Our casework process - end to end

Editor's Notes

• #3: Chris to introduce this slide – purpose is to provide a brief run through our end to end casework process. There will be more detail in workshops later when you will have an opportunity to tell us how the process works for you and your clients and to have your say on what more you think we could do to work more effectively together. In this session we will explain how, as part of our work to develop our casework process and service, we conducted research into what people thought of our work and we have used to set out our casework process or service model. The research will also be used to inform our service charter (which Julie spoke about earlier ). We will also tell you a bit about how we share the learning from our individual investigations more widely to help drive forward improvements in NHS care and services. Will now hand over to Andy Medlock, AD CS, who will tell you about the work we have undertaken to develop our service and to run through the first stages of our casework process, those stages prior to us investigating a case and I will then briefly run through the investigation process. As I mentioned earlier we will run through these parts of the process in far more detail in the workshops later today. Plenty of opportunities for questions at that point. Over to Andy
• #4: ANDY - As part of our work to develop our service (Julie referred to earlier) we have looked at what our research was telling us about our casework process. The clear message from all parties – including many of you - was that we needed to improve on – the consistency of decision making and on our customer experience. These underpin the Service Model – TWO KEY DRIVERS. The Service Model is the framework for how PHSO approaches casework. It describes what we do & how we do it from ‘beginning to end’ It is based on feedback we have received and changes we have made to our service. It includes key behaviours we expect to see from staff when carrying out their work. It provides clarity and certainty for staff to ensure we give a consistent, high quality service: focus on consistency of decision making and providing a good experience. It is the cornerstone of our Quality Assurance process and staff performance will be measured alongside its expectations. It is a key component in helping us shape ‘one vision’ of our service. ----------------------------------------------------------------------- What does it mean for you? Our casework staff are measured against the expectations of the Service model. This includes numerical targets on various metrics (caseload and throughput), quality and equally importantly behaviours. Translated into practical terms – this means you and your clients should experience what the Service Model requires from our staff – particularly around proactive and timely communication, well reasoned decisions and well developed levels of understanding of the needs of your clients.
• #5: ANDY - When we first receive a complaint, our customer service staff consider three basic questions to determine if the complaint is one that we can investigate. They check that it is properly made (in writing for NHS complaints - referred by an MP for parliamentary complaints), involves NHS-funded services in England and that it has exhausted the local complaints procedure. In addition to accepting email complaints we now also have an on line form that people cam fill in – and our web design team are here today and will be happy to talk to you about our website and the form, to answer any questions you have and to capture your feedback. If a complainant has difficulty filling in the form we will be happy to do that for them and send it for their agreement. We will also signpost people to your services if they need support when submitting complaints to us or to help them with the earlier stages of the process if they have come to us too soon. If a complaint passes these three checks we take a closer look.
• #6: ANDY - We then consider a number of assessment tests, these include: Suitability of complainant – our legislation says that a complaint must be made by the personal directly affected by the poor care or service, unless they are not capable of doing so. If a complainant needs help they can nominate a representative to assist them (this can range from a friend or family member through to a professional advocate). If they are not capable of making their own complaint then somebody else can make it for them. Time limit – our legislation also says that complaints should be brought to the Ombudsman within 12 months of the person knowing about the issues they are complaining about. However, we do have discretion to investigate cases that don’t meet this requirement when we think it is appropriate to do so – when a complaint is put to us out of time we give careful consideration to reasons for the delay in coming to us (such as a long time at local resolution, illness, communication difficulties), how serious the issues raised and potential injustice are and how practical it would be to carry out the investigation and so help to provide closure on the complaint for all the parties involved. Each case is different and we make decisions on a case by case basis. Alternative legal remedy – Our legislation also says that the Ombudsman cannot investigate if there is a legal remedy that the complainant could pursue unless we consider that it is not reasonable for them to do so. This usually depends on the nature of the case and what the person wants to achieve by complaining to us. As you will know a court cannot order a body to apologise or recommend systemic changes to ensure mistakes do not happen again and the court process is not focused on providing explanations to individuals seeking closure, which is what is at the forefront of the vast majority of complainants we receive. If we believe that the complainant does have a legal remedy we then consider if it would be reasonable to expect them to pursue. In doing so we have to balance the arguments that we should not encroach upon matters that are properly in the purview of the courts against the fact that pursuing a legal claim can be too difficult or costly for the complainant to pursue. Some decisions can be very finely balanced and staff regularly consult with our legal advisers when making this decision and we will carefully consider any representations made by the complainant and organisation complained about this test. Finally we consider if another organisation is more appropriate to investigate –some complaints could be considered by us and another complaints handler. We usually only expect one organisation to investigate and following discussion with the parties involved we may decide that the other organisation is more suitable. For example a fitness to practice complaint may be more suitable for the GMC/GDC/NMC to consider. As you can imagine these tests can sometimes be difficult to answer so our staff may make enquires of the complainant, organisation, company or practice complained about and seek jurisdictional and legal advice when needed.
• #7: ANDY - If a complaint passes our initial tests we finally consider if there is a ‘Case to answer’ that is to say can we see at least some indication that the complainant may have suffered some injustice or hardship arising from a possible failure in service that has not yet been remedied. We are not investigating at this stage and we only need to see some indication that there is something for us to look at. At this stage we will pause to consider whether we can resolve the case quickly and without the need for an investigation – e.g. person is seeking a particular piece of information that we can get the organisation to agree to provide If we cannot see a quick way to resolve the complaint we will contact the complainant and organisation complained about to let them know we are proposing to investigate. Our letter will set out a brief summary of the complaint we propose to investigate and will seek comments on that. Our letter will also request that the organisation send us the evidence we will need to start our investigation. This will usually include: the complaint file (including copies of any interviews, witness statements or clinical opinions that have been sought during the local investigation), copies of any relevant local standards, guidance or policies that applied at the time of the events complained about, and relevant extracts from the clinical records. The Ombudsman has the power of the High Court to compel the production of those documents or information. Hand back to Chris
• #8: CHRIS - Once we receive the background papers and any initial comments on the proposal to investigate, and we decide to proceed with the investigation, we will assign the complaint to an investigator as soon as possible to start the investigation. We will contact the parties to tell them who the investigator is. This is the person they should contact with questions or queries they may have during the investigation . The investigator will contact the parties involved to discuss the complaint and then confirm the detail of what we will investigate. They will share their plan for investigating the complaint and when they hope to complete their work. They will also agree with the parties how they will keep them updated. As well as the initial papers submit by the parties, we will consider whether we need any further evidence. As you can imagine this can vary enormously depending on the complexity of the case and can include: Consulting national standards and guidance, and any relevant policies in place at the time of events Seeking clinical advice from our own advisers (who are also NHS clinicians) or advice from our legal advisers Interviewing NHS staff and any witnesses Visiting premises Viewing CCTV footage, looking at phone records etc Some cases require no more than a review of the documentary evidence and advice from a single clinician to confirm that the care or service provided met the relevant standards or guidance. Some cases, particularly those where we find evidence of potentially significant systemic failures will go much further in terms of investigation and recently we have been moving towards carrying out root cause analysis for these cases to ensure that systems that are failing are identified and put right.
• #9: CHRIS - In a nut shell our investigations look to see if what happened in the particular case was in keeping with relevant regulations, standards and guidance or established good practice. If it wasn’t, we look to see what impact that shortfall has had and if it has had an impact (caused hardship or injustice) has it already been remedied by the organisation. When the investigation is close to completion, we will share our provisional findings – usually by sending a draft of the investigation report to the parties for comment and to agree any recommendations that we have proposed to remedy any injustice we may have found arising from service failure. The investigator is happy to discuss any questions about the report. If a complainant or an organisation believes we have got the facts of the case wrong or they disagree with our conclusions, we ask that they give us reasons for that as soon as possible and they must provide explanations and evidence to support their position. It is not enough to simply say that they disagree with the conclusions. The investigator and their manager will carefully consider any comments and evidence provided before they come to a final decision. Once we have issued the final report, the organisation should complete any actions recommended in the report within the time agreed, sending us relevant evidence of compliance. If we find evidence of a systemic problem we will usually request the organisation to draw up an action plan – in essence we put the onus back on the organisation to tell us and the complainant what they are going to do to make sure the failing doesn’t happen again.
• #10: CHRIS - As you will know – there is often wider learning from the individual investigations we carry out and we are moving towards sharing more and more information from our casework to feed that learning back to the NHS Case summaries We now regularly publish case summaries on our website. They are searchable and provide examples of the complaints we handle. We hope they will give public service users confidence that complaining can make a difference and also manage expectations of the sorts of outcomes of bringing a complaint to us . We also hope that they will be a useful source of learning for public bodies. Themed reports We have also published a number of reports looking at particular themes and issues, For example a report into midwifery regulation, the diagnosis and treatment of sepsis, dental charges and most recently end of life care. These are all availble on our website DETAIL BELOW IF QUESTIONED Sepsis A failure to rapidly diagnose and treat sepsis in a large number of cases we investigated indicated the need to improve awareness of sepsis – a potentially life-threatening condition that occurs when the body’s immune system goes into overdrive, setting off a series of reactions including widespread inflammation, swelling and blood clotting. We brought together the Royal Colleges from the medical professions, the UK Sepsis Trust, NHS England and the National Institute for Health and Care Excellence to share our insight and develop system-wide changes. These included producing guidelines for healthcare professionals on recognising and treating sepsis, which are now being taken forward by NHS England, the Royal Colleges and the National Institute for Health and Care Excellence. The UK Sepsis Trust estimates that these changes could save up to 12,500 lives each year. We published and laid before Parliament our findings and recommendations in Time to Act: severe sepsis: rapid diagnosis and treatment saves lives. We hope Parliament will follow up on our report and find out how quickly and effectively our recommendations are being acted upon. Midwifery In our investigations into complaints about midwifery services, we found that the lives of mothers and babies could be put at risk because of a potential conflict of interest between midwifery regulation and supervision. This is because on the one hand midwives investigate incidents on behalf of the regulator and on the other hand they are responsible for the professional support and development of a group of local midwives who are often their peers. We worked with the Nursing and Midwifery Council, NHS England and the Department of Health to identify changes in the law that would be needed to overcome this area of weakness. We published Midwifery Supervision and Regulation: recommendations for change and laid this before Parliament. The Nursing and Midwifery Council has since announced an independent review of midwifery regulation.