Recommendation 14

HM Government Accepted

We have now completed implementation of all recommendations made by the Donaldson Review into PHSO’s approach to clinical advice. We have a framework for assuring the quality of clinical advice. The framework supports the delivery of high-quality advice by setting out standards, measures to assess theses, and an assurance process. This includes peer reviews, two-way feedback between clinicians, caseworkers and their managers and sampling by lead clinicians. The Clinical Advice service is now embedded in the casework operation, so performance and demand are reviewed and managed alongside other aspects of casework. Clinical Advisers are also now more closely involved overseeing cases that involve a higher level of risk. Where clinical advice has been sought on a complaint, and for all of the most serious health cases assigned to a senior caseworker, the caseworker’s “provisional views” are now shared with clinical advisors. This gives clinical advisors an opportunity to review how caseworkers have interpreted their expert advice before a final decision on a complaint is made. The Donaldson Review into Clinical Advice recommended that PHSO carry out a pilot to name clinical advisors. After careful consideration, we have decided not to do this. There are four main reasons: • PHSO has an established policy not to disclose the names of staff below Assistant Director level. The ICO supports this policy as confirmed following an appeal to the ICO and their decision promulgated in autumn 2022. • We are concerned about the safety of clinical advisers. Unfortunately, it is not uncommon for PHSO staff to encounter abuse from members of the public. A survey of 140 of PHSO’s clinical advisers found that advisers were concerned about their personal safety and security, should they be named. The survey found that advisers would be less likely to work for PHSO if their names were disclosed. • Naming clinical advisers would risk giving disproportionate weight to the evidence they provide when they are not the decision makers. Caseworkers carefully balance different sources of evidence provided by clinicians, complainants, organisations we investigate, and others before reaching a decision. • Other bodies, such as professional regulators, do not normally disclose the names of clinical advisors involved in casework. PHSO’s approach is consistent with these other bodies. PHSO remains committed to transparency. The improvements we have made to the clinical advice process were intended to improve its robustness, customer experience, and openness. We are currently evaluating the impact of these improvements.