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Clinical Advice Review: Final report and our response

Effective and consistent communication with all those involved in a complaint

Recommendations

Sir Liam proposed that:

  • there should be greater contact and better communication with complainants, including sharing the qualifications and speciality of the clinical advisers proposed, and asking complainants to comment on requests for clinical advice and the subsequent advice before it is adopted
  • the tone and content of final reports and letters conveying decisions to complainants should be improved to ensure sensitivity.

The Review strongly agreed that effective and consistent communication, particularly with complainants, throughout the lifetime of a case is essential for ensuring trust and confidence in the Ombudsman process.

The Review gave careful consideration to whether this should include sharing the names of clinical advisers. On the one hand, this is in line with our commitment to transparency and would enable complainants and bodies in remit to assure themselves about the independence and suitability of clinical advisers. On the other, the Review felt we do not yet have the right processes in place to deal with the concerns raised by clinical advisers about potential harassment and vexatious referrals to professional regulators.

Moreover, the Review concluded that the anonymity of advisers was only one of a series of factors affecting trust and confidence in our process. They felt that it was important that we evaluate the impact of implementing the Review’s other recommendations before making a final decision on publicly naming clinical advisers.

The Review recommended that PHSO:

  • provide more information to those involved in a complaint about the clinical advice process across the lifetime of a case, including sharing clinical advice before sharing provisional views
  • engage with professional regulators before proceeding with any plans to name advisers, to explore whether a protocol can be established to provide assurances about how any vexatious referrals of advisers will be dealt with
  • evaluate the impact of the Review's changes on trust in the Ombudsman process to inform any subsequent decision to share the names of advisers with those involved in a complaint
  • review the language used to describe its decisions and findings to ensure they have appropriate sensitivity.

Findings

The Review heard from complainants that they expected greater visibility of what is happening at the point that clinical advice is requested and greater opportunities to input views before clinical advice is incorporated into provisional views.

The majority wanted more information about clinical advisers, to be assured of both their competency and independence. Some felt the names of clinicians should be should be shared to provide this assurance, whereas others thought sharing qualifications and experience was sufficient.

More generally, people felt frustrated about the lack of information they received about the progress of their case.

Although our existing Service Model prompts caseworkers to involve and update complainants on the progress of their case, the Review found this was not done consistently and that there are gaps with respect to the clinical advice process.

Several clinical advisers told the Review that they had strong concerns about potential harassment and vexatious referrals to regulators if their names were shared with those involved in a complaint. Some said that they would be reluctant to continue at PHSO if we moved to routinely naming advisers in reports.

Sir Liam also noted that: 

'introducing a policy to name clinical advisers could have unintended negative consequences even though it would fit with the PHSO’s commitment to transparency.'

Our response

In 2019/20 we will:

  • Produce new information for complainants at the outset of an investigation explaining the role of clinical advice, how it is used and how complainants and organisations we investigate will be involved in this part of our process.
  • This information will be updated to include changes to our processes to reflect the recommendations of the Review so that we consistently:
    • inform complainants and organisations when clinical advice has been requested
    • tell both sides of the complaint proactively about the qualifications and experience of the clinical adviser and why they were chosen
    • share the clinical advice received with those involved in a complaint before our provisional views on the case are issued.
  • Review the language we use to communicate the outcome of our investigations and pilot how this is presented in our final reports. This will form part of the work we are developing to publish the majority of our casework online by the end of our current 3-year strategy.
  • engage with professional regulators to explore whether a protocol can be established to provide assurances about how any vexatious referrals of advisers will be dealt with, should we proceed with proactively naming them.

In 2020/21 we will:

  • Evaluate the impact of implementing the Review’s recommendations on trust in our process and related Service Charter scores.
  • Following our discussions with professional regulators, develop a pilot to begin naming clinicians.
  • Begin publishing the vast majority of our casework online and using new language to communicate the outcome of our investigations in all of our final published reports.