Assessing and credentialing standards of care: the UK Clinical Negligence Scheme for Trusts (CNST, Maternity).

The Clinical Negligence Scheme for Trusts (CNST) provides NHS trusts with a set of risk management standards for maternity services. These standards are designed to act as a framework, bringing focus to the clinical risk management procedures adopted by maternity services, and to contribute to the development and implementation of clinical governance, thereby improving patient care. Both the Royal College of Obstetricians and Gynaecologists (RCOG) and the Royal College of Midwives (RCM) have endorsed the standards because of their potential to benefit clinical care. By improving clinical risk management procedures within maternity units, the standards are ultimately intended to reduce the level of clinical negligence claims. Assessments against the CNST Maternity Clinical Risk Management Standards are currently conducted by Det Norske Veritas Ltd (DNV) on behalf of the NHS Litigation Authority (NHSLA) to ensure that members' contributions reflect their standards of clinical risk management. Although the claims data have not been collected on a consistent basis and are too immature to provide conclusions in an area notorious for its long tail, it does indicate that there has been a fall in the number and cost of maternity claims as a percentage of total clinical negligence claims reported to the NHSLA since the inception of CNST. This chapter examines whether there is evidence that the standards have had a measurable effect on clinical negligence claims.