On 15 September 2018 the PHSO announced a Clinical Advice Review chaired by Sir Alex Allan and with Sir Liam Donaldson as an Independent Adviser. A Consultation Paper and Background Paper were published online. One of the most striking features of the documents was that there was no mention of any direct engagement with complainants during the consultation process. PHSOtheFACTS members had a chance opportunity to submit documents to Sir Liam Donaldson at another patient safety event and submitted 7 case studies to demonstrate how poor clinical advice had affected the outcome of their cases. We would have welcomed closer engagement with the review in line with the commitment Rob Behrens made to PACAC at his pre-appointment hearing to work with PHSOtheFACTS who are the only body set up to represent service users.

It came as a surprise therefore when it was discovered, shortly before the consultation closed on 15 October 2018, that there had indeed been a face-to-face meeting between Sir Alex and Sir Liam and a select group of 11 complainants at a Round Table event not mention in either of the previous documents. According to PHSO the lucky 11 were chosen on a first come first served basis after invitations were sent out to 1662 complainants whose cases had been closed recently. PHSO had complete control over who to invite and who to accept for the very limited number of places available. (15 in total). No PHSOtheFACTS members were chosen though some applied. When PHSOtheFACTS asked for a meeting with Sir Alex and Sir Liam we were told that the consultation was now closed (see email exchange below)

This raises some pertinent questions, not least of which is why there would be such secrecy over the face-to-face meetings with complainants? Why would details of the planned meeting with complainants not be disclosed in the consultation document? It was after all a key part of the consultation. And if Sir Alex and Sir Liam were really intent on obtaining as much information as possible about the use of clinical advice in investigations, why would they not arrange to meet with PHSOtheFACTS, the only group with not only first-hand experience of poor clinical advice but also with the depth of knowledge of the PHSO processes necessary to put it into perspective? Isn’t the purpose of a consultation to get as wide a range of opinions as possible, even if they may be unpalatable? Was there an attempt to limit critical voices?  Whatever the reason, the failure to fully engage with complainants will cast a dark shadow over the report produced for the Clinical Advice Review and upon the promise to be open, transparent and restore public confidence.

 

To: Sir Alex Allan

Sir Liam Donaldson

c/o Parliamentary and Health Service Ombudsman

31st October 2018

 

Dear Sir Alex and Sir Liam.

I am writing on behalf of PHSOtheFACTS, a group representing members of the public who are dissatisfied with the quality of the service they have received from the Ombudsman.

We are concerned at the lack of representation of complainants in the Clinical Advice Review you are currently undertaking, particularly in relation to meetings and discussions. We are not alone in our concerns. To quote from the submission to the Clinical Advice Review by the Patients Association

“Given the short timeframe of the consultation, we would have been pleased to see more active work by PHSO to take on board the views of patients, over and above the opportunity to submit written responses. We note that one face-to-face event is due to be held, albeit we understand that invitations to attend it were sent only to complainants identified by PHSO, and that places on it were booked up within 24 hours. PHSO consulted us informally about this meeting: we advised making it open to the public rather than invitation-only and were surprised that PHSO expected demand for places to be low.” 

We understand that a round table discussion did take place on 12th October 2018. However no details of who attended or what was discussed have been released.

The only way to understand how clinical advice provided to the Ombudsman has failed complainants on multiple occasions is to speak directly with those who have been failed.

We therefore request that you arrange a meeting with members of our group so that we can discuss our concerns.

Complainants need to be seen to be given a full voice or the report on the Clinical Advice Review will lack credibility amongst complainants.

We look forward to hearing from you.

For clarity we will publish this email and any reply on the PHSOtheFACTS website.

Yours sincerely

Nicholas Wheatley

PHSOtheFACTS

 

cc. Sir Bernard Jenkin

Rob Behrens

Ronnie Cowan

Paul Flynn

Marcus Fyshe

Dame Cheryl Gillan

Kelvin Hopkins

Dr Rupa Huq

David Jones

Sandy Martin

David Morris

Tulip Siddiq

Rachel Power – Patients Association

 

Dear Mr Wheatley

Thank you for your email, which I can confirm I have shared with Sir Alex Allan, who is chairing our clinical advice review.

I can confirm that as part of our consultation almost half of the submissions we received (84 of 167) came from individuals who have previously used our service. The Patient’s Association response also included feedback from 36 individuals who have previously been in touch with them about their experience at PHSO. In addition to the written response you submitted to us, I am also aware that members of your group approached Sir Liam to share information with him at a separate event he was attending, which he committed to taking account of as part of his work. Finally, as you note below, we also held a roundtable with complainants attended by Sir Alex and Sir Liam, who we identified by emailing all recent users of our service and asking those interested to highlight their willingness to attend, selecting the first ones that responded to us.

The consultation has now closed and we are considering the responses carefully. We do not plan to have any further meetings at this stage while we complete this work, although I would like to take this opportunity to thank you for the written evidence your group submitted both collectively and from individual members. I can also confirm that we have shared all of the written responses we received with Sir Liam to inform the work he is contributing to the Review.

We will be publishing the recommendations from the Review in the New Year, which will also include a summary of the key themes that emerged from the evidence the Review Team and Sir Liam received. We will publish this online and I am happy to ensure you receive a copy directly on the day of publication if that would be useful.

Kind regards

Warren

Warren Seddon

Director of Strategy and Insight 

Parliamentary and Health Service Ombudsman

 

Dear Mr Seddon

Thank you for your email. We are pleased that the consultation has taken submissions from a number of complainants and hope that the written evidence proves to be useful.

However we are still concerned about the lack of involvement of complainants in discussions and meetings, and the process by which attendees were chosen for the round table event remains unclear. It would be useful if you could provide answers to the following questions:

  • How many complainants applied to attend the meeting?
  • How many complainants attended the meeting?
  • How long after sending out the invitations to attend the meeting were all the available places filled?
  • How many attendees were complainants whose complaints had not been upheld?
  • Over what period of time were complainants judged to be recent enough to be invited to attend the meeting?

There are obvious problems with the perception of impartiality when the organisation being reviewed controls the process by which complainants are chosen.

PHSOtheFACTS members have a wealth of first-hand experience of failures of clinical advice that have negatively impacted their cases. It would be thought that this information would be of great use when conducting a review of clinical advice and ask you to reconsider holding a meeting with our members.

We remain of the opinion that the report on the Clinical Advice Review will lack credibility amongst complainants unless complainants are seen to be given a full voice.

For clarity we will publish this email and any reply on the PHSOtheFACTS website.

Yours sincerely

Nicholas Wheatley

PHSOtheFACTS

cc. Sir Liam Donaldson

Rachel Power – Patients Association

 

Dear Mr Wheatley,

I’m afraid I have nothing to add to my previous email in relation to a further meeting at this stage. I can confirm, however, that the feedback we have received is being considered very carefully both by Sir Liam and the rest of the Review Team – I hope you and other members of your group will be reassured about how important the feedback we have received has been in informing both Sir Liam’s work and the thinking of the Review Team itself when you see the final report when it is published next year.

I am also happy to answer your other questions now rather than referring them to our FOI team if that is helpful.

I can confirm that we emailed over 1500 former complainants from across this financial year and the last to highlight that we had launched a consultation on our clinical advice function, to encourage feedback and to seek expressions of interest for attendance at the roundtable to discuss the Review in more detail. We received initial expressions of interest from 76 of the complainants that we emailed and based on the size of the room we were using on the day invited 15 of these complainants to the roundtable on a primarily first come, first served basis. We don’t have a precise record of exactly when we had received enough expressions of interest to fill the roundtable, but it was within 24 hours of the invite going out. On the day itself a couple of people could not make it and so 11 of the 15 people we had invited ended up being able to attend. 7 of those who attended had been involved in complaints that we had not upheld, 4 had been involved in complaints that we had partly upheld. Both Sir Liam and Sir Alex were in attendance for the discussion, which was hugely helpful and helped build on many of the points made by the significant number of written responses we have also received and that I mentioned in my previous email.

I hope that is useful and that you have a good weekend.

All the best

Warren

Warren Seddon

Director of Strategy and Insight 

Parliamentary and Health Service Ombudsman

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