Sir Liam was clear that achieving the changes necessary to address the findings of the Clinical Advice Review would be a developmental process, requiring strong leadership, cultural change and the embedding of new behaviours. To enable this, he recommended creating two new senior posts in our structure:
- a Medical Director to lead and oversee the development of the new system of working
- a Director for Patients and Families to develop a more complainant centred service.
The Review Team agreed that these changes would take time and needed to be underpinned by new cultural norms and behaviours. The Review noted that decisions about the structure of our senior team are for the Ombudsman and Chief Executive to take in light of the requirements of the organisation and the budget that is available.
With respect to the Medical Director post, the Review said PHSO should provide clarity about who has responsibility for the Clinical Advice function in its senior structure and if this includes overseeing the changes recommended by the Review.
The Review Team agreed with the Independent Adviser that the culture of the organisation needs to be more attuned to patients and families experience. It noted that we have committed in our strategy to “develop options for involving complainants in improving our service, to improve trust and confidence in our decision making”. However the Review Team was not convinced that creating a separate director post is necessary or appropriate, as the aim is to embed the voices of patients and carers across all facets of our work.
As part of our approach to delivering the 24% cuts required of PHSO in the last Spending Review, PHSO has significantly reduced the senior team to streamline the management structure and to help protect frontline staff. This remains a priority and we do not currently have the resources to introduce the new posts proposed at such a senior level.
However, as part of the implementation of the Review’s recommendations, we will give full consideration to any changes that may be needed to the structure and leadership of the clinical advice team as we develop our next Comprehensive Spending Review bid.
We are also confident, however, that our now well-established senior team is capable of implementing the recommendations of the Review without the need for a specific Medical Director to support this. Our Clinical Advice team is already managed by three experienced clinicians.
Since Sir Liam started his work, the mix of backgrounds we have in these roles has also changed from three nursing practitioners to a spread across the most common generalist areas where we require advice (emergency medicine, general practice and nursing).
We agree that clarity is needed about who will be overseeing this work at a senior level. We can confirm that our Director of Operations will be leading the project to implement the activity outlined in this response, while our existing clinical leads and other senior staff will also be closely involved to support the significant changes recommended by the Review. We will also be exploring the creation of an expert advisory panel with a mix of clinicians, patient safety experts and others to use in our work as appropriate in the future.
In respect of a ‘Director for Patients and Families’ it also important that all of our senior team have an understanding of the needs of our service users from across public and health service organisations. To maintain our impartiality, it is also important to take account of the views of the organisations we investigate.
We therefore agree with the Review that, even ignoring the lack of budget for such a post, it would not necessarily be the most effective way of achieving greater confidence in our service.
We do agree, as set out in our 3-year strategy, that PHSO should ‘develop options for involving complainants in improving our service, to improve confidence and trust in our decision making’. Meeting this commitment goes well beyond the remit of the Clinical Advice Review and we will share our plans on involving complainants in the coming months.
In 2019/20 we will:
- Make clear in our published business plan where ownership for implementing the clinical advice review sits in the organisation.
- Explore the creation of an ‘expert advisory panel’ with a mix of clinicians, patient safety experts and those from other backgrounds that we can use in our work as appropriate.