Aneurin Bevan Health Board Putting Things Right Policy Procedure for the Management Of Public Service Ombudsman for Wales Investigations N.B. Staff should be discouraged from printing this document. This is to avoid the risk of out of date printed versions of the document. The Intranet should be referred to for the current version of the document.
Contents: 1 Executive Summary... 2 2 Introduction... 2 3 Policy Framework... 3 4 Changes within the Public Services Ombudsman for Wales (PSOW) (After April 2011)... 3 5 The PSOW involving Independent Providers... 3 6 Principles... 3 7 Public Service Ombudsman for Wales Investigations... 3 8 Initiation and Types of PSOW Investigations... 4 Type of Outcomes Reported from an Investigation... 5 Outcome... 5 Withdrawn Cases... 5 Quick Fix... 5 Not Merited... 5 Premature... 5 Out of Jurisdiction... 5 Not Upheld... 5 Upheld... 5 9 Procedure on the Management of Public Service Ombudsman Investigations... 5 10 Report provided by Public Services Ombudsman for Wales (PSOW) Investigation... 7 11 Procedure following receipt of PSOW Final Report... 8 12 The Public Service Ombudsman for Wales Annual Report... 9 Appendix I - PSOW Investigations Flow Chart... 10 Appendix II - Transitional arrangement affecting cases that have been received before 1 April 2011... 11 Appendix III - Independent Review Flow Chart... 14 Appendix IV Action Plan... 15 1
1 Executive Summary Welsh Government legislation the National Health Service (Concerns, Complaints and Redress Arrangements) (Wales) Regulations 2011), (the Regulations) sets out the requirement that all Local Health Boards adopt the Welsh Government Putting Things Right Guidance on dealing with concerns about the NHS from 1 April 2011 PTR Guidance. These regulations came into force on 1 April 2011, except part 7 which deals with the consideration of Redress where a Welsh NHS body has commissioned care from a NHS Provider in England Cross Border Arrangements Part 7 will come into force on the 1 ST of April 2012. This policy aims to ensure that ABHB fulfils the requirements of standard 23 of the Standard for Healthcare services, the management of patient concerns. Where a person remains dissatisfied with the outcome of the investigation of a concern, they can refer their concern to the Public Services Ombudsman for Wales. Under the Public Services Ombudsman (Wales) Act 2005, the Ombudsman has the broad powers of investigation as set out in Section 14 of the Act. Under the legislation he can require any person, whom he considers can help him in his investigation, to do so. He can also acquire any documentation from the ABHB. The Act gives the Ombudsman power to request an organisation to facilitate the settlement of a concern, as well as or instead of investigating it. This enables the quick fix process is undertaken without an investigation by the Ombudsman. When a PSOW investigation is being conducted, the PSOW will investigate the concerns raised and also the service provided. 2 Introduction An investigation requested by the Public Services Ombudsman for Wales is investigated by the Division/Locality with corporate support. The Putting Things Right Team oversees concerns that are investigated by the Public Service Ombudsman for Wales (and the Independent Complaint Secretariat until March 2012 see Appendix II), on behalf of the organisation. The Concerns Review Manager 2
supports the Divisions and Localities in responding to, evidencing and learning from the PSOW investigations received by the Health Board. 3 Policy Framework This Policy and procedure sets out the requirements under the Public Services Ombudsman (Wales) Act 2005 for the management of and learning from Public Services Ombudsman for Wales investigations of concerns. 4 Changes within the Public Services Ombudsman for Wales (PSOW) (After April 2011) The Public Service Ombudsman for Wales (PSOW) investigates concerns of maladministration and service failure. The PSOW investigates the areas of concerns raised but will also look at the service provided. Furthermore, it is expected that the PSOW will also be able to investigate the Redress process under Putting Things Right. 5 The PSOW involving Independent Providers The PSOW informs the Chief Executive of ABHB investigations they have decided to conduct regarding independent providers. On completion of a PSOW investigation into an independent provider, the Welsh Government and PSOW request evidence of the actions taken to implement the recommendations. 6 Principles The principles of the management of second stage concern is in line with the Policy for Putting Things Right, The Management of Concerns (Complaints, Claims and Patient Safety Incidents). 7 Public Service Ombudsman for Wales Investigations The Public Service Ombudsman (Wales) Act 2005 enables persons raising a concern to request an investigation into their concern about the service received from a public body once the concern has gone through local resolution stage. 3
The Ombudsman s jurisdiction enables him to investigate actions taken in connection with the exercise of clinical judgment by health service professionals and concerns about health services. Once an investigation has been completed the Ombudsman can issue two types of report: A report issued under Section 16 (public) of the Public Services Ombudsman (Wales) Act 2005 ( the Act ) Where a concern is upheld and has a public interest the Ombudsman can issue a Section 16 Report. The ABHB has a duty under Section 16 of the Act to publicise the report and make it available to the public at its offices and via its website. The Health Board has a duty to accept the recommendations within the Report. In accordance with normal practice the ombudsman s office will send a copy of the report to AMs/MPs and media organisations one week after the date of the report. In addition, the report will be on the ombudsman s website two weeks after the date of the report. A report issued under Section 21 of the Public Services Ombudsman (Wales) Act 2005 ( the Act ) Where a concern is upheld and has limited public interest, the Ombudsman is empowered to issue a Section 21 Report as long as the Health Board has agreed to implement the recommendations before the end of the permitted period. 8 Initiation and Types of PSOW Investigations The person raising the concern (patient or their representative) needs to approach the PSOW and request an investigation. The PSOW will contact the person raising the concern and provide information about the type of investigation the PSOW will undertake. The PSOW has a number of investigation options to choose from and these are tabled below: 4
Type of Outcomes Reported from an Investigation Outcome Withdrawn Cases Quick Fix Not Merited Premature Out of Jurisdiction Not Upheld Upheld Definition The person raising the concern has decided not to proceed with the investigation. Cases with scope to resolve the concerns. The PSOW Complaints Advice Team (CAT) may contact the ABHB and request resolution of the concern. This process is a pro active approach with the aim of quick resolution rather than a full investigation by PSOW. Classification used when the initial concern process has been appropriate or not part of the PSOW s remit for example: Expenses/Payment. The concern has not been through the full concern process with the organisation. Cases over 18-24 months old would be out of jurisdiction. This is when the PSOW carried out a full investigation of a concern and their findings are that concerns are not justified and there is no evidence of maladministration. The PSOW carries out a full investigation. The findings are that the concern has been upheld in whole or in part. Usually where a concern has been upheld the report will carry recommendations. 9 Procedure on the Management of Public Service Ombudsman Investigations A Flow Chart is provided in Appendix 1. 9.1 Once a decision has been taken to investigate a concern, the Ombudsman will write to the Chief Executive outlining the terms of the investigation. The organisation is asked to nominate a liaison officer to act as the principal point of contact with the Ombudsman s office. 5
9.2 The liaison officer s role is provided by the Putting Things Right, Concerns Review Manager (CRM) together with the investigation lead appointed within the Division/Locality. 9.3 The Investigation Lead must ensure that all staff involved in the concern are notified of the PSOW investigation. A meeting will be arranged with the key members of staff involved in the concern. 9.4 The CRM reviews the initial documentation and concern file to establish if there are any shortcomings and identify areas for further investigation. If appropriate, a request for a second clinical opinion may be made. 9.5 The PSOW base their investigation on the documentation that ABHB provide and together with the independent clinical advisor s reports (which they commission). The documentation provided is: The original medical records The concerns file including the Investigating Lead s file Any Policies or procedures or documents to support the service being investigated 9.6 During the course of an investigation the PSOW may request further information; the CRM with the Investigation Lead will provide this additional information. The ABHB may be open to criticism if documents are not safeguarded and are mislaid. 9.7 Interviews From the documents provided and statements taken from the person raising the concern, the PSOW may interview ABHB staff. If this is necessary, the CRM will provide support and assistance to staff. The CRM is responsible for the arrangements for the interviews. When an investigation concerns the exercise of clinical judgment by NHS staff, the Ombudsman s investigating officer may be accompanied by one or more independent 6
professional assessors from the appropriate discipline, who may wish to ask questions about the clinical aspects of the concern. 9.8 In some instances staff will have left the employ of the organisation and the ABHB will be asked to provide a forwarding address for them. 9.9. All those staff asked to give evidence to the Ombudsman do so willingly. However, statute gives the Ombudsman the power to compel the attendance of witnesses and the production of documents. The relevant paragraphs of the Health Service Commissioners Act 1993 (section 12(1) and (2)) read as follows: For the purposes of an investigation under this Act the Commissioner may require... any officer or member of the... body concerned or any other person who in his opinion is able to furnish information or produce documents relevant to the investigation to furnish any such information or produce any such document. For the purposes of any such investigation the Commissioner shall have the same powers as the court... in respect of the attendance and examination of witnesses (including the administration of oaths or affirmations and the examination of witnesses abroad) and in respect of the production of documents. Although rarely used, the Ombudsman has powers to bring before the courts persons who obstruct the work of the Ombudsman or his officers. 10 Report provided by Public Services Ombudsman for Wales (PSOW) Investigation Before the PSOW issues a Final Report, it is practice to provide a draft report to the ABHB for comments and observations. The draft report provides an opportunity to comment on the findings of the investigation and ensure that the factual accuracy of the report is correct. The Public Services Ombudsman (Wales) Act 2005 will report either a report under Section 16 (S16) of the Act which are 7
public interest reports. The body concerned is obliged to give publicity to such a report at its own expense. Or the PSOW will issue a Section 21 (S21) issued (provided that the body concerned has agreed to implement the recommendations made by the PSOW). There is no requirement on the body concerned to publicise S21 reports. 11 Procedure following receipt of PSOW Final Report The Chief Executive of the ABHB will receive a copy of the Final Report which may carry recommendations to be implemented. The report will carry a time frame to complete the recommendations. Standard practice on receipt of the Final Report is to: 1. Provide an apology letter to the person raising the concern within a month. 2. Provide a formal response with an overview of the action taken to implement the recommendations and if appropriate an action plan (Appendix IV) within one or three months. To ensure consistency and accuracy for PSOW Investigations the action plan would be managed corporately by the Concerns Review Manager. 3. Evidence of the actions taken provided to Welsh Government. 4. Actions that require an audit are followed through and reviewed. 5. If appropriate the recommendations are implemented across the organisation. 6. The action plan is revisited on review dates or when audits have taken place so that this further evidence and information is provided to the PSOW. 7. The Assistant Director for Putting Things Right will reviews all action plans following a PSOW review. 8. The case history and action plan will be presented at the Learning Committee. 8
12 The Public Service Ombudsman for Wales Annual Report The PSOW issues an annual report providing a table for each organisation of all the cases that the PSOW has reviewed. This report is presented to the Learning Committee for analysis. 9
Appendix I - PSOW Investigations Flow Chart Notification from PSOW of new investigation Notify staff via email; request IL & concern file medical records & evidence of change in practice Confirm details of Investigation Lead Review Case Do we need a second opinion YES/NO NO Provide concerns file /medical records & Action Plans to PSOW Provide further information On receipt of Draft Final Report 4 weeks to respond Disseminate Draft Report to staff for comments Meet Staff to Compile CEO response for Draft Report on factual content and findings of the preliminary investigation YES Meet staff involved in concern to discuss case Arrange a second opinion from Divisional Director or Clinical Director Provide as appropriate outcome of review to PSOW Agree Lead to address recommendations/action plan Receive PSOW Final Report Develop Action Plan Arrange Lead to take forward action Disseminate Report Review and Audit actions Prepare PSOW Action Plan to address recommendations with identified leads and agree actions Corporate/Divisional Action Plan Provide Response and copy action plan to complainant Review Actions/Audit Update PSOW of outcome of reviews Share Learning Present at Learning Committee Copy send to WG, PSOW Close Action Plan at Learning Committee Learning across the HB 10
Appendix II Transitional arrangement affecting cases that have been received before 1 April 2011 Concerns received by ABHB before 1 April 2011 must continue to be handled in accordance with the 2003 Directions and Guidance until they are completed. Complaint in the NHS a guide to handling complaints in Wales April 2003. NHS Complaints guidance 2003 Under this process where a person remains dissatisfied with the outcome of the investigation, they can refer their case to the Independent Complaint Secretariat or the Public Services Ombudsman for Wales. This was referred to as the second stage of the concerns process under the 2003 Complaint Guidance. 1.1 Independent Review Process The Independent Review process is managed by the Independent Complaints Secretariat (ICS), an external body supported by the Welsh Government. The ABHB Divisions and the Putting Things Right Concerns Review Manager manage this process. The Independent Complaint Secretariat (ICS) appoint an Independent Lay Reviewer to conduct a review from the Medical Records and the Concerns file provided by the ABHB. Where appropriate the ICS will request expert Clinical Advisor s Report. The Lay Reviewer s decision is based on the documentation and the Clinical Advisor s Report. Complainants would usually contact the ICS themselves. However, any requests received by the Chief Executive will be acknowledged and forwarded to the ICS. During the Independent Complaints Process, the Health Board will provide support to any staff involved in the complaint. If a Panel Hearing is to be convened then a meeting will be held to provide support to staff witnesses. Any evidence of changes in practice or lessons learnt can be provided to the ICS before the panel hearing. On receipt of the Panel s report, the Concerns Review Manager on behalf of the Chief Executive will ensure that: 11
an action plan is produced if appropriate its recommendations are formally addressed within the Health Board or by the Primary Care Practitioner The Chief Executive will aim to write to the complainant within 4 weeks informing the person raising the concern of any action the Health Board has taken, or is taking. The request should be made by the complainant within 28 days of the conclusion of local resolution, although discretion to exceed the timescale can be used by the ICS where appropriate. Any requests received by the Chief Executive will be acknowledged and forwarded to the ICS. A review is undertaken based on the complaint and medical records by a lay reviewer and independent clinical advisors. Actions following a review that the Independent Complaints Secretariat may take include: Referring the case or part of the case back to local resolution: Recommending a meeting with the complainant Recommending the Health Board use an Independent Complaints facilitator Recommending actions to be taken Recommending all of the above Take no further action if local resolution has been carried out satisfactorily. Decide to set up a Panel Hearing. An independent panel may be set up to investigate the complaint if the ICS consider that a further investigation is likely to find out more information about what happened, or because the complaint has not been adequately investigated at local resolution stage. In the event of a hearing, designated key staff will receive notification to attend the panel hearing. A panel report is produced within 6 months of a hearing which may include recommendations. The Concerns Review Manager will arrange a meeting to provide support to staff witnesses. Evidence of changes in practice or lessons learnt can be provided to the ICS before the panel hearing 12
On receipt of the Panel s report, the Chief Executive will ensure that: an action plan is produced if appropriate its recommendations are formally addressed within the Health Board or by the Primary Care Practitioner The Chief Executive will respond to the complainant within 4 weeks informing the complainant of the action the Health Board has taken. 13
Appendix III - Independent Review Flow Chart Notification from Secretariat of new request for Independent Review Acknowledge receipt of notification and give consent for disclosure of information Inform IL and Division of new request for Independent review and request complaint file Full Panel Inform IL/Key Staff/Senior Team No further action Inform IL and Division IL to ensure that whole team know the outcome of the complaint Update Database Complaint Completed Log on Database Request Medical Records Send 2 copies of complaint file and medical records to Secretariat Await Lay Reviewer and Lay Advisors Decision On receipt of decision Back for further Local Resolution (back to complaint process) Email to IL and other relevant professionals notifying action required attach Clinical advice report Actions: Meeting with complainant Provide Formal Response Implement recommendations/ action Respond to complainant within 20 days Monitor/review action plan On receipt of witness list, alert those being called to panel in writing include IL and appropriate professionals. Ensure witnesses have adequate support and informed of process On receipt of T of R distribute to all witnesses Meet with witnesses to go through the process Provide any further information as required to the Secretariat Draft sections of report will be sent to the individual witnesses HB checks sections of report send back to secretariat Secretariat provides Final Panel Report with recommendations and actions distribute to IL Action Plan to be organised and actions monitored and reviewed by IL HB responds to complainant within 20 days outlining actions taken Disseminate HB wide learning 14
Appendix IV Action Plan Action Plan - Investigation Lead/Liaison Officer: Actions/Reviews from this case will be shared across the ABHB as appropriate. Ref. Issue/Recommendations Action Clinical/Lead Director Responsible Manager Target Date Progress and/or action at review date and Date Completed 15