Ombudsman to change way it uses clinical advice in NHS-casework

The Parliamentary and Health Service Ombudsman has today published its response to a Review of the way it uses clinical advice in NHS-related casework.


The Review Steering Group, chaired by Sir Alex Allan KCB, PHSO non-executive board member, with independent advice from former Chief Medical Officer, Sir Liam Donaldson, considered responses to a public consultation before reporting and making recommendations. Both Sir Liam’s and the Review team’s reports have been published today alongside the Ombudsman’s response.


Parliamentary and Health Service Ombudsman, Rob Behrens said:


We use clinical advice as a key source of evidence to inform our thinking in around three-quarters of our health investigations. It is therefore crucial we commission and use it correctly and that those involved in a complaint understand and have confidence in the way it has informed our decisions.


‘We will implement the vast majority of the Review’s recommendations to enhance confidence and trust that we have commissioned, used and reported clinical advice correctly.’


The Ombudsman will implement changes that will provide greater assurance to those who use our service that we have used clinical advice correctly and greater transparency of our service for complainants and those we investigate.


Clinical advisers will be more integrated in the casework process, interacting more regularly with caseworkers to ensure requests for advice are framed correctly and their advice has been accurately reflected in final decisions. Those using our service will have clearer information about why we are using clinical advice, the credentials of those providing it and earlier opportunities to see the content of that advice.


Sir Alex Allan KCB said:

I am immensely grateful to all those who made submissions to the Review and to Sir Liam for identifying improvements to the way in which the Ombudsman uses clinical advice to resolve complaints about the NHS.


‘The Ombudsman’s role in providing redress to people who have suffered injustice and helping to drive improvements in public service is hugely important. I am pleased that the Ombudsman will be implementing the great majority of the Review’s recommendations. Some are to be implemented immediately; others, as the Review suggested, need piloting first. I believe these are important changes which will help the Ombudsman to further improve its service.’


Sir Liam Donaldson said:


As independent adviser to the Clinical Advice Review, I made a number of proposals to improve the robustness and transparency of the Ombudsman’s use of clinical advice. In particular, I sought to increase the depth of understanding of why and how some patients’ care fails and to ensure that patients and families can have trust in the quality and independence of the resulting assessment and investigation. Also, I wanted to see a much stronger voice for patients and families reflected within the procedures and behavioural norms of the organisation.


‘I welcome that the Ombudsman will now be implementing the majority of these proposals. This is a significant set of measures that will require changes to culture as well as process. That is not easy to get right immediately. The Ombudsman is right to implement them in a phased and measured way to make sure that beneficial change is sustainable and long-lasting.’


The Clinical Review reports are available here


Contact the Parliamentary and Health Service Ombudsman press office: | 0300 061 4639 

Out of office hours | | 0300 061 4444


Notes to editors

  1. The Parliamentary and Health Service Ombudsman provides an independent and impartial complaint handling service for complaints that have not been resolved by the NHS in England and UK government departments. We look into complaints where someone believes there has been injustice or hardship because an organisation has not acted properly or has given a poor service and not put things right. We share findings from our casework to help Parliament scrutinise public service providers and to help drive improvements in public services and complaint handling.
  1. From 1998 to 2010, Sir Liam Donaldson was Chief Medical Officer for England and the United Kingdom's Chief Medical Adviser. His work helped shape public health, NHS care and clinical practice including: the introduction of clinical governance, a comprehensive patient safety programme, smoke-free public places, regulated stem cell research and the establishment of a health protection service. He is currently the World Health Organisation’s Envoy for Patient Safety and Chairman of independent boards that monitor the global polio eradication programme.
  1. The Clinical Advice Review was chaired by Sir Alex Allan, non-executive Board member, Parliamentary and Health Service Ombudsman. Sir Liam Donaldson is Independent Adviser to the Review. Other contributors are Dr Julia Tabreham, non-executive Board member, Parliamentary and Health Service Ombudsman and those in clinical, operational and legal roles at the Parliamentary and Health Service Ombudsman.
  1. Sir Alex Allan, KCB, is currently the Prime Minister's Independent Adviser on Ministerial Interests. Sir Alex was a senior British civil servant with a long career at the highest levels of the Civil Service. Former roles include Principal Private Secretary to the Prime Minister and to the Chancellor of the Exchequer, Permanent Secretary at the Ministry of Justice, High Commissioner to Australia and chairman of the Joint Intelligence Committee. Sir Alex joined the Parliamentary and Health Service Ombudsman as a non-executive Board member in January 2018.