Recommendation 5

HM Government Accepted in Part

PHSO commissioned Sir Liam Donaldson and Sir Alex Allan in 2018 to review PHSO’s approach to using specialist clinical advice in casework. To date, PHSO has delivered and fulfilled 22 of the 25 recommendations of the Clinical Advice Review. We are currently progressing the remaining three recommendations, as set out below. We are carrying out a phased roll-out of the sharing of provisional view reports with clinical advisers and applying lessons learnt to future phases. This will enable us to understand the costs and benefits of this approach. Early data from the phased roll-out with senior caseworkers found that 83% of participating clinical advisers said that being able to see the provisional view made them feel more engaged with PHSO. Feedback also showed that clinicians were content with the manner in which their advice had been considered and applied. We now plan to pilot this model with the broader casework population during 2022–23, but will need to ensure that we do so in a way that supports PHSO’s work to reduce waiting times for complainants. We are introducing 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. Through piloting the surveys, we found that maximum value would be achieved by rolling these out alongside a wider range of quality measures. As above, changes of this nature can have a short-term effect on operational productivity. We will carefully consider when and how to implement this change, to manage the impact it may have Parliamentary and Health Service Ombudsman Scrutiny 2020–21: PHSO and Government responses 5 on reducing the queue of complaints waiting to be looked at by a caseworker. However, we have introduced a quality review by a lead clinician of clinical advice requested and received from our external advisers, so that any issues can be quicky identified. Internal advisers undergo in-house quality assurance checks. The Clinical Advice Review also recommended that PHSO consider whether clinicians should be named in PHSO’s decision reports. We considered the risk that clinical advisers may be subject to vexatious referrals to their professional regulator from complainants who disagree with their professional advice. We also considered the risk that they could be approached directly by dissatisfied complainants, or could be publicly denounced online by those disagreeing with our decisions. We discussed with professional regulators the possibility of a protocol about dealing with vexatious referrals. They advised that they could not offer a special protocol or guarantee to protect clinical advisers in such circumstances. Many other bodies who use expert clinical advice, such as the professional health regulators, do not routinely name their clinical advisers in casework considerations. A Tribunal decision is awaited about a request made under the Freedom of Information Act seeking the names of certain other (non clinical) PHSO colleagues. We anticipate a decision in Quarter 2 or 3 of 2022–23, and we will then consider the outcome of this case as we consider the possibility of naming clinical advisers in decision reports. Looking more generally at clinical advice, we have also appointed a Senior Lead Clinician to provide senior clinical oversight on complex cases and embed learning from the Clinical Advice Review within casework teams. We now have a multi-disciplinary (MDT) approach to high-risk case management which includes senior clinical input in case discussions, prompt recruitment of suitable clinical advisers and exploring different approaches to these cases such as mediation. This work is shared widely with casework teams through casework discussion forums and through lead clinician promotion of MDT working, involvement in review of clinical advice submissions and learning and development opportunities.