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Clinical Advice Review: Final report and our response

Greater integration of clinical advisers into the casework process

Recommendations

Sir Liam proposed that:

  • clinical advisers should be much better integrated into casework, including agreeing how their advice is used in provisional views and final reports
  • clinical advisers should be encouraged to identify any serious problems in care even if it is not an area covered by the complaint.

The Review fully supported these principles and recommended that PHSO:

  • explore increased involvement of Clinical Adviser’s at key stages of the casework process while maintaining professional, caseworker led decision making and timely casework outcomes
  • ensure that clinical advisers consistently receive all relevant background case material and that there is greater clarity on how they identify serious problems that are not directly in scope
  • enable continuous learning and improvement between caseworkers and clinical advisers.

Findings

Under our current process, clinical advisers primarily respond to questions from caseworkers when a complaint has been accepted for investigation. They are not routinely involved at other stages of our process, including when complaints are assessed and when their advice is incorporated into provisional views and final reports.

Sir Liam found the effectiveness of our current process for commissioning and using advice varied depending on the caseworker’s level of understanding and clinicians access to information. Where these were limited or partial, he judged that the relatively limited level of interaction between caseworkers and advisers made the PHSO process vulnerable to errors of fact, interpretation and omission.

The Review also heard from some complainants that they felt that the clinical advice cited in PHSO’s reports did not address the substance of their complaint or omitted key aspects of it. This undermined their trust and confidence in our process, leading some to question whether we used the appropriate adviser and/or whether caseworkers asked the right questions.

The Review also identified some inconsistent practice across the organisation. Some advisers noted that they would only provide advice on the questions they were asked, whereas others noted they would advise on wider issues if they felt that was appropriate based on the evidence that was provided to them on the case. Advisers also noted that there was inconsistency in the amount of documentation provided to them on a case. Sometimes they just received the key clinical records, but at other times they would also receive the original complaint and organisational response as additional background.

Our response

In 2019/20 we will:

  • Issue new guidance for caseworkers on the information they should provide to clinical advisers when requesting advice.
  • Issue clearer guidance for clinical advisers on how they can raise issues outside of the caseworker’s questions they have received; including where they identify serious failings that are outside the scope of the complaint.
  • Introduce surveys for clinical advisers to comment on the quality of requests from caseworkers and for caseworkers to comment on the quality of clinical advisers’ responses.
  • Develop and, if possible due to wider business plan activity, launch pilots to test the benefits, costs and understand the impact on resources and current case handling times of:
    • sharing provisional views with clinical advisers
    • sharing clinical advice in advance of provisional views with complainants and bodies in remit
    • convening multidisciplinary meetings with advisers and others (for example, legal colleagues) once specialist advice has been received.
  • Develop evaluation and lessons learned exercises for pilots to inform the approach to full implementation.

In 2020/21 we will:

  • Launch any pilots not commenced in 2019/20 due to wider business plan pressures and develop a further pilot to test the benefits, cost and understand impacts on case handing times of increased involvement of clinical advisers at our assessment stage.
  • Develop evaluation and lessons learned exercises for the pilots to inform the approach to full implementation.