Clinical Advice Review: Final report and our response


PHSO has a unique role to play as the last resort for people who are dissatisfied with the treatment or service they have received – be it from government departments, their agencies or an NHS organisation.

This means that there must be trust and confidence in the Ombudsman if we are to provide an effective resolution to the complaints brought to us. Decisions must be demonstrably impartial, fair and informed by a thorough and competent consideration of the relevant evidence.

Clinical advice is a key aspect of our NHS-related casework process. We use it as a vital source of evidence to inform our thinking in around three-quarters of our health investigations. So it is crucial that PHSO commissions and uses it appropriately and that those involved in a complaint understand and have confidence in the way it has informed our decisions.

I established a comprehensive review of how PHSO draws upon clinical advice for resolving complaints to ensure it is in line with our values of independence, transparency, fairness and excellence. We must embed these values in everything we do in order to meet the ambition set out in our 3-year strategy to become an exemplary Ombudsman service.

I am very grateful to Sir Alex Allan for chairing the Review, to Sir Liam Donaldson for his work providing independent advice to it and to the rest of the Review Team for helping craft a challenging but vital set of recommendations. I also want to thank all those who engaged in the Review’s consultation process, providing Sir Liam, Sir Alex and the rest of the team with the unvarnished insight they needed to develop these recommendations.

PHSO is accepting the vast majority of the recommendations made by Sir Liam in his role as Independent Adviser, and Sir Alex’s Review, as a whole. The Review’s recommendations show us how to improve assurances to all involved in a complaint that we have commissioned, used and reported clinical advice appropriately.

Some of the recommended changes are significant in that they include greater interaction between clinical advisers and caseworkers, and more frequent communication with complainants.

The Review makes clear these changes will have a significant cost impact on the delivery of PHSO’s service and will require changes to process, internal guidance and staff training.

It is important that we implement the recommendations speedily and in a structured way that complements other aspects of our transformation. We have undertaken considerable planning to ensure that our approach to implementing the Review is deliverable alongside our wider business plan, which is carefully phased across 2019/20 and 2020/21 to take us to the end of our 3-year strategy.

As we will make clear in our business plan, this approach includes a need for flexibility across the next two years. We will use the in-year learning we generate from implementing the significant changes we have planned to help us deliver activity more quickly where possible, or move it back where this is needed, including in relation to the plans set out in this response.

I am confident that by the end of our current 3-year strategy the implemented recommendations will further enhance the quality, fairness and transparency of our decisions on complaints that require clinical advice.

Rob Behrens, CBE 
Ombudsman and Chair
Parliamentary and Health Service Ombudsman