PUTTING THINGS RIGHT
GWEITHIO I WELLA
Briefing paper for LHBs
March 2008
Background to NHS Redress
Reforming the system for handling medical negligence claims made against
the NHS was the key recommendation in Making Amends, the consultation
document published by the Chief Medical Officer for England in June 2003.
The document highlighted failures in the current system because it is:
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perceived to be too complex and too slow.
costly both in terms of legal fees and diverting clinical staff from clinical
care; there is a negative effect on NHS staff morale and on public
confidence.
not satisfying patients because of the lack of explanations, apologies or
reassurance that action has been taken to prevent the same incident
happening to another patient.
said to encourage defensiveness and secrecy in the NHS, which stands in
the way of learning and improvement in the health service.
The introduction of an NHS Redress ‘Scheme’ was recommended to provide
investigations when things go wrong, remedial treatment, rehabilitation and
care when needed; explanations and apologies; and financial compensation
in certain circumstances.
The Department of Health accepted this
recommendation which subsequently formed the basis of NHS Redress Act
(November 2006) which outlines an NHS Redress Scheme for England.
Background about the NHS Redress (Wales) Measure 2007
The NHS Redress Act also sets out a framework power which enables the
National Assembly for Wales to decide upon and develop arrangements for
NHS Redress that are suitable for Wales. The power is broad enough to
enable the Assembly to establish a Redress Scheme in Wales or to make
such other arrangements for delivering redress, within the scope of the
regulation making power, thereby allowing the Assembly to determine
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arrangements for redress which are most relevant to its policies and plans for
the health service in Wales.
Background about the Putting Things Right Project
In order to ensure that this new legislative power is used to best advantage,
the Welsh Assembly has set up a project – Putting Things Right – to look at
the scope for developing and implementing an integrated and workable
process that delivers effective and fair redress when things go wrong for
patients who are eligible for NHS care in Trusts in Wales, by 2009.
The underlying principle of Putting Things Right is that whenever concerns
are raised about treatment and care, whether that is through a complaint,
claim or patient safety incident, those involved can expect to be dealt with
openly and honestly; receive a thorough and appropriate investigation; a
prompt acknowledgement and detailed response and clarity about next steps,
and an appropriate option for resolution. This is in line with priorities already
set out in:
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The Healthcare Quality Improvement Plan (November 2006) which makes
a commitment to developing integrated arrangements for dealing with
things that go wrong including appropriate redress (Action 9).
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The Healthcare Standards for Wales (May 2005) which sets standards for
healthcare organisations to look at complaints promptly and thoroughly in
accordance with complaints procedures (Standard 15) and identify and
learn from all patient safety incidents and other reportable incidents
(Standard 16).
Putting Things Right Project work to date
Earlier this year, as part of the Putting Things Right Project, NHS Trusts were
asked to complete a questionnaire on how they deal with concerns now and
what improvements they feel could be made. The information provided was
extensive and helpful, and forms the basis for the work being undertaken by
three working groups who are taking forward the work for the project board.
These groups are working closely with stakeholders to look at three key
areas:
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Investigation and process – chaired by Adam Peat, the Public Services
Ombudsman for Wales
Legal advice – chaired by Anne-Louise Ferguson, Welsh Health Legal
services
Advocacy and Assistance – chaired by Cathy O'Sullivan, Gwent
Community Health Council
The groups have already made interim recommendations to the Assembly, to
provide background for the NHS Redress (Wales) Measure Committee's
report which was published in January 2008. The report supported the
general principles behind the Measure and made a number of
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recommendations how the Measure should proceed. The working groups are
due to make final recommendations to the Assembly by September 2008.
The interim reports, other information about the project and links to the
Measure Committee's report can be found by visiting www.wales.nhs.uk/ppi.
What does this mean for Primary Care?
One of the key recommendations in Measure Committee's report, having
sought wide-ranging evidence on the issue of whether primary care should be
included under the NHS Redress (Wales) Measure at the outset, concluded
that:
"Before any decision is taken to expand the redress arrangements to include
primary care a full evaluation is conducted of the scheme's operation in the
secondary care setting. We also recommend that the Minister should carry
out a full and thorough consultation with stakeholders on any proposed
expansion of the scheme to include primary healthcare and that this should
take place prior to the drafting of the relevant regulations."
At this stage therefore the NHS Redress (Wales) Measure and the Putting
Things Right Project are concentrating on developing arrangements that will
apply to secondary care.
Although the focus remains on secondary care, one of the recommendations
of the Investigation and Process Working Group is that the way in which NHS
complaints are dealt with in primary care needs to be reviewed, as part of the
process of reviewing the current NHS complaints guidance. In particular, the
roles and responsibilities of Local Health Boards, as commissioners of
healthcare, when dealing with complaints needs to be strengthened. This is
not to say that primary care practitioners and independent contractors should
not continue to investigate complaints and concerns, but that, for example,
there may be occasions when it would be appropriate for Local Health Boards
should become more involved.
In order to start this work, a questionnaire will be sent out to all Local Health
Boards in the near future to ascertain how complaints managers feel that their
organisations currently deal with complaints and concerns, and what
improvements they feel could be made to the current guidance and practice.
Should you require any further information, please contact the Project Office:
Putting Things Right Project Office
Public & Patient Involvement Branch
Welsh Assembly Government
Cathays Park
Cardiff CF10 3NQ
Ann-Marie Carpanini-Lock
Piera Cassettari:
Tel: 02920 823 218/ e-mail: [email protected]
Tel: 02920 801 081/ e-mail: [email protected]
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Briefing paper for LHBs