Our caseworkers have a good understanding of the NHS through their training and experience, but they are not medically qualified. That’s why we sometimes ask experienced medical professionals for advice when looking at a case. Not all NHS complaints need clinical advice.
Clinical advisers do not make the decision on the outcome of the complaint. Our caseworkers have the skills and experience to investigate complaints and make this decision on behalf of the Ombudsman.
How we select clinical advisers
We choose an adviser based on the clinical area involved in the complaint. Sometimes a case needs advisers from more than one area. If our caseworkers are unsure which specialisms are needed, they ask our lead clinicians for guidance.
All our clinical advisers work at a senior level in the NHS, for example, as a consultant or senior nurse. Our principles say clinical advice must come from appropriately qualified and experienced healthcare professionals.
We make sure any clinical adviser who advises on a case:
- has no connection to the case
- does not work for any organisation involved in the complaint
- works in, or has knowledge of, the same clinical area as the complaint.
Once we’ve identified the right adviser, they review the case and give us their advice. They will also confirm:
- their qualifications
- their current specialist area
- why they are suitable to advise on that case.
Each time, the adviser signs an agreement confirming they have no conflicts of interest that would affect their independence.
How we recruit and check clinical advisers
We have a small team of internal clinical advisers who regularly advise on the clinical areas we see most complaints about. We have a larger group of external advisers who help less often, usually on more specialised areas.
When we appoint a new clinical adviser, we check that they are fully registered with their professional regulator (such as the General Medical Council) and currently practising in the NHS. For external advisers, we check the regulator’s register each time we ask them for advice. Internal advisers provide evidence of their annual appraisal and revalidation. When appointed, all clinical advisers receive our adviser agreement. This covers:
- review periods and quality checks
- our Clinical Standard
- how to write advice.
All clinical advisers must tell us if they retire from NHS clinical practice or do not complete their professional revalidation.
Clinical advisers must also tell us if they are under investigation by their regulator (known as a ‘fitness to practise’ investigation). If an external adviser is under investigation, we will not ask them to advise on cases until the outcome is known. For internal advisers, we assess each situation individually.
How we check the quality of clinical advice
We have a thorough process for checking the quality of clinical advice.
- For new internal advisers, a lead clinician checks their first three pieces of advice. After they complete their induction and probation period, they move to an annual review where a peer checks four pieces of their advice each year.
- For new external advisers, their first piece of advice is peer reviewed. If it meets our standards, they move to an annual review. External advisers may only give one or two pieces of advice a year, and a peer checks one of those. If an external adviser’s first piece of advice does not meet our standards, we check their next piece too (up to a maximum of three checks). After that, we decide whether to continue using them.
- For our most serious cases, the clinical adviser reviews our provisional findings. This makes sure we have correctly understood and applied their advice.
Other evidence we look at
Clinical advice is only part of the evidence we use to make a decision. Our caseworkers will look at any clinical information you send us. They may also request relevant records, such as your complaint file, from the organisation. Our caseworkers consider this advice alongside all relevant evidence when making a decision.
How we assess evidence
We have guidance that sets out the approach we will take when considering and assessing evidence.
Evidence is information we look at when we consider a complaint. This may include, but is not limited to:
- complainants’ accounts (verbal or written)
- an organisation’s policies and guidance
- clinical records
- advice from our advisers.