Recommendation F92: NHS Litigation Authority Improvement of risk management
From Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry, published 6 February 2013.
Recommendation
The financial incentives at levels below level 3 should be adjusted to maximise the motivation to reach level 3.
In brief (written by this site)
In February 2026, DHSC and NHS England stated that the NHS Litigation Authority, now NHS Resolution, had moved away from assessment against risk management standards, having introduced a Maternity Incentive Scheme in 2017 that offers indemnity contribution reductions for meeting ten safety actions (DHSC and NHS England, Feb 2026). In May 2024, the Thirlwall Inquiry legal team noted that the government had accepted the recommendation, observing that 2013 pricing changes had replaced risk management discounts with financial rewards for trusts with fewer and less costly claims (The Thirlwall Inquiry legal team, May 2024).
AI-generated summary of the record on this page, checked by a second model and automatic checks, 26 Sep 2026. The record below is the sources' own words.
Government response
Accepted.
From 1 April 2013, the NHS Litigation Authority introduced a revised pricing methodology for the Clinical Negligence Scheme for Trusts.
The new approach means that organisations with a good claims record will see the benefit of this in their Clinical Negligence Scheme for Trusts pricing whereas those organisations with a less favourable claims history will contribute more to the risk pool. These changes were discussed extensively with members of the scheme. The Department of Health and other relevant parties across the system agreed this represents a more equitable way of distributing the costs of the scheme.
The NHS Litigation Authority is also already bringing the focus of NHS organisations onto their claims activity which it is hoped will in turn assist in reducing the costs associated with Clinical Negligence Scheme for Trusts and ultimately reduce the level of harm to patients.
How this response relates to the recommendation
Site note: This is volume two of "Hard Truths: The Journey to Putting Patients First" (Cm 8777-II), the government's response to the Inquiry's 290 recommendations, published by the Department of Health on GOV.UK on 19 November 2013 and dated to that day here. The PDF the row links to is the accessible edition, whose title page reads "January 2014". The Department of Health has been the Department of Health and Social Care since January 2018. The volume says it includes accounts from each of the national organisations the recommendations name, but it does not mark which passage each organisation wrote, so every row is filed under the Department that published it.
Blanket government agreement does not establish acceptance or delivery by each addressee. Some response passages cover groups of recommendations.
Scope of the government response
Government responded via "Hard Truths: The Journey to Putting Patients First" (2014), a single document covering all 290 recommendations with a blanket acceptance. Individual recommendation responses were not broken out.
Delivery
DHSC and NHS England state no delivery position (27 February 2026)
The NHS Litigation Authority, now NHS Resolution (NHSR), has moved away from assessment against risk management standards. In 2017 NHSR started a Maternity Incentive Scheme under which it sets participants 10 safety actions to achieve for which they are given the incentive of a reduction in their maternity indemnity contribution.
Site note: DHSC and NHS England's own account of progress, supplied to the Thirlwall Inquiry in September 2024 and printed in the Inquiry legal team's Review of Implementation of Recommendations from Previous Inquiries into Healthcare Issues (version dated April 2025, published 27 February 2026). It is not a finding of the Inquiry. Their reviewed extent of implementation reads “Superseded”. Table row: section 18.2 No. 92, PDF page 469.
Department of Health and Social Care says in progress (11 February 2015)
In 2013 the NHS Litigation Authority informed the NHS that it would be moving away from the system of risk management discounts on members’ contributions whilst aiming to avoid large swings in price for members who currently receive discounts. The revised pricing methodology, which has been in place since April 2013, financially rewards organisations with fewer, less costly claims and financially incentivises organisations to focus on their claims with a view to reducing them, thereby reducing harm and improving patient and staff safety. In addition, the NHS Litigation Authority is supporting Sign up to Safety, the campaign launched by the Secretary of State for Health that aims to listen to patients and staff, learn from when things go wrong and act to make care safer. The NHS Litigation Authority will review members’ safety plans and where they aim to reduce claims and are robust, the NHS Litigation Authority will make a payment to support implementation of the safety improvement plan.
Site note: This is the supporting annex published on 11 February 2015 with "Culture change in the NHS: applying the lessons of the Francis Inquiries" (Cm 9009), attached to the GOV.UK page as "Culture change in the NHS supporting annex". The annex has no title page; that title is GOV.UK's and the PDF's own. Its table has four columns (No., Recommendation, Hard Truths Government response, Progress update), and the row carries the Progress update cell. No column says which organisation wrote an update, so the row is filed under the Department of Health (now the Department of Health and Social Care), which published it.
Site note: The Inquiry addressed this recommendation to the NHS Litigation Authority (now NHS Resolution), not to the Department of Health. The annex gives this update in the Department's publication and does not say who wrote it, so the row is the Department's report of the progress made on it.
What other bodies have found
In their own words. These do not change the delivery statement above.
Thirlwall Inquiry legal team (15 May 2024)
This recommendation was accepted by the Government.
The Government referred to changes to pricing methodology for the Clinical Negligence Scheme for Trusts implemented in April 2013, which moved away from the system of risk management discounts. Instead, the revised pricing method rewarded organisations with fewer, less costly claims.
Site note: The Thirlwall Inquiry legal team's own notes on implementation, from its Review of Implementation of Recommendations from Previous Inquiries into Healthcare Issues (version of 15 May 2024). The review does not colour its Extent of Implementation cell for this recommendation green; it leaves the cell uncoloured where a recommendation was rejected, where evidence of implementation was insufficient, or where steps had been taken but implementation was not yet complete. Table row: section 16.2 No. 92, PDF page 434.
Source
Themes and tags
Who has spoken
- Department of Health and Social Care
Response, delivery statement - DHSC and NHS England
Delivery statement - Thirlwall Inquiry legal team
Finding