, other inspecting bodies and stakeholders on how areas of risk covered by the standards are being managed at the time of the assessment. 5

6 4.2 Level 1 At Level 1 the approved documents which clearly describe how risks are to be managed are reviewed and assessed. A score is only awarded if these documents meet each of the minimum requirements specified within the individual criteria. This includes being compliant with national guidance and recommendations e.g. NICE, RCOG etc where applicable. The maternity service is being assessed against five standards each containing ten criteria giving a total of 50 criteria. In order to gain compliance at Level 1 the maternity service is required to pass at least 40 of these criteria, with a minimum of seven criteria being passed in each individual standard (set of ten). 4.3 Outline of the Standards Framework (see Appendix for detailed dashboard) Standard 1: Organisation The promotion of good risk management, governance and assurance are integral components to the maternity service s working practices and help to ensure that quality assurance, quality improvement and patient safety are central to the service s activities. This standard requires the maternity service to demonstrate good leadership, with an open and supportive culture, which provides a service that can fulfil the needs and expectations of women and their families. Standard 2:ClinicalCare_ Central to the care provided to all pregnant women is the care provided in labour. This can be provided in a variety of care settings and at all times it must be appropriate to the needs of the woman and consistent with current national guidance. This standard examines the care provided around the time of labour and requires the maternity service to have in place approved documentation for such activities. Standard 3: High Risk Conditions The provision of approved guidelines against which care should be provided and on which practice should be based is pivotal to the care women receive during the antenatal, intrapartum and postnatal periods. This standard seeks to address some of the high risk conditions that will occur within a maternity service. Standard 4: Communication Effective communication is the cornerstone of good clinical practice. The maternity service must ensure that approved procedures underpin these communication processes. Communication should occur between all team members in each discipline, as well as with women and their families. This standard guides the maternity service into setting up robust systems. Standard 5: Postnatal & Care For most women and their newborn the postnatal period is uncomplicated but care during this period needs to address any deviation from the expected recovery after birth. This standard is concerned with care of women, their newborn and families during the first few weeks after birth and addresses key issues which may arise. 6

7 CNST Clinical Risk Management Standards ( ) Appendix Standard Criterion Organisation Clinical Care High Risk Conditions Communication Postnatal & Care 1 Risk Management Strategy (Organisation) Care of Women in Labour Severe Pre- Eclampsia Booking Appointments Referral When a Fetal Abnormality is Detected 2 Risk Management Strategy (Leadership) Intermittent Auscultation Eclampsia Missed Appointments Life Support 3 Staffing Levels (Midwifery & Nursing Staff) Continuous Electronic Fetal Monitoring Operative Vaginal Delivery Clinical Risk Assessment (Antenatal) Admission to Neonatal Unit 4 Staffing Levels (Obstetricians) Fetal Blood Sampling Multiple Pregnancy & Birth Patient Information Immediate Care of the 5 Staffing Levels (Anaesthetists & Assistants) Use of Oxytocin Perineal Trauma Maternal Antenatal Screening Tests Feeding 6 Labour Ward Staffing Caesarean Section Shoulder Dystocia Mental Health Examination of the 7 Maternity Records Induction of Labour Postpartum Haemorrhage Clinical Risk Assessment (Labour) Bladder Care 8 Incidents, Complaints & Claims Severely Ill Women Venous Thromboembolism Handover of Care (Onsite) Support for Parent(s) 9 Training Needs Analysis High Dependency Care Pre-Existing Diabetes Maternal Transfer by Ambulance Postnatal Care 10 Skills and Drills Vaginal Birth after Caesarean Section Obesity Non-Obstetric Emergency Care Recovery 7

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