PALs and Independent Advocates

Hello. Welcome to this clinical negligence session from Data Law. In the session, we're going to be looking at dissatisfied patient support on particularly Powell's or the patient advice on liaise and service on the role of independent advocates. My name's stuff Barber on I'm a retired solicitor from Law Hound Limited following the revamp of the NHS litigation authority to NHS resolution. They've made it plain that their aim is to avoid litigation and deal with claims they say are often pursued in search of an explanation or the acknowledgement that something's gone wrong. This session is an opportunity to examine the background to the NHS complaints system on those services on individuals who are there to support patients when things go wrong. On Prior to the thought of any litigation, we're going to look at the redesigned patient advice on liaise and service or Powell's, which is the service designed to provide on the spot help to patients who want to try and resolve the problem without making a formal complaint on the role of independent advocates. Let's look at the background to the complaint system, starting with the legislation. Let's look at Regulation 16 off the health and Social Care Act 2000 Late Regulated Activities Regulations 2014. The aim of the regulation is to ensure that people can make a complaint about their care and treatment, Onda, as the Care Quality Commission, point out in order to comply with that regulation. It means health care providers establishing Andi effectively operating an accessible system for identifying, receiving handling on responding to complaints from service users. That system need to include thoroughly investigating all complaints and taking the necessary and proportionate action where failures have bean identified. It also means that, as and when requested, provides the care quality commission or seek you see with a summary of complaints, responses on other related correspondence or information within 28 days off their requests on a failure to do so could result in immediate action without even the necessity off a warning notice. The Health and Social Care Act of 2012 requires all local authorities to make such arrangements as it considered appropriate for the provision off independent advocacy in relation to its area. In the provision off assistance for individuals making or intending to make an NHS complaint, and this needs to cover all NHS services, including trusts and foundation trusts. Primary health care services provided for the NHS by GPS dentists, opticians on community pharmacies, clinical commissioning groups, private healthcare organizations if treatments being paid for by the NHS on all other health services commissioned by the NHS prior to April 2013 a complaint about in NHS service could be made either to the NHS funded care or the PCT that commissioned the care on the Department of Health Commission services such as the independent Advocacy Services. Centrally after April 2013 a complaint must be made either to the provider or the NHS commissioning body or local CGC. Whichever body commissions the service in question. Onda. The funding provided previously to the Department of Health together with additional funding to compensate for the loss of economies of scale, has been transferred to the local authorities. So that means that local authorities are now responsible for commissioning services such as the Independent Advocacy services. Prior to April 2017 we have the NHS Litigation Authority which described itself as indemnifying NHS bodies in respect of both clinical negligence on DNA, on clinical risks on managing claims and litigation under both headings and having risk management programs in place against which the NHS trusts assessed. However, from April 2017 the NHS litigation Authority brought together their main functions on relaunched under the new name of NHS resolution and they have a new website currently under development. At the time of recording this session, NHS resolutions describe themselves as an arm's length body of the Department of Health and a not for profit part of the NHS, which provides indemnity cover for clinical and non clinical liabilities. It assists by learning from claims on providing legal and professional services together with dispute resolution between commissioners and contractors. It also helps healthcare providers in the performance management off commissions through advice, training and other support On one of the clear aims off. The NHS resolution is to reduce the number on amount spent in relation to clinical negligence claims whilst retaining the relationship between the NHS and the patient. So very much about looking at alternative resolution on stopping claims before they get anywhere near the court. Let's have a look at the role of the patient Advice and Liaison service or Powell's well pals was originally designed to help patients and their families and carers using the NHS to get the best possible service, including from GPS dentists, pharmacists Onda Opticians originally created in 2002. Pals were there to provide information and on the spot help to patients who wanted resolve A problem without making a formal complaint on the role of pals was to provide confidential advice, support and reassurance the idea being to resolve small problems locally. However, they were also there to assist with the filing off A formal complaint on supporting a patient, at least in the initial stages off it Pals is an organization was actually abolished by the Health and Social Care Act 2002 but now some remain in place. Commissioned individually by each local authority, The palace team aimed to be a free and accessible welcoming point, provide information to patients and carers. Their aim is to listen and offer confidential advice, support and information on health related matters. They'll also provide information about the NHS on help patients with any other health related inquiry. They help resolve concerns or problems when using the NHS. ANDI provide information about the NHS complaints procedure on how to get independent help. If a patient decides they want to make it complaint. They'll also help with information and introduce a patient. Agencies on support groups outside of the NHS possible also inform patients about how they can get more involved in their own health care on the NHS locally aiming to improve the NHS by listening to concern suggestions on experiences ensuring that people who design a manage services are aware of any issues that patients raise. They're also there to provide what they refer to as an early warning system for NHS trusts and monitoring bodies by identifying problems or gaps in services on reporting them. The Pell services intended to be accessible on something which can be accessed through the NHS Choices website to contact the nearest Powell's office. There's usually a Powell's office in most hospitals, and most service providers provide leaflets and contact numbers which operate during business hours. Unfortunately, some of the websites that you visit, though you'll find have broken or non existent website links to what is assumed to be pals services on the time of recording this session on example is the Norfolk Community Health and Care NHS, and if a patient needs help resolving an issue. What exactly compels do well, First of all, pals say that they will listen if there's been an issue, their first step is to simply listen to what's happens. Secondly, pals Elaine. To try and resolve things locally, they will arrange the patient to meet with the relevant stuff. Usually there was responsible for dealing with patients care, but they will also liaise with other relevant organisations, such as GP surgery on other trust, etcetera. They also pass on comments and suggestions on improving services to the relevant management teams. Thirdly, they will assisting complaints or sign posting So where an issue isn't resolved or perhaps is incapable of resolution on the patient asks for further assistance. Then pals should provide information on sign posts. The relevant service such as, for example, the relevant independent complaints advocacy services. All the formal complaints procedure and pals can assist in making that complaint. As I've already mentioned, it's interesting to get an idea of how Powell's actually work because of low the Powell services such exists in principle. The different NHS providers are responsible for the service, and certainly an independent report found that some hospitals actually combined the Powells function with complaints management on that leads to a big question, of course, with regard to a potential conflict of interest. The first example of pals I'm going to discuss is for Oxford University hospitals and the annual report shows they determined that the key role for Powell's is to provide an opportunity for patients, relatives and carers to discuss their concerns. Enabling issues to be appropriately identified on provide a timely response in a manner that will support a suitable resolution when necessary. Pals do escalate concerns the relevant complaints coordinator, and that's for action through the formal complaints process. But Powell's also in provides a means for patients and relatives to share compliments with the trust's, and these are also recorded. The report actually states, we believe it's important to listen carefully to what people tell us on where open, honest and transparent when responding to concerns or complaints. We do all that we can to resolve concerns on complaints in a timely way and learn from our mistakes to put things right for the future and improve the services and care that we provide. They go on to say that it's a personalized approach to managing complaints, which involves listening to individual experiences, planning with the complainants an appropriate response according to their wishes on ensuring, if necessary, actions taken to address issues raised in a timely manner. Some key findings off their 13 14 report are that there were 887 formal complaints received on investigated 515 of thes related to medical, including surgical issues, because of inadequate care treatments, communication and attitude. Off the formal complaints, 699 were upheld or partially upheld following investigation on day, 160 not upheld. Following investigations. There was one formal complaint investigated. Vyron Independent Review Off the Karen Treatments provided to patients on five complaints investigated by the parliamentary on Health Services Ombudsman. Contrast that with a total of 4931 pals contacts which were recorded in terms of top complaints. The majority of complaints related to surgical medical care. Examples include infection linked to surgery or treatments, poor outcome of surgery or treatment, or inadequate or insufficient clinical treatments. They provide an example off pals. Work was that a patient at the Oxford I hospital was worried that he might have been given conflicting advice regarding his treatment and what should be done on did. He also perceived the consultant was dismissive about his concerns, so pals in those circumstances arranged for the patient to meet his consultant to discuss those concerns. The second area off complaint related to appointment admission on discharge on the third area of complaint that was most popular related to communication information on consent on the example given was of a woman who experienced a very long first delivery stage and subsequently required on emergency Caesarean section. The woman's husband had asked why Scam was not undertaken earlier, as they'd raised concerns that the baby was breech. The division shared the policy and practice of scanning for a breech birth. The midwife who didn't engage with a couple was spoken to on the apology was made tooth um, Andi. A second example of Powell's is Middle six between 2000 and 15 and 16 on. In total, the trust had 2000 136 concerns raised with Powell's, and they had four main areas of complaint women's and Children's services, followed by emergency care than medical specialities and surgery on the main subject area of complaint. Each category was clinical treatments, and they provide an example of the type of case Powell's was involved in on that related to specialist surgery. Whether we're concerns in ophthalmic care, which resulted in damage to the patients I and Panels were involved in the apology for the failings had been identified on supporting the patient in making a claim for clinical negligence on input into an action plan. Detail ing The lessons being learned Let's have a look at the independent complaint Advocacy Support. Who are they? Well, the Independent Complaint Advocacy Service was a national independent advocacy service that supported people who wanted to make it complaint about their NHS care or treatment. That service actually ceased in April 2013 when the commissioning of NHS Complaints Advocacy services transferred to individual local authorities. So it's now left to individual local authorities to appoint independent advocates to help patients on this means. Whilst the still is free and independent advocate services from trained individuals who support patients making complaints about NHS care or treatments, It means, of course, that's the service, and the quality will vary across the regions. There are a range of complaint support providers and you can find details on the local government website. I've put the link on the screen and it's also in your notes. So, for example, in south west of England there 16 local authorities dominated by five providers in respect of independent advocacy support. However, there are core characteristics of independence. Health complaints advocacy Andi. As a minimum, the core characteristics, often effective service are unknown. Accessible response. So clear communication Onda A proactive engagement focused on empowerment on the promotion of self advocacy wherever appropriate services need to be professional. Andi independent. And that means to say that commissioning on funding arrangements shouldn't compromise the prevision off independent advocacy two kinds and finally, the's services must be able to demonstrate that they do make a difference. As part of that, services should be able to demonstrate a commitment to the principles off the advocacy charter or a local equivalent. The advocacy charter and code of practice is available from the Advocacy Project Website, and there's a link on screen. Andi in your notes on the principles include clarity of purpose, independence, taking a person centred approach, being respectful of people's needs, views, culture on experiences facilitating empowerment, equal opportunity accessibility, supporting advocates, having a system of accountability. So monitoring and evaluating the work of off the advocates confidentiality, having their own complaints system and safeguarding. So what services do independent advocates offer? While they say they'll help patients to understand their options on the implications of each option on, then support that patient to take the course of action? They wanting they? Might he be included in such things as writing letters, Andi attending meetings? And, as I've mentioned, because the advocacy service is provided by different providers across the region, one of the concerns raised is, of course, the consistency off approach, despite the fact that there is theatric asi, charter and principles. And that concludes this session from Data Law. Thank you so much for joining me, Steph Barber on the session.