Ombudsman said clinical advisers “now get to see evidence”

The request was partially successful.

Dear Parliamentary and Health Service Ombudsman,

Giving evidence to Pacac on 18 May 2020 Ombudsman Rob Behrens referred to a significant change in PHSO procedures. Before, caseworkers just asked questions of clinical advisers: clinical advisers “now get to see evidence”.

1. Please provide the date on which this change was implemented.

2. Do clinical advisers have to request to see the evidence or is the evidence routinely passed to them?

3. Since the change was implemented, please state the number cases where clinical advisers have been passed evidence.

4. If your computer-based case-management system has a field or fields to record how the change in procedure is recorded, please provide the relevant field heading or headings?

5. If caseworkers are required to decide what evidence clinical advisers get to see, please provide the guidance that they use.

6. Please provide the guidance clinical advisers use related to the change referred to by the Ombudsman.

7. Can clinicians ask caseworkers to obtain further evidence from complainants?

Yours faithfully,

J Roberts

InformationRights, Parliamentary and Health Service Ombudsman

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InformationRights, Parliamentary and Health Service Ombudsman

Dear J Roberts 

 

RE: Your information request: R0001256

         

I write in response to your email to the Parliamentary and Health Service
Ombudsman (PHSO) dated 29 May 2020 requesting information under the
Freedom of Information (FOI) Act 2000.

 

Your request

 

Giving evidence to Pacac on 18 May 2020 Ombudsman Rob Behrens referred to
a significant change in PHSO procedures.  Before, caseworkers just asked
questions of clinical advisers:  clinical advisers “now get to see
evidence”. 

 

1.  Please provide the date on which this change was implemented.

 

2.  Do clinical advisers have to request to see the evidence or is the
evidence routinely passed to them?

 

3.  Since the change was implemented, please state the number cases where
clinical advisers have been passed evidence.

 

4.  If your computer-based case-management system has a field or fields to
record how the change in procedure is recorded, please provide the
relevant field heading or headings?

 

5.  If caseworkers are required to decide what evidence clinical advisers
get to see, please provide the guidance that they use.

 

6.  Please provide the guidance clinical advisers use related to the
change referred to by the Ombudsman.

 

7.  Can clinicians ask caseworkers to obtain further evidence from
complainants? 

 

Response

 

As part of the clinical advice review we have been piloting new approaches
to sharing and receiving clinical advice. Further details about these
pilots are available in the documentation we have published about the
review on our website here:

 

[1]https://www.ombudsman.org.uk/clinical-ad...  

 

Following the conclusion of these pilots any approved changes to approach
will be included within our Service Model policy and guidance and
published on our website.

 

1.As mentioned above we have been piloting these changes from the last
business year, and the work on this is ongoing.

 

2. When submitting a case for clinical advice a caseworker will point the
advisor to specific evidence they consider is most relevant for their
request. The clinical advisor will have full access to the same
information the caseworker has received from the organisation. A clinical
advisor can also request any additional information they need from the
caseworker in order to provide an appropriate response.

 

Further information and guidance about how caseworkers should request
clinical advice is available in our Service Model policy and guidance
which is published on our website. A newer version of this guidance is
currently being finalised, which includes an updated annex providing
additional support to caseworkers on how to request advice. This is
intended for future publication within the next month or so.

 

3.Whilst we may be able to obtain the number of cases where clinical
advice has been requested, this level of information in terms of evidence
passed to clinical advisors, is not held centrally. This would require the
manual inspection of case records to ascertain if this detail is recorded
on each case and it would then have to be extracted and gathered. This
work could not be conducted without incurring disproportionate cost.
Section 12(1) therefore applies to this element of your request.

 

However, as specified above, our casework policy and guidance sets out how
a clinical advice request should be made, and the expectation is this is
followed for every request.

 

4.There are no fields on our casework management system that meet the
requirements you have specified.

 

5.Please see the previous responses provided above. For further
information on this, please see our Service Model policy and guidance.

 

6.As explained this is the Service Model policy and guidance which is
published on our website. I have provided a link to this below:

 

[2]https://www.ombudsman.org.uk/about-us/co...
 

 

7.Yes, as explained above. For further information on this, please see our
Service Model policy and guidance.

 

If you believe we have made an error in the way your information request
has been processed, it is open to you to request an internal review in
writing or by email to [3][PHSO request email] . Beyond
that, it is open to you to complain to the Information Commissioner’s
Office ([4]www.ico.org.uk ).

 

Yours sincerely

 

Freedom of Information/Data Protection Team

Parliamentary and Health Service Ombudsman

W: [5]www.ombudsman.org.uk  

References

Visible links
1. https://www.ombudsman.org.uk/clinical-ad...
2. https://www.ombudsman.org.uk/about-us/co...
3. mailto:[PHSO request email]
4. http://www.ico.org.uk/
5. http://www.ombudsman.org.uk/

J Roberts left an annotation ()

I am surprised that the computer-based case-management system doesn't routinely capture significant information concerning the evidence passed to clinical advisers. Recently, the PHSO invested £353,000 in new ICT:

"2. As explained on p.44, you “invested £353,000 in new ICT capabilities and technical infrastructure. Were there any teething issues with this new ICT provision? And were there any write-offs under this investment?"

"Delivering the replacement of our ICT infrastructure and the first phase of replacing our Case Management System during 2019 were major undertakings. Both projects were delivered on time and within budget, and in the context of continuous consultation with case handlers. As with any project of this nature, the ICT team and a team of change champions were on hand to provide support to staff following implementation to work through any post go-live issues. These were addressed quickly and effectively."

https://committees.parliament.uk/publica...

J Roberts left an annotation ()

Annual Report and Accounts 2019-2020 (page 17)

'In 2019-20 we ran a pilot in which senior caseworkers shared their provisional views on cases with clinical advisers to ensure that their advice was being reflected accurately in these reports. This was successful and will be implemented across all our senior casework teams.'

'We have also commenced multidisciplinary meetings as recommended by the Review. These are an opportunity for colleagues with expertise in different fields to come together to discuss complex cases and test our thinking before we issue provisional views. In 2019 we also published new information to help complainants understand the role of clinical advice from the outset of an investigation.'

https://www.ombudsman.org.uk/sites/defau...

J Roberts left an annotation ()

PACAC - Second Special Report of Session 2019–21

[PACAC]

"3. The Committee recommends that the PHSO closely monitors and reports back on the effectiveness of the changes to clinical advice. A further follow-up review should be commissioned at the end of the two year implementation period, and again this should be overseen by an independent expert adviser. (Paragraph 29)"

[PHSO]

"We agree this is an important area of work and that it will be necessary to monitor and assess the effectiveness of the changes that we are making to the way we use clinical advice.

As PHSO has had to focus resources on managing the impact of Covid-19 on casework, this may result in a delay to some of the planned changes to the clinical advice processes.

We will update the Committee on progress during the next scrutiny inquiry. During the next Peer Review of PHSO’s service, we will conduct an independent evaluation to assess the impact of these changes once they are embedded, as the Committee recommends."

https://committees.parliament.uk/publica...

J Roberts left an annotation ()

PACAC 23 November 2020:

https://committees.parliament.uk/oralevi...

'Q36 Lloyd Russell-Moyle: I think you have touched on this slightly, but I will ask it. Has progress been made on the recommendation of using clinical advisers? Has that been delayed at all by Covid-19?

Rob Behrens: Yes and yes. We have made progress in this critical project but ithas been delayed by the resource available, which has had to be put into managing the pandemic. We are not as far along the line as we would like to be but some key things have been done. As I explained to you, we now make sure that people have sight of the clinical advice on both sides in advance of the provisional view being made. We now have a system of ensuring that clinical advisers are not just asked questions about the case but they participate in a discussion of issues that might be outside of the original complaint. We hold multi-team meetings of clinical advisers and case handlers, internally and externally, in very complex cases to make sure that there is a conversation between the clinical adviser and the caseworker. Liam Donaldson said that he picked up an overwhelming view that our case handlers deferred to the clinical advisers unnecessarily and that that was not a good thing.

We also make sure that both sides are peer reviewed. Clinical advisers give feedback to the case handler and the reverse is the case.'