Question to the Department of Health and Social Care:

To ask the Secretary of State for Health, what amount of contribution private healthcare providers which are unable to arrange their own insurance make to the Clinical Negligence Scheme for Trusts; and whether that amount is the same as the contributions required of NHS trusts.

It is a requirement of the NHS standard contract, which is mandated by NHS England for use by commissioners for all contracts for healthcare services other than primary care, that providers have appropriate indemnity cover in place. The Department of Health took steps when it amended the Clinical Negligence Scheme regulations in April 2013 to enable independent sector healthcare providers performing NHS contracts to have in place sufficient indemnity cover to meet the cost of clinical claims arising from any negligent treatment by the independent sector provider in the course of providing those NHS services.

There were two key elements to these changes. Firstly, to allow independent sector providers to become members of the Clinical Negligence Scheme for Trusts (CNST) if they hold a direct contract for relevant health services with a commissioning body, and/or if they subcontract with another body, who is not a member of CNST, which does hold a direct contract for relevant health services with a commissioning body. Secondly, where the organisation holding a direct contract with a commissioning body is a member of CNST, certain of the liabilities of any subcontractors it engages to provide NHS services in relation to that contract are treated and dealt with as though a liability of the member.

The April 2013 amendment regulations were designed in this way to address the issue of increasingly complex care pathways involving multiple healthcare providers, revising CNST to provide a means of covering the whole potential care pathway within the NHS and enabling main contractors to meet their responsibilities under the NHS standard contract with respect to indemnity for the liabilities of subcontractors. The intention is to provide more positive and timely outcomes for claimants and to improve the sub-contracting carried out by members.

The costs of CNST are met by membership contributions. The projected claim costs are assessed in advance each year by professional actuaries. Contributions are then calculated to meet the total forecast expenditure for that year. Individual member contribution levels are influenced by a range of factors, including the nature and volume of services provided, the number of ‘whole time equivalent’ clinical staff employed within each service, and claims history. For the independent sector, this last factor is not the reflected in their contributions in the same way as NHS members, because the NHS Litigation Authority does not yet have sufficient information on the claims experience of independent sector providers since they have not been delivering care as members of CNST for long enough.

Information on the contributions made by all members of CNST, including independent sector members, are published annually by the NHS Litigation Authority on its website, and a copy of the data for 2013-14 is attached to this reply:

http://www.nhsla.com/Pages/Publications.aspx?library=currentactivity%7cfactsheets%7cfactsheet5trustandhealthauthorityclaimsdata