The number of negligence claims made against health authorities rose dramatically during the 1980s.1 Since Crown Indemnity was introduced in 1990 the responsibility for meeting these claims has shifted from defence organisations to health authorities and NHS trusts. Settling these claims in England currently costs an estimated pounds sterling 75m a year2 - money that could otherwise be spent on patient care. What can NHS trusts do to minimise these costs?

The NHS Executive has recently issued Risk Management in the NHS, which recommends to chief executives that “risk management . . . is no longer an optional extra.”3 Four categories of risk management are identified: risks that relate to clinical care; non-clinical risks to patient safety, such as security and fire hazards; risks to the health of the workforce; and organisational risks, such as failure to safeguard confidential information and unlicensed use of computer software.

But how does risk management relate to clinical care? It aims at reducing adverse events (incidents that …