Working together: The Investigation process
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These slides delivered at the NHS Advocacy conference are from the session aimed at helping advocacy organisations understand how the investigation process works at the Parliamentary and Health Service Ombudsman.
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Working together: The Investigation process
- 1. Working together The Investigation process NHS Advocacy Providers Conference Chris McAlpine – Assistant Director of Investigations Linda Tomlinson – Liaison Manager 8 October 2015 1
- 2. The Investigation Process Purpose of the workshop • Understanding the investigation process; • Keeping in touch and contributing; • Sharing draft and final decisions; • Improving the NHS.
- 3. Our casework process – Investigation The Service Model • Why have we developed a Service Model? – Evidencing sound decision making; – Providing a good customer experience. • What does this mean for you and your clients? – You should experience what is set out in the model; – You should be involved, informed and kept up to date; – You should know what’s going on!
- 4. Our casework process – proposal to investigate • Let’s go back a step….. – Is there a case to answer ? (some indication of an injustice or hardship arising from a possible failure in service that has not yet been remedied) – Can it can be resolved quickly ? • Proposal to investigate
- 5. Our casework process – investigation The initial discussion • Talking to the you and your client – A really important point in the process – you can help us make sure we understand and get it right; – Try and make sure your client has provided us with everything relevant; – We will tailor our communication style/pattern to suit; – We will tell people what we are investigating and how we will do it.
- 6. Our casework process – Investigation How we investigate • How we investigate – Follow the Service Model; – The Investigation Plan; – Agreed communication pattern/needs; – Evidence gathering – What are we looking for?
- 7. Our casework process – Investigation Professional advice • Professional advice – Clinical Advice – Internal and External – Established good practice & relevant standards – Legal Advice • Lay-led process
- 8. Our casework process – Investigation Draft reports •Draft report and comments • Another important process point; • A chance to comment on our draft findings; • Simultaneous sharing; • No surprises; • We need explanations and evidence;
- 9. Our casework process – investigation Final reports, Compliance & Learning • Final reports, compliance & learning – Consider all comments in response to draft; – Will explain what difference they have made (or not); – Final Report is issued; – Actions to be completed by organisation – Action plans/Learning from mistakes – Compliance monitoring – Case summary
- 10. How can advocates help 10 • What help, advice and information can Advocates provide to assist our caseworkers ?
- 11. Any questions and comments? ?
Editor's Notes
- Purpose of the workshop is to provide you with a full and thorough understanding of our Investigation process. Not only about how our process works and how we make decisions but also how you and your clients get to contribute and have your say, key touch points in the process and what behaviours & outcomes we expect to deliver to you and your clients In terms of process, we will look at key process points such as confirming the scope of the investigation and sharing draft investigation reports We will also look at how our investigation works seeks to put right any injustice suffered by your clients but also improve the NHS for others. MOVE ON TO QUICKLY SUMMARISE WHAT THEY HAVE ALREADY HEARD IN MAIN PRESENTATION ABOUT SERVICE MODEL AND NEED FOR CHANGE
- A quick reminder – As we mentioned earlier in the main presentation, as part of our work to develop our service we have looked at what our research was telling us about our casework process. The clear message was that we needed to improve on – the consistency of decision making and on our customer experience. These two drivers underpin the Casework Service Model . ----------------------------------------------------------------------- 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 but equally importantly it measures their 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. ON TO NEXT SLIDE - PROPOSAL TO INVESTIGATE
- Hopefully most of you will be attending/have attended the workshop on the process we follow during our initial consideration of a complaint. We are picking up at the point at which we think there is something to investigate If we cannot see a quick way to resolve the complaint without an investigation we will contact you and your client to let you know we are proposing to investigate, setting out a brief summary of the complaint at this stage and tell you what will happen next. Hopefully by this time we have already spoken to you and your client about any particular communication needs and you will have submitted any evidence you think is relevant. If that is not the case please tell us at this stage so that we can deliver the service your client needs and we can ensure we consider the evidence they think is key. CHRIS THIS MAY BE A GOOD POINT TO PAUSE TO SEE IF THEY HAVE ANY COMMENTS OR FEEDBACK ON THE PROPOSAL TO INVESTIGATE STAGE At this point we will also contact the organisation complained about to let them know we are proposing to investigate, setting out a brief summary of the complaint we propose to investigate and will seek comments on that. We will also ask them to submit any relevant evidence. Occasionally at this stage the NHS organisation may tell us that they think there is more they could do to try and resolve the complaint. If they do we will consider that offer and discuss it with you and your client and if we agree we will usually return the complaint to the organisation for further work which will hopefully provide a quicker resolution for your client. CHRIS THIS MAY BE A GOOD POINT TO PAUSE TO SEE IF THEY HAVE ANY COMMENTS OR FEEDBACK ON THE POSSIBILITY OF RETURNING COMPLAINTS TO THE ORGANISATION. IN THEIR EXPERIENCE DOES THIS HELP,DOES IT WORK, IS THERE ANYTHING ELSE THEY THINK WE SHOULD BE DOING LIKE AGREEING WITH THE PARTIES AND SETTING OUT WHAT FURTHER WORK SHOULD BE DONE AND BY WHEN AND THEN CHASING THAT UP IF DEADLINES MISSED. ON TO NEXT SLIDE – TALKING TO THE COMPLAINANT/ADVOCATE
- 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 (including you and your client) to tell you who the investigator is. This is the person you and your client should contact with questions or queries you may have during the investigation. The investigator will contact you and your client to discuss the complaint and the impact it has had on your client and to find out what they are hoping to achieve by complaining. The investigator will discuss and then confirm the detail of what we will investigate, tell you how we will go about investigating and when we hope to complete our investigation. This is also another opportunity to tell us about any communication preferences, to draw our attention to any particular key pieces of evidence and to agree how and when you and your client would like to be kept updated on the progress of the investigation. THIS INITIAL DISCUSSION IS REALLY IMPORTANT AND SHAPES THE PATH OF THE INVESTIGATION although that’s not to say we won’t adapt or change our plan as the case develops. We will then ‘confirm’ the investigation which usually means we write to all parties to confirm what we are going to be looking at CHRIS THIS MAY BE ANOTHER GOOD POINT TO PAUSE TO SEE IF THEY HAVE ANY COMMENTS OR FEEDBACK ON THE INITIAL DISCUSSION PHASE (CONFIRMING SCOPE, SHARING PLANS ETC). ON TO NEXT SLIDE - HOW WE INVESTIGATE
- As I mentioned earlier one of the key aims of introducing our service model is to ensure consistency in our decision making – we therefore expect an Investigator to follow the process steps set out in the Service Model PLAN - Each investigation has its own plan for completion and we do what is needed for the case. Some cases require no more than a review of the documentary evidence and sometimes 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. We will share our thinking on the plan with you and your client so that you have an opportunity to say if you think there is something we might be missing or more we should do or consider. COMMUNICATION – the Service Model and our new Service Charter both refer heavily to the value of high quality communication. I have already mentioned that we will agree with a complainant an appropriate communication pattern at the start and will tailor this to the needs of the complainant to make sure they receive regular and meaningful communication on the progress of their case. EVIDENCE GATHERING - As well as the initial papers submited 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, complainants and any witnesses – this happens in relatively few cases Visiting premises Viewing CCTV footage, looking at phone records etc. As I have already mentioned it is important that you and your client draw our attention to anything you think is of particular importance when we discuss our plans for the investigation with you. DISCUSS- AS SERVICE MODEL IS NEW NOT ALL OF YOU WILL HAVE EXPERINCED THIS INCREASED LEVEL OF OPENNESS AND COMMUNICATION. HAS ANYBODY? IS IT WORKING/WILL IT WORK. ANYTHING ELSE THEY WOULD LIKE TO HAPPEN DURING THE COURSE OF THE INVESTIGATION THAT WOULD HELP THEM OR THEIR CLIENTS What are we looking for We investigate claims of injustice or hardship in consequence of Mal/SF. That means for example: We need to see whether there was mal/SF; We need to see whether the mal/SF led to the injustice being claimed; We need to see whether the injustice has already been remedied; MOVE ONTO CLINICAL ADVICE SLIDE
- As part of our investigation of health complaints we regularly seek CLINICAL ADVICE PHSO has access to in-house clinical advice from a range of disciplines. On occasion we use external advisors – this might be when the subject matter is complex or rare The Investigator will ask questions of the Clinical Adviser to allow them (the Investigator) to reach conclusions on the case. We expect advisers to support their views with reference to relevant standards and established good practice, e.g. NICE guidance etc. Our ‘test’ is not at the same level of establishing negligence – we look at what was established good practice and what relevant standards and guidance were in place at the time of the events complained about and whether they were followed . The investigator will keep you and your client informed about any advice they are taking LEGAL ADVICE PHSO also has access to in-house legal advice. We may seek to establish an ‘is it for us?’ question about aspects of a complaint. However, the final decisions are for the investigator to make. It is a lay led process and the advice we recieve is just one piece of evidence that we consider. MOVE ON TO DRAFT REPORT
- When the investigation is close to completion, we will share our provisional findings – We make our decisions by looking at what happened in the case and compare that to what should have happened (ie were the relevant standards, guidance or established good practice followed). If they weren’t we look to see if the shortfall had a negative impact (injustice or hardship) on the individual that we need to put right. We usually share our provisional thinking by sending a draft of the investigation report to the parties for comment and to agree any recommendations that we have proposed. To be fair to everyone, we share reports simultaneously as a general principle. In a small number of cases we may share sequentially. Perhaps where a case is finely balanced and the injustice very significant. This is about managing expectations. IMPORTANT - We have not finalised our view at this point so it is important that all parties give careful consideration to what we are proposing to say. There should be no big surprises at this point. The investigator will have kept you and your client updated on any major revelations along the way. The investigator is happy to discuss any questions about the report. HOWEVER 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. In a small number of cases we may reissue a draft report. CHRIS THIS MAY BE ANOTHER GOOD POINT TO PAUSE TO SEE IF THEY HAVE ANY COMMENTS OR FEEDBACK ON THE DRAFT SHARING STAGE PARTICULARLY AROUND HOW WE SHARE AND TAKE COMMENTS> MANY ADVOCATES BELIEVE WE SHOULD BE DOING FACE TO FACE MEETINGS. THE ISSUE OF OUR LANGUAGE IN REPORTS AND WHAT WE COULD DO TO OVERCOME THAT MAY ALSO BE GOOD TO EXPLORE. MOVE ON TO NEXT SLIDE – FINAL REPORT AND COMPLIANCE
- We carefully consider all comments submitted following the draft report. If we are going to change the findings from the draft we sometimes re-share the draft but if not, will explain why the comments changed our view or why they did not. 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. We ask for a range of actions such as apology, action plan, financial remedy etc. We try and make sure the person affected is put back in the position they would have been in – that is not always possible. 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. We do monitor compliance We publish a number of case summaries on a regular basis. CHRIS THIS MAY BE A GOOD POINT TO PAUSE TO SEE IF THEY HAVE ANY COMMENTS OR FEEDBACK ON THE FINAL STAGES AND WHAT HAPPENS AFTER TO THEIR CLIENT. MOVE ON TO WHAT THEY CAN DO TO HELP INVESTIGATORS AND ANY ADDITIONAL QUESTIONS or COMMENTS
- We have talked about the stages of our investigation and the various interactions and have heard about what you would like from us. Would now like to hear from them on what help advice and information advocates can provide to assist our caseworkers Discussion to capture the types of knowledge and experience that advocates hold that would assist PHSO in our investigations Examples to prompt discussion – Knowledge of their clients needs and preferences Knowledge of the local area and service provider Assistance on how to communicate and actually communicating decisions