Ymddiriedolaeth GIG Gwasanaethau Ambiwlans Cymru Welsh Ambulance Services NHS Trust Putting Things Right Policy

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1 Ymddiriedolaeth GIG Gwasanaethau Ambiwlans Cymru Welsh Ambulance Services NHS Trust Putting Things Right Policy Approved by: (TBC) Version: 0.6 Issue Date: (TBC) Review Date: (24 months from issue TBC)

2 Policy: Welsh Ambulance Services NHS Trust Putting Things Right Policy Owning Department: PTR Version: 0.6 Title of Author: National Mgr for Concerns & Service Imp. Number of Pages:30 Implementation Date: TBC Next Review Date: 2 YEARS Ratification Committee: Quality, Safety & Governance Committee Date Ratified: To be read in association with the following documents: Welsh Government Putting Things Right, Guidance on Dealing with Concerns about the NHS from 1 April NHS (Concerns, Complaints and Redress Arrangements) (Wales) 2011 Welsh Risk Pool Standard 5 concerns & claims National Patient Safety Agency Being Open (2009) Public Service Ombudsman for Wales Act (2005) Wales Interim Policy & Procedures for the Protection of Vulnerable Adults from Abuse All Wales Child Protection Procedure Coroners Procedures Access to Health Records Act 1990 Freedom of Information Act 2000 WHC (97) 17 Clinical Negligence and Personal Injury Litigation: Claims Handling WAST ADI Hazard Reporting, Investigating & Learning Policy WAST A tool kit for carrying out Equality Impact Assessment WAST Scheme of reservation and Delegation and Terms of Reference for the Board s Committees WAST Policy & Procedure for Organisational Learning and Promoting Improvements in Patient Safety WAST Formal Complaints Process WAST On The Spot Concerns Process WAST Compliments Process WAST Safeguarding Children and/or Vulnerable Adults Policy; When an allegation/concern is raised about an Employee or Volunteer. Target Audience: All Trust staff dealing with concerns WAST PTR Policy V0.6 December 2013 Page 2 of 31

3 Version Date Directorate Status Comment 0.1 Mar 13 Medical & Draft Initial draft Clinical Services Directorate 0.2 Mar 13 Medical & Clinical Services Directorate Draft circulated Limited in initial circulation within Medical Directorate 0.3 Aug 13 Medical & Clinical Services Directorate 0.4 Nov 13 Medical & Clinical Services Directorate 0.5 Dec 13 Med & Clinical Services Directorate 0.6 Dec 13 Med & Clinical Services Directorate Draft Draft Draft Draft Added in previous comments from C Hinton, Aileen Evans, Chris Preston. Circulated to Medical Directorate teams prior to formal consultation. Updated. Sent for initial consultation to PTR Team, Pat Safety Mgrs, Medical Directorate, Service Delivery Directorate, Unions, Director of Quality, Equality Lead, POVA Lead, Child Protection Lead and Trust Solicitor. Updated following comments. Circulated to CMG. Updated following input from Safeguarding Team on definitions and titles section 8 and read in association with section. WAST PTR Policy V0.6 December 2013 Page 3 of 31

4 Contents Contents... 4 Equality & Diversity Policy Statement Introduction Scope of Policy Trust Principles Putting Things Right Principles Definitions Organisational Arrangements Safeguarding Complaints (concerns reported by service users) Incidents (Concerns reported by staff) Compliments Redress Claims Coroners Court and Coroners Rule Public Services Ombudsman for Wales Key Performance Indicators Communication Organisational Development & Training Service User Feedback Organisational Learning Concerns Monitoring, Assurance & Reporting References Appendix A Equality Impact Assessment Appendix B On the Spot Concerns Process Diagram Appendix C Formal Complaints Process Diagram WAST PTR Policy V0.6 December 2013 Page 4 of 31

5 Equality & Diversity This policy has been assessed to ensure it conforms to current equality and diversity guidelines (Appendix A). 1. Policy Statement The Welsh Ambulance Services NHS Trust (the Trust) recognises the value in the effective management of concerns and the subsequent organisational learning that supports the development and improvement of services. The purpose of this policy is to establish the Trust s arrangements for the management of concerns under the NHS (Concerns, Complaints and Redress Arrangements) (Wales) Regulations The Trust is committed to dealing with concerns in accordance with the Putting Things Right Guidelines issued by Welsh Government This policy ensures that the Trust fulfils the requirements of Standard 23 of the Standards for Healthcare Services, management of patient concerns and provides assurance to the Welsh Risk Pool under Standard 5, concerns and claims management. Through the effective management of concerns the Trust aims to: Apply common principles to the management of concerns raised regarding services provided by the organisation; Establish a common model for the dealing of concerns within the organisation and jointly with other partner organisations; Apply common data collection procedures; Establish common methods for learning from concerns; Establish a means to identify and disseminate good practice and learning throughout the organisation. The Welsh Ambulance Service is committed to dealing with concerns effectively to identify where things have gone wrong or are perceived to have gone wrong, to work with our service users to put things right by developing and improving our services. 2. Introduction This policy sets out the principles for the Trust s Management of concerns in compliance with the NHS (Concerns, Complaints and Redress) (Wales) Regulations 2011 and in accordance with the Putting Things Right Guidelines for Dealing with Concerns The Putting Things Right Guidance has been produced for the NHS in Wales to enable responsible bodies to effectively handle concerns according to the requirements set out in the National Health Service (Concerns, Complaints and Redress Arrangements) (Wales) Regulations WAST PTR Policy V0.6 December 2013 Page 5 of 31

6 The guidance applies to all Health Boards, NHS Trusts in Wales, independent providers in Wales providing NHS funded care and primary care practitioners in Wales. The guidance exists to assist staff in interpreting the Regulations and provides practical advice on applying best practice at the various stages of handling and investigating a concern. These arrangements represent a significant culture change for the Trust in the way in which it deals with things that go wrong, introducing a single and consistent method for grading and investigating concerns, as well as more openness and involvement of the person raising the concern. The concept of Redress forms part of the new arrangements, with Welsh NHS bodies (Health Boards and NHS Trusts) being placed under a duty to consider when a concern notified contains an allegation that harm has or may have been caused whether they have caused harm to a patient through a breach in duty of care and if so whether the Redress arrangements set out in the Regulations and explained in the guidance apply. These arrangements play a significant role in improving patient safety and experience, with an explicit requirement to show how services have improved as a result of concerns that have been notified and dealt with under the arrangements. 3. Scope of Policy The policy covers the management of compliments and concerns, including complaints, reported patient safety incidents and claims. It sets out how the Trust will meet the statutory requirements outlined in the Regulations The policy applies to staff, permanent and temporary, employed by or working within the Welsh Ambulance Services NHS Trust, including independent providers who have a responsibility to report, manage and or be involved in concerns raised or investigate concerns. The term concern should be taken to mean any complaint, claim or reported patient safety incident. Regulation 13 sets out that people can raise concerns about any service, decisions and/or care and treatment provided by the Trust. As set out in Regulation 12, this policy covers concerns raised by: people who are receiving or who have received services from the Responsible Body; people affected or likely to be affected by the actions, errors or decisions of the Responsible Body; staff members of responsible bodies; independent member (non-executive director or non-officer) of a NHS body; partners, e.g. a partner in a GP practice; a third party acting on behalf of a person who is unable to raise a concern e.g. a young child or someone who lacks capacity to act on their own behalf; or because that person wants someone else to represent them; a third party on behalf of a person who has died. WAST PTR Policy V0.6 December 2013 Page 6 of 31

7 Not all concerns can be dealt with under the arrangements for dealing with concerns. Matters excluded are set out in Regulation 14 which include: concerns notified by a primary care provider relating to a primary care provider s contract or arrangements under which they provide primary care services - these issues are dealt with through different mechanisms relating to the Regulations covering primary care; concerns where a member of staff has an issue with their employment contract these matters would be dealt with under the organisation s HR policies and procedures; where the concern is being or has been investigated by the Public Services Ombudsman for Wales; where the Responsible Body has not complied with the Freedom of Information (FOI) Act 2000 such concerns would be dealt with by the Information Commissioner s Office; disciplinary proceedings identified as a result of the investigation these would be looked at under local HR processes; concerns which are raised and resolved on the same day, that is, on-thespot this is covered at the beginning of the guidance; where someone tries to re-open the same concern that they have already agreed was dealt with satisfactorily on the spot unless an organisation considers it needs to look into the issue again and then it must follow the process for handling and investigation of concerns; where the concern has already been investigated under the previous complaints procedure, that is, complaints that were reported pre 1 April 2011 and concerns that have already been considered under the Regulations; concerns, in respect of which court proceedings have already been issued. If court proceedings are issued when a concern is already under investigation in accordance with the Regulations, all further investigation of the concern must stop (see Regulation 14(1)(i); where a concern relates to an individual patient funding treatment request, that is, requests for funding of services not usually provided on the NHS in Wales these concerns will be dealt with under a separate all-wales process for decision and review, currently being finalised. 4. Trust Principles The main Trust principles within this policy are: to comply with the principles of the Putting Things Right Guidelines to ensure compliance to the Regulations 2011; to ensure that all staff and managers understand their responsibilities in terms of the management of compliments and concerns and subsequent learning; to provide assurance to the Trust Board and Welsh Government that suitable arrangements are in place for the management and learning from concerns within the Trust. This policy is to support the Trust s core values that are to be applied to the handling of concerns within the Trust which are to: WAST PTR Policy V0.6 December 2013 Page 7 of 31

8 Act with integrity and honesty; Treat everyone with respect and dignity; Put the patient at the heart of everything we do; Encourage learning, innovation and new ways of working; Remove waste, variation and harm. Although the Regulations 2011 are prescriptive in the 30 day target for complaint responses, the Trust recognises (in line with Putting Things Right) that it is important to investigate well and investigate once and in some more complex cases, the 30 day target cannot not be achieved due to the complexity of the investigation and involvement of other parties. This policy recognises that the management of concerns is the responsibility of every member of staff providing a service across the organisation. On the spot concerns should be dealt with by the most appropriate member of staff at the time that the concern is raised. It is therefore important that all staff across the organisation are aware of the Putting Thing Right Guidelines. Concerns will be treated impartially and sensitively in confidence. People raising concerns have the right to be heard, understood and respected. However, there may be times when the distress of a situation leads to the person raising a concern acting out of character and becoming determined, forceful, angry, make unreasonable demands of staff or even resort to violence. In the event that a person raising a concern develops unreasonable demands the Trust has the right to undertake actions outlined within Appendix M of the Putting Things Right Guidelines. This may include limiting the complainants contact to a single manager, limiting contact to written correspondence or in extreme cases involving threats or violence, involving the police. 5. Putting Things Right Principles The Welsh Government Putting Things Right, Guidance on dealing with concerns about the NHS from 1 st April 2011 has the following general principles that a person should: Be able to notify their concern through a single point of entry; Have their concern dealt with efficiently and openly; Have their concern investigated properly and appropriately; Have their expectations and involvement in the process established early on; Be treated with respect and courtesy; Be given advice on the availability of assistance to pursue their concern, and where they may obtain it; Have a named contact throughout their concern and know how to contact that person; If an investigation reveals that there is a qualifying liability, the Welsh NHS body must give consideration to the application of the Redress arrangements; WAST PTR Policy V0.6 December 2013 Page 8 of 31

9 Receive a timely and appropriate response to a concern and be kept informed if there is a delay; Be informed of the outcome of the investigation; Be assured that appropriate action has been taken as a result of raising their concern and lessons learnt; Have their concern managed and investigated in line with guidance issued by Welsh Ministers. 6. Definitions 6.1 Concern The term concern is taken to mean any complaint, claim or reported patient safety incident (about NHS treatment or services) to be handled under the Regulations and Putting Things Right arrangements. A concern can be notified no later than 12 months from the date on which the concern occurred or if later, 12 months from the date the person raising the concern realised they had a concern. The discretion to consider a concern that has been notified outside the 12 month period is subject to the Regulation 15 (3) and can be considered by the Trust in line with the limitation period in place for clinical negligence claims. A concern may be notified by: A person who receives or has received services from the Trust; Any person who is affected, or likely to be affected by the action, omission or decision of the Trust; Staff members of the Trust; A non-executive Director of the Trust; Partners e.g. in a GP Practice; A third party acting on behalf of a person who is unable to raise a concern e.g. a young child or someone who lacks capacity to act on their own behalf; or because that person wants someone else to represent them; A third party on behalf of a person who has died. A concern can be withdrawn at any time by the person who notified the concern. In these cases, the Trust will confirm the person s decision in writing and consider whether the investigation of the concern is still appropriate. In some cases it will be necessary to continue the investigation for the purposes of organisational learning. 6.2 Concern Grading An initial assessment of the concern must be undertaken in accordance with the principles outlined in Regulation 23 to determine the depth and parameters of the investigation, which needs to be proportionate to the severity of the concern notified. All concerns must be graded in terms of severity initially by the Putting Things Right Team in conjunction with advice from the Patient Safety Team where there is an allegation of harm. The depth of the investigation will then vary according to the issues under consideration. It is not appropriate to conduct in-depth root cause WAST PTR Policy V0.6 December 2013 Page 9 of 31

10 analysis investigations for all concerns and so it is important to determine as accurately as possible from the outset what will be proportionate in the circumstances. Within the PTR Guidelines, there are 5 levels of grading identified as follows: (for detailed descriptions, please refer to Appendix J of the Putting Things Right Guidelines). Grade 1 no harm Grade 2 low harm Grade 3 moderate harm Grade 4 severe harm Grade 5 death Concerns raised will be graded initially on receipt to determine the level and detail of investigation required. The grading will then be reviewed during the investigation based on the findings to be given a final grade in the investigation report by the Investigation Manager in conjunction with the Investigation Supervising Officer and Patient Safety Manager in cases where there is harm. 6.3 Root Cause Analysis Concise and Comprehensive Investigations The number of people participating in an investigation is dependent on the severity and complexity of the concern. For a low grade concern (grade 1 or 2) it may be sufficient for one person to undertake the investigation, whereas a higher grade concern (grades 3-5) may require a multidisciplinary team approach supported by the Putting Things Right Team. In these cases, it is likely that a comprehensive or concise Root Cause Analysis will be required. It is important that the investigator(s) are appropriately selected according to their knowledge and experience and the nature of the concern. The difference between a concise and comprehensive Root Cause Analysis lies in the number of investigation tools utilised and the level of detail in the investigation. For more serious concerns with significant potential harm, it is likely that the Investigation Manager will be required to work with the Patient Safety Managers to go into the significant detail of a comprehensive investigation to determine the root cause effectively. 6.4 Compliment A compliment can be defined as an expression of appreciation for a service received. Although the regulations 2011 refer to concerns, the Trust also values compliments with a view that concerns should be balanced with compliments that tell the stories of positive patient experiences to learn best practice from. A compliment can be raised verbally or in writing with the Trust. Compliments will be collated centrally and records kept within the Datix system. If a compliment is raised as part of a concern, this information will be recorded. WAST PTR Policy V0.6 December 2013 Page 10 of 31

11 7. Organisational Arrangements Welsh Ambulance Services NHS Trust 7.1 Strategic Oversight Within responsible bodies, an individual must be charged with keeping an overview on how the organisation s arrangements are operating at a local level and ensuring that they comply with dealing with concerns as outlined within the Regulations. In the case of Welsh Ambulance Services, this is a Non-Executive Director as an independent member of the Board. 7.2 Responsible Officer Each Responsible Body must designate an individual as Responsible Officer who is charged with overseeing the day to day management of these arrangements and ensuring that they operate in an integrated manner. In the case of Welsh Ambulance, the Putting Things Right Team are the responsibility of the Executive Director of Medical and Clinical Services and the Chief Executive Officer. The Executive Director of Medical and Clinical Services as a Responsible Officer ensures arrangements are in place to: Deal with concerns in line with the Regulations; (in the case of a Welsh NHS body) allow for the consideration of qualifying liabilities; Provide for incidents, complaints and claims to be dealt with under a single governance arrangement. The Chief Executive Officer as a Responsible Officer ensures arrangements are in place to: Respond to concerns within the timeframes within the regulations; Approve individual concern responses at Chief Executive Officer level. 7.3 SIM/National Manager for Concerns & Service Improvement The actual handling and consideration of concerns in accordance with the Regulations is the responsibility of the Senior Investigations Manager (SIM). As well as the handling and consideration of concerns under the Regulations, part of the Senior Investigations Manager s role will require them to undertake other functions in relation to dealing with concerns and to co-operate with other persons or responsible bodies, e.g. Health Boards, to facilitate the handling and investigation of concerns. Pending the review of the Medical & Clinical Services Directorate Structure, this role will be undertaken by the National Manager for Concerns and Service Improvement. This role will be supported by additional suitably trained staff as part of the Putting Things Right Team. Details of the responsibilities of this role can be found in Appendix C of the PTR Guidelines. 7.4 Putting Things Right (PTR) Team At a local level within Welsh Ambulance Services, there is a Putting Things Right Team with Investigation Supervising Officers (ISOs) and Concerns Co-ordinators (CCs) based within each Health Board area of the Trust and a central administration WAST PTR Policy V0.6 December 2013 Page 11 of 31

12 team based at Trust Headquarters. The administration team work with Trust managers and administration staff throughout the organisation. These members of staff provide a central point of contact and are supported at a local level by the ISOs and CCs who in turn support Investigating Managers with their concern investigations. The central team register, acknowledge, and co-ordinate the completion of a response. This team are also responsible for closing concerns once an appropriate and quality response has been signed off by the Chief Executive Officer. 7.5 Claims Team Claims made against the Trust are handled by the Trust s Claims Manager/Solicitor who is supported by a Claims Administrator. The Claims Manager also supports the Putting Things Right Team ISOs in the latter stages of redress case management. 7.6 Patient Safety Team The Trust has a patient safety team available to support with investigations raised as concerns, claims or patient safety incidents. In concerns where there is an allegation of harm or actual harm caused to a patient, the team will support the investigation process to ensure that the root cause of the issue is identified and acted upon to improve patient safety and mitigate against the possibility of future incidents occurring. 7.7 Investigating Managers Concerns will be investigated by the most appropriate manager from the business area within the Trust. Investigating managers will possess subject expertise to apply to the investigation and concluding information for the concern response and subsequent learning. Managers will be provided with training to support them in conducting root cause analysis investigations and providing quality and open responses to concerns. 7.8 Heads of Service It is the responsibility of the appropriate Head of Service to support their managers in conducting investigations within a timely manner to achieve the 30 day response target and to undertake a quality assurance review of the concern response before it is submitted to the Chief Executive Officer for approval. Heads of Service will be required to address any issues with the quality of investigations within their areas and to ensure that lessons are being learned and shared across the Trust to improve services and prevent incidents recurring. 7.9 Quality, Safety and Governance Committee (QSG) The Trust s Quality, Safety and Governance Committee will report to the Trust Board on the operation of the Trust s Putting Things Right Policy. The Committee will consider quarterly reports on concerns activity via a quality report and make recommendations as appropriate. WAST PTR Policy V0.6 December 2013 Page 12 of 31

13 7.10 Concerns Management Group (CMG) The Concerns Management Group will meet regularly to monitor the concerns management activity and performance with a focus on both responses and organisational learning. This group will report into the Quality, Safety and Governance Committee. 8. Safeguarding When a person raises a concern on behalf of a child or a vulnerable adult, the Trust must be satisfied that: There are reasonable grounds for the concern being notified by a representative and not by the individual themselves (Regulation 12(3)(a); and When the child or vulnerable adult raises a concern themselves, the Trust must ensure that they are given reasonable assistance in order to pursue the concern. Where a concern indicates that a child or vulnerable adult may have been abused or neglected, the Trust s Child Protection or Protection of Vulnerable Adult (POVA) Procedures must be used in conjunction with this policy and management of concern processes. Where child protection or POVA issues are identified during the raising or investigation of a concern, then a discussion must be held at the earliest opportunity with both the Investigation Supervising Officer and the Trust s POVA or Child Protection Specialist who has responsibility for the area where the concern is raised. The concern must be considered for any possible safeguarding issues and action taken as outlined in the Trust s Safeguarding Policies and Procedures. In cases where a POVA or Child Protection referral is made to the Safeguarding Team in Social Services or NHS Trust, the WAST Putting Things Right concern investigation will be suspended until the safeguarding investigation is concluded. If the safeguarding investigation does not address all of the concerns raised, the Trust will continue to investigate the outstanding concerns. 9. Complaints (concerns reported by service users) 9.1 On the Spot Concerns There are some concerns which are not handled under the Regulation arrangements and are referred to as on the spot concerns. These include concerns which have been raised and can be dealt with to the satisfaction of the person who notified the concern not later than the next working day. In many cases, these types of concerns relate to relatively easy to address issues and the person who raised the concern must be satisfied with the immediate actions agreed in order to remedy the concern raised. It is important for staff to check if the person is happy because if they are not, then they should be advised how to raise a concern formally under the arrangements set out in the Regulations and this guidance. WAST PTR Policy V0.6 December 2013 Page 13 of 31

14 On the spot concerns can be dealt with by any member of Trust staff and once dealt with, must be reported either on an on the spot form or electronically via the Datix System to the Putting Things Right Team. Appendix B contains details of the Trust s on the spot process. The latest version of this is available on the Trust s intranet site. Although the Trust is not required to report on these on the spot concerns to Welsh Government, the collection of data regarding these cases is an important part of information in identifying trends and themes of concerns within the Trust from which to learn lessons and improve patient safety and services. 9.2 Formal Complaints The Trust is obligated to manage complaints according to the requirements set out in the National Health Service (Concerns, Complaints and Redress Arrangements) (Wales) Regulations 2011 and committed to following the Putting Things Right Guidelines to support this. Please refer to the Trust s Concerns Management Process documents available on the intranet for details of the specific procedures for the handling of concerns Central Putting Things Right Team The Trust has established a central Putting Things Right Team (based in Headquarters) with local Investigation Supervising Officers to support Investigating Managers and Heads of Service in the investigation of concerns. Any concern raised to the Trust must be notified immediately to the central Putting Things Right Team administration staff in Trust Headquarters for registration, acknowledgement and allocation to an Investigation Supervising Officers to allocate to the most appropriate Investigating Manager. Following sign off of a response, the central team will update Datix and close the concern in accordance with the standard operating procedures within the Putting Things Right Department Single Point of Access The Trust has established a single address, phone number, mailbox and fax to ensure ease of access for service users to contact the Putting Things Right Team. A formal complaint can be received verbally or in written format by the Trust. Formal concerns received verbally, must be recorded on a form as outlined in Appendix F of the Putting Things Right Document and uploaded onto Datix by the Putting Things Right Team. Record keeping is fundamental to the handling of concerns and therefore records must be kept centrally on Datix. All records must be accurate, complete, understandable and contemporaneous in accordance with the professional standards and guidelines outlined in Putting Things Right. Consideration will be given to reaching members of the community who may wish to raise a concern, but who might feel the process is not accessible to them. Staff should develop an understanding of why people might be reluctant to raise a concern, including some of the cultural, social, gender and other reasons, and look WAST PTR Policy V0.6 December 2013 Page 14 of 31

15 for ways to assure people that it is safe for them to do so. The Trust is committed to providing access to raise a concern in a number of different ways to ensure equality Concern Investigations It is Welsh Ambulance policy that concern investigations must be carried out by a Trust Manager or nominated member of staff who has the skills and knowledge to manage the investigation in the area of the business. Investigations should not be carried out in isolation and the level of support required in the investigation will depend upon its grading (please refer to section 6.2 of this document) and the expectations of the person raising the concern. Investigations must be carried out in accordance with the Trust s formal complaints management process, utilising the formal investigation template which can be found in Appendix C. The Trust has a multidisciplinary team of experts available to support Investigating Managers including Investigating Supervising Officers, Patient Safety Managers, Safeguarding Team and Operational Managers Quality Assurance The Trust has implemented a quality assurance process for all concern responses which includes a quality review of investigations and response letters by the appropriate Head of Service followed by sign off by the Chief Executive or nominated deputy. IMPORTANT: It is Trust policy that no letters should be sent to complainants directly from Trust Managers; all written correspondence to a complainant (other than acknowledgement, consent and holding letters) MUST be sent from and approved by the Chief Executive Officer. Where possible, resolution letters will not be sent to complainants in the post on a Friday. This is to ensure that the Putting Things Right Team is available to answer any queries that a complainant may have on receipt of their letter of resolution. All Investigating Managers conversations, interviews and meetings with the complainant must be documented and submitted to the Putting Things Right Team to ensure that an accurate up to date Datix central file is kept of the concern and its investigation progress. Performance indicators for concern acknowledgment and responses are set in Putting Things Right and outlined in the key performance indicators section of this document. 9.3 Consent Almost anyone can raise a concern and the Responsible Body will be under a duty to consider whether it can be investigated. However, it might not always be possible to share the full details of the investigation with the person raising the concern, for instance, if they are not the patient or not their next of kin. WAST PTR Policy V0.6 December 2013 Page 15 of 31

16 In the majority of cases, the investigation of a concern requires access to medical records, and so the issue of consent will need to be considered. The Information Commissioner provides advice called Health Data use and disclosure and organisations must have due regard to any advice that might apply Implied Consent Where the patient him/herself raises the concern, then in doing so, they can be deemed to have given implied consent to an investigation. This will also apply if a concern is raised by a representative who has shown proof that they are legally entitled to act for the patient (e.g. the representative has a Power of Attorney). However, in order for individuals to be clear in the knowledge that their medical records may need to be accessed, this should be explained in the acknowledgement letter so that they have the opportunity to indicate if they do not want their health records accessed Required Consent Where a third party has raised a concern on behalf of someone else, then the patient or their representative must be asked to give written consent to the access to medical records and the conduct of an investigation. In the event that the patient/personal representative contacts the Responsible Body after raising the concern to say that they are not happy for consent to be inferred and they do not want their records to be accessed, then the Responsible Body must take a view on whether the issue in question is of sufficient seriousness to merit an investigation without access to the medical records. It is not necessarily the case that there will be no investigation of the concern. Responsible bodies should evaluate the issue to determine whether it would be in the interests of the health service to continue to look into the matter. This decision must be recorded before proceeding with or closing the matter. The consent process will be managed by the central Putting Things Right Team however, should any member of staff be unsure about the consent process they should contact the central Concern Team for advice. 9.4 Joint Investigations In cases where a primary concern has been raised with one organisation but a secondary issue has also been raised within the concern regarding another NHS organisation, the first organisation is obliged to contact the person raising the concern within 2 working days to: inform the person raising the concern that there is another responsible body involved in the concern; and seek consent from the person raising the concern to contact and notify the other responsible body that they are involved in the concern. WAST PTR Policy V0.6 December 2013 Page 16 of 31

17 Once consent has been received, the receiving organisation must inform the other responsible body within 2 days of receipt of the consent. The organisations involved in the concern should then co-operate to agree: which organisation will take the lead in co-ordinating and investigating the concern in accordance with the regulations; who will directly liaise with the person raising the concern to keep them updated regularly; to agree a joint response to the concern, issued by the lead organisation; to the sharing of information relevant to the concern; to the appropriate representation of the relevant organisations at any meetings held. IMPORTANT: Where the Trust has been requested to support investigations being undertaken by partner organisations, the response will follow the normal quality assurance process and be subject to the approval of the Head of Service and Chief Executive Officer before it is provided to the partner organisation. 10. Incidents (Concerns reported by staff) 10.1 What Staff should not raise as Concerns via Incident Reporting In accordance with Putting Things Right, not all concerns can be dealt with under the arrangements for dealing with concerns. Matters from staff excluded are: Concerns where a member of staff has an issue with their employment contract these matters are to be dealt with under the organisations HR policies and procedures; Disciplinary proceedings identified as a result of an investigation must be looked at under local HR processes Adverse Incidents In all organisations and working contexts, adverse incidents will occur. Through effective reporting, investigation and review the Trust aims to learn, change and develop strategies in order to reduce the level of risk within the organisation. Furthermore the Trust Board have a statutory responsibility to monitor adverse incidents. The Trust has an ADI Hazard Reporting, Investigating & Learning Policy. The purpose of this policy is to encourage incident reporting, initiate investigations where appropriate and learn from adverse events thus maintaining and improving the quality of patient care, reducing or eliminating the risk of loss, damage or injury to patients, staff and others and protecting the Trust s assets and improving the service. 11. Compliments Ambulance Service compliments are often made to an individual member of staff or an ambulance crew where these accolades are not visible to the wider Trust. WAST PTR Policy V0.6 December 2013 Page 17 of 31

18 Where a compliment is received by anyone in the organisation, a copy of it should be sent to or details highlighted to the central Putting Things Right Team for registering on the Datix system. The compliment details will then be sent to the most appropriate Head of Service who will ensure that the staff are made aware of the comments received and a record of thanks is made on their personal file. The number of compliments received will be reported to the Quality & Safety Governance Committee and the Concerns Monitoring Group. For more information please refer to the WAST How to Deal with Compliments document. 12. Redress If during the management and investigation of a concern it is considered that a qualifying liability that would attract financial compensation of 25,000 or less exists or may exist, the Trust will determine whether or not an offer of Redress should be made. Redress relates to situations where the patient may have been harmed and that harm was caused by a Welsh NHS body. Redress comprises of either one or a combination of all of the following: the offer of financial compensation and/or remedial treatment, on the proviso that the person will not seek to pursue the same through further civil proceedings. the giving of an explanation, a written apology, and a report on the action which has or will be taken to prevent similar concerns arising. Redress will only be considered if there is a proven qualifying liability in tort. Investigations will therefore be seeking to prove that the Welsh Ambulance Service NHS Trust has both failed in its duty of care to a patient and that the breach of duty of care has been causative of the harm that the person has suffered. It is only when both these tests are satisfied that a payment of compensation will be considered by the Trust. It is the Trust policy to make this clear to patients and their representatives as often people believe that there only needs to have been poor care for the test of negligence to be satisfied and for compensation to be owed. However, it is the case that the person also needs to have suffered harm as a consequence (known as causation of damage ). Where necessary, the Trust will commission independent expert advice to determine causation. The Trust has a Redress Panel established to consider these cases. For more details on the Trust s process managing Redress cases please refer to section 7 of the Putting Things Right Guidelines, Regulations 25 to 33 and the Trust s Redress Management Process. WAST PTR Policy V0.6 December 2013 Page 18 of 31

19 13. Claims Compensation and personal injury claims are handled in the Trust under the direction of the Trust s Claims Manager/Solicitor. As a Responsible Body the Trust has a written policy on the handling of clinical negligence and personal injury compensation claims. Please refer to the Trust s Policy on the Management of Compensation Claims. 14. Coroners Court and Coroners Rule 43 Ambulance staff come across patients in circumstances which become the subject of Coroners Inquests. The Trust has a HM Coroner Inquest Procedure to ensure that staff are well prepared and supported for both routine and complex inquests. All inquest dates must be make known to the Head of Clinical Services and the Trust Claims Manager/Solicitor. A case conference will then be held prior to the inquest. At the outcome of an inquest, the Coroner may decide to issue a Rule 43 to the Trust. These are actions relating to the case that the Trust must carry out to prevent further deaths. The Coroners (Amendment) Rules 2008 amended Rule 43 of the Coroners Rules 1984, with effect from 17 July The amended Rule 43 provides that: Coroners have a wider remit to make reports to prevent future deaths. It does not have to be a similar death; a person who receives a report must send the coroner a written response within 56 days; coroners must provide interested persons to the inquest and the Lord Chancellor with a copy of the report and the response; coroners may send a copy of the report and the response to any other person or organisation with an interest; the Lord Chancellor may publish the report and response, or a summary of them; and the Lord Chancellor may send a copy of the report and the response to any other person or organisation with an interest. 15. Public Services Ombudsman for Wales 15.1 Right to Raise a Concern with the Ombudsman Where a person remains dissatisfied with the outcome of the investigation of a concern, they can refer to the Public Services Ombudsman for Wales. Final responses to concerns issued by the Trust under Regulation 24 must contain information regarding the person s right to raise the concern with the Public Service Ombudsman for Wales. The Trust will endeavour to co-operate with the Ombudsman regarding any concerns escalated and will endeavour to respond as soon as possible to requests for WAST PTR Policy V0.6 December 2013 Page 19 of 31

20 information. The Putting Things Right central team will act as the single point of contact with the Ombudsman s Office for all enquiries. In the event that the Ombudsman decides to interview key staff involved in the complaint the Head of Business Management & Concerns or Trust Claims Manager/Solicitor will ensure that such staff are fully briefed, and receive whatever help and support they require to assist their preparation for the interview. Following the Ombudsman s investigation the draft report will be provided to the staff interviewed for their comment. When the final report is received by the Trust, the Head of Business Management & Concerns will co-ordinate a draft response to the complainant for consideration by the Management Team, setting out proposed action plans where necessary. All Public Services Ombudsman for Wales (PSOW) are copied to the Welsh Government Improving Patient Safety Team at the same time they are sent to the Welsh NHS body concerned. In accordance with Putting Things Right Guidelines, the Trust should as an automatic course of action, share any correspondence/action plans issued to the person who raised the concern with the PSOW or with the Welsh Government via the mailbox Ombudsman Reports Under the Public Service Ombudsman (Wales) Act 2005, the Ombudsman can issue one of two types of reports following an investigation into a complaint by a member of the public that they have suffered hardship or injustice through maladministration or service failure on the part of a public body. The first type of report (known as a Section 16 report) is issued when the Ombudsman believes that the investigation report contains matters of public interest. The Trust is obliged to give publicity to such a report at its own expense. The second type of report that the Ombudsman can issue is known as a Section 21 report. He can do so if the Trust has agreed to implement any recommendations he has made and if he is satisfied that there is no public interest involved. Summaries of all Section 21 reports can be found in the quarterly editions of The Ombudsman's Casebook available on the publications page of the Public Service Ombudsman Wales Website Key Performance Indicators 16.1 Acknowledgement All concerns raised by service users must be acknowledged in writing within 2 working days of first receipt. For more information on the acknowledgement of concerns refer to section 6 of the Putting Things Right guidelines. In terms of concerns reported by staff (incidents), staff must receive an acknowledgement from the manager handling the concern and an opportunity to discuss the concern. The Trust is committed to encouraging staff to report their WAST PTR Policy V0.6 December 2013 Page 20 of 31

21 concerns by being clear about the process to support change. This is underlined by the importance of feedback to staff who report concerns through the Trust s incident reporting process Final Response Regulation 24 The response to a formal concern that does not qualify for Redress should be issued by Welsh Ambulance Services in line with Regulation 24 (PTR Part 6, 6.74). The Trust has created a template letter with guidance from which a final response letter should be created to ensure that the final response includes all of the areas stated within the Putting Things Right Guidelines. In respect of concerns that have alleged harm, the response will also require an explanation of why there is no qualifying liability and why the Redress arrangements will not be triggered. The response must be quality assured by the appropriate Head of Service and signed off by the Chief Executive Officer or their designated deputy. Final responses under Regulation 24 should be issued within 30 working days of first receipt of the concern, but if this is not possible the person raising the concern must be informed of the reason for delay and provided with a holding letter. The response must then be sent as soon as possible and within 6 months of the date the concern was received. If in very exceptional circumstances, the response cannot be issued by the Trust within 6 months, then the person raising the concern must be informed of the reason for the delay and given an expected date of response Interim Response Regulation 26 Where the Welsh Ambulance Service considers there is or may be a qualifying liability which, in accordance with Regulation 29, would attract financial compensation of 25,000 or less, an interim report under Regulation 26 needs to be issued within 30 working days of first receipt of a concern from the person or their representative. Interim responses under Regulation 26 should be issued within 30 working days of first receipt of the concern, but if this is not possible the person raising the concern must be informed of the reason for delay. The response must then be sent as soon as possible and within 6 months of the date the concern was received. If in very exceptional circumstances, the response cannot be issued within 6 months, then the person raising the concern must be informed of the reason for the delay and given an expected date of response Redress Cases In accordance with Regulation 33, an offer of Redress must be communicated to the person raising the concern, or their representative, within 12 months of the first receipt of the concern. WAST PTR Policy V0.6 December 2013 Page 21 of 31

22 In exceptional circumstances, if the Welsh NHS body is unable to make a decision within the 12-month period then the reason for delay and an expected date for the decision should be explained in writing to the person who notified the concern. The person raising the concern or their representative must be advised that they have 6 months to respond to the offer of Redress. 17. Communication 17.1 Being Open The principles of Being Open are at the heart of the Putting Things Right arrangements and support improvements in the management of concerns. Being open is about how healthcare staff communicate with patients and/or their carers following a patient safety incident. Trust staff should to be honest and use a consistent approach to communication with patients and/or their carers following a patient safety incident. This communication should happen as soon as possible following the incident and includes: Saying sorry for what has happened. Keeping patients and/or their carers informed about the progress with the incident investigation. Reassuring patients and/or carers that the incident is being taken seriously. Ensuring measures are taken to prevent the incident from happening again. Apologising to patients is not an admission of liability. Being open is about good communication and trust, which is fundamental to the relationship between healthcare professionals and patients. It has many benefits and it is ethically the right thing to do. Being open is part of a broader Welsh Government initiative to create an open and fair culture in the NHS Communication with the Person Who Notified the Concern As a responsible body the Trust must ensure that the person who notified the concern is kept updated in a timely manner about the investigation in a format that meets any needs that have already been identified. Consideration should also be given to inviting them to attend meetings with staff and at what stage in the investigation those should most usefully be arranged. It can do more harm for clinical staff to meet a patient too early; neither should things be left so long that the person raising the concern feels they have been forgotten about. Timing should be carefully considered to allow everyone to prepare and for any meeting to be as useful as possible Communication with Staff The Trust recognises that being the subject of a concern or even reporting a concern as a member of staff can be very stressful. In terms of being the subject of a concern, when an issue is raised, whether by a patient or through a report from a member of staff, the details should be shared with the staff member involved wherever appropriate. This should be done supportively and staff may want to have WAST PTR Policy V0.6 December 2013 Page 22 of 31

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