On 21st May two members of the PHSO Pressure Group attended the Department of Health’s stakeholder meeting to discuss the proposed legislative changes to the regulation of Health and Social Care professionals.
The regulatory bodies within the remit of the project include:
- General Chiropractic Council
- General Dental Council
- General Medical Council
- General Optical Council
- General Osteopathic Council
- General Pharmaceutical Council
- Nursing and Midwifery Council
- Pharmaceutical Society of Northern Ireland
The project also covers the legal regulation of the Professional Standards Authority, which oversees the work of all nine regulators. None of these bodies come within the remit of the Parliamentary and Health Service Ombudsman.
Here is our summary of the meeting:
It is obvious that the healthcare professionals come to complaint handling from a different perspective when they use terms like ‘complaint disposal’ without flinching. They give the impression that although the regulatory system isn’t perfect, by and large it works quite well dealing with the complaints that reach investigatory panels. What they ignore is the dam which holds back huge numbers of valid complaints from coming anywhere near scrutiny. They state with certainty that ‘not everyone can have an investigation’ without considering for one moment the damage caused by turning complainants away with no acknowledgement and no remedy. It became clear that the professional lady in our discussion group, who carries out some regulatory work for the GMC, approached the task with two certainties. That the vast majority of healthcare professionals were competent and decent people and that the regulatory system operated with integrity. On that basis, the only conclusion to be drawn was that the complainant was probably in error and her job was to look for that error and dismiss the case. It could be that the complainant misunderstood the responsibilities of the healthcare professional; the complainant may be emotionally overwrought or possibly just vindictive and vexatious. It was as if complainants acted like ‘hoodies’ just wandering round the regulatory system looking for trouble. If you turn the whole thing on its head and start with the perception that the complainant is likely to be a genuine person who has a valid concern, then the spotlight for investigation falls upon the system and why this complaint has been escalated without resolution. It also falls on the healthcare professionals; whether they managed expectations appropriately and delivered to a professional standard. It just depends on which side of the table you sit on, which view you take. So it was a good job we were there to put the other point of view. Stuart has first hand experience of being turned down by every single organisation in his quest for justice and remedy. As each new regulatory body was drawn from the hat and offered as a solution, Stuart was able to give the reasons they used to deny him an investigation and remedy. I think this came as a bit of a surprise to some in our group. Peter Walsh from AvMA was in our discussion group, he stated that it was a waste of time to ask regulatory bodies to review their own decisions. He wants the Professional Standards Authority (PSA) to have the power to investigate individual complaints and carry out reviews. Peter stressed the importance of getting it right at the start of the process and the risk to patient safety if issues were not dealt with appropriately. The PSA could have an active role in resolving individual complaints where people felt they had not received a fair hearing, if they were given the powers to investigate complaints. They also need the power to make binding recommendations for this to be effective. This could come through the proposed legislation and would be a major improvement. In the draft bill there is a ‘duty to cooperate’ clause which requires all regulatory bodies to share information. Stuart and I had talked about falling through the gaps, where no single body had the remit to investigate your complaint and you were bounced around the system like a pinball machine. The professional representative determined that the duty to cooperate meant that it would now be necessary for the regulatory bodies to work together and disclose information in order to resolve cases. She determined that with this in place the complainant could hold them to account if they refused to do so. Simple as that. She did not recognise the scenario I presented of regulatory bodies not cooperating but colluding together to prevent scrutiny of valid complaints and deliberately withholding key information. She just did not believe that this would happen. As our group discussion drew to a close we talked about the issue of advocacy. Peter Walsh was in agreement that all complainants need to be guided by an independent advocate and offered the services of AvMA. Many valid complaints are not given a fair hearing because the complainant has not provided a structured account of the events with key issues raised and supported with evidence. Although we all agreed on this point, it was unclear whether this could be addressed by the proposed legislation. At the final plenary, Peter Walsh raised the issue of the five year rule which prevented older cases being investigated. A lady from the midwifery council remarked on a case which had blighted their profession when a grieving parent continued to make complaints against a midwife ten years after the original event. It was very unfair, in their opinion, for this person to be able to ask for another investigation when her matter had been dealt with. They described the unnecessary stress this had caused to the midwife concerned. Although it is understandable that a returning complaint must be a nightmare, the question has to be asked as to why the complainant returned ten years later. Because she didn’t agree with the previous decisions, came the reply. So for the mother, there had been no satisfactory outcome, no resolution and consequently no closure. The professional solution is to firmly enforce a five year time limit which protects the professional staff from continued stress, but does nothing to alleviate the pain suffered by the complainant, who is now shut out of the system. The real solution, for all parties, should be to improve the complaint handling service to find proper solutions at the outset. No one wants to drag a complaint on for years. We do it because the delay, deny, defend culture forces us to.More meetings will follow this initial gathering and we will be able to attend and continue to influence this legislation in the making. Your comments are welcome.