How we use clinical advice to inform our decisions

Our caseworkers who investigate NHS complaints have a good level of knowledge about the NHS through their training and experience, but are not medically qualified. That is why we may seek advice from experienced clinical professionals who are specialists in particular areas of care when we consider a case. However, not all NHS complaints that we consider require clinical advice.

How we select clinical advisers

All our clinical advisers are currently working at a senior level in the NHS, for example as a consultant or senior nurse. Our ‘Principles for the provision of clinical advice’ state that ‘Clinical advice is obtained from appropriately qualified and experienced healthcare professionals’.

We make sure that any clinical adviser who provides advice on a case:

  • is unrelated to the case
  • does not work for any organisation complained about in that case.

The clinical adviser will work in, or have knowledge of, the same clinical setting or specialism as the clinical area complained about. They work with our caseworkers to give them informed advice. This helps us get a better understanding of the clinical issues.

Find out more about clinical advisers.

Other evidence we consider

Advice from a clinical adviser forms only part of the evidence used to make a decision on a case. The clinical adviser is not the decision maker. The Ombudsman is responsible for making decisions about complaints, as are his caseworkers, acting on his authority. 

Our caseworkers will consider any clinical information or evidence you send to us. They are also likely to request relevant clinical records and information, such as a complaint file, from the organisation complained about.

Our caseworkers have the skills, competencies, and experience to look into complaints. They will take clinical advice we receive and all other relevant evidence into account when making a decision on a case.

Read more about the approach we take when considering, balancing, and assessing evidence.

Keeping you updated

We will:

  • keep you, and the organisation complained about, updated about what information we have requested and what this means for our investigation
  • share facts with you and discuss what we are seeing
  • let you know if we need to get more information
  • tell you when we think we will have all the information we need.