The report, Clinical Risk Management: Making a Difference?, says 85% of health trusts now have risk managers - staff who identify problem areas, such as the rising pattern of baby deaths following heart operations at Bristol Royal Infirmary.

However, only 11% of trusts have got formal qualifications in risk management.

Those who have been trained on the job have only had an average of four days training a year and a third have had no training at all.

More investment

The NHS Confederation says many trusts have risk management procedures at board level, but no-one dealing with possible problems on a day-to-day basis.

It is calling for more investment in risk management, pointing out that the bill for settling the Bristol case is likey to reach up to £10m.

Storing information

Many hospitals sit on information about problem areas

The NHS Confederation's report found that some trusts tried to correct problems identified by risk managers.

However, many merely stored up information "but made little effort to use it".

It also found that risk management had little impact on reducing medical negligence cases, but had led 74% of trusts to change their practices.

The Confederation says standards of care have been driven up by medical litigation cases and structures set up to deal with them, such as the Clinical Negligence Scheme for Trusts.