Health Department
Directorate of Finance

Dear Colleague

CLINICAL NEGLIGENCE AND OTHER RISKS INDEMNITY SCHEME (CNORIS)

Purpose

1.         This circular:

q       updates the financial thresholds above which Health Boards and NHS Trusts can seek assistance from the Residual Pool;

q       introduces the Level Two criteria, plus revised Level One criteria, for both clinical and non-clinical risk;

q       introduces a fast track re-assessment process for those that narrowly fail assessment at Level One;

q       provides instructions on the delegated limit process for settling cases; and

q       provides an update on scheme cover for volunteers.

Background 

2.         The Clinical Negligence and Other Risks Indemnity Scheme (CNORIS) was launched on 1 April 2000 with membership mandatory for all health bodies. The Scheme has two principal aims: 

Ø      Financial efficiency through cost-effective risk pooling and claims management;

Ø      Effective risk management by encouraging a rigorous approach to treatment of risk. 

3.         The Scheme comprises one financial pool incorporating: 

Ø      New Pool – clinical and non-clinical incidents occurring and reported on or after 1 April 2000 and incidents incurred but not reported (IBNRs) as at 1 April 2000 (except for non-clinical claims that are covered by previous commercial insurance cover);

2nd August 2001

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Addresses

For action
Chief Executives, NHS Trusts

General Managers, Health Boards
Common Services Agency
Scottish Ambulance Service
State Hospitals Board for Scotland
Directors of Finance,
  Health Boards and NHS Trusts

For information
Chief Executive, Clinical Standards
   Board for Scotland 

The Director, Mental Welfare
   Commission for Scotland 

Executive Director, SCPMDE

Medical and Nursing Directors

______________________________

Enquiries to:

Colette Templeton
Directorate of Finance
Health Department
Room 401
16 Waterloo Place
EDINBURGH EH1 3DN

Tel: 0131-244 2271
Fax: 0131-244 2371
Email:
Colette.Templeton@scotland.gsi.gov.
uk

________________________

Ø      Residuals Pool – clinical incidents which the service knew about on or prior to 31 March 2000.

4.         The Residual Pool continues to operate as before under the terms and conditions detailed in MEL(1999)63 with the exception of the individual ‘thresholds’ (i.e. deductibles) that for 2001/2002, have been uplifted by 5.5% on the previous level. The new levels, which come into effect on the date of this HDL, are detailed at Annex 1.

5.         It should be noted that, unlike the New Scheme, the member’s own legal costs do not rank for reimbursement calculation purposes in the Residual Pool.

6.         Applications for reimbursement from the Residuals Pool should be submitted to the Scheme Manager, Willis Limited in the first instance and not to the Management Executive as in the past. Applications for reimbursement from New Pool should also be submitted to the Scheme Manager.

RISK MANAGEMENT STANDARDS

7.         The Scheme is underpinned by complementary clinical and non-clinical risk management standards, which are subdivided into Levels One, Two and Three.  Together these constitute the foundation of a comprehensive Risk Management programme and systematic Governance of risk.  The standards are published on the CNORIS website (www.cnoris.com).

8.         Members are able to use these standards to develop their approach to risk management, and can be assessed against the criteria contained within each Level of the standards once in each financial period.  Fast-track re-assessment, as detailed further in Annex 2, is considered to form part of the original Level One assessment. Assessment at Level Two is only available following a successful assessment at Level One.  Further details in Annex 2 build on the detail contained within NHS MEL(2000)18 and provides information on the new procedures to be followed during assessments and the introduction of fast track re-assessment process for those that narrowly fail Level One standards.

DELEGATED LIMITS PROCESS

9.         Where a Member intends to recover payments from the pool and the award exceeds the revised delegated limit (£250,000), prior approval is required from the Scottish Ministers.  Further details on the process to be followed is set out in the protocol at Annex 3.

SCHEME COVER: VOLUNTEERS

10.       Both the Department and Willis have received a number of enquiries about the scheme’s coverage for volunteers following a recently circulated leaflet from Volunteer Development Scotland. Annex 4 provides guidance on this issue and seeks information from individual Members by 12 October 2001 so that the coverage situation can be further clarified.

ACTION

11.       Chief Executives and General Managers are requested to:

q       circulate copies of the HDL to all staff with CNORIS and/or risk management responsibility;

q       note the revised threshold limits (Annex 1) for Residual Pool and the arrangements for dealing with claims against this pool (paragraphs 4, 5 and 6 refer);

q       note the introduction of new Level Two criteria, amendments to Level One criteria, and the revisions to the assessment procedures including the introduction of a fast track re-assessment process for Level One (Annex 2);

q       ensure compliance with the revised delegated limit and approval procedures as detailed in Annex 3;

q       note the guidance on volunteers (Annex 4) and ensure the associated questionnaire is completed and returned to Alan Barn, Willis Limited no later than Friday 12 October 2001.

Yours sincerely

Annex 1: Central contribution to damages awards: 2001/02 - health boards and other (PDF file, 7 KB)

Annex 1: Central contribution to damages awards: 2001/02 - NHS Trusts (PDF file, 9 KB)

Annex 2: Risk management standards and procedures: update (PDF file, 19 KB)

Annex 3: Clinical Negligence and Other Risks Indemnity Scheme (CNORIS): delegated limits process (PDF file, 35 KB)

Annex 4: Guidance note on protecting volunteers (PDF file, 62 KB)