Written evidence from Anne Ward Platt
(CAL 24)
1. My name is Anne Ward Platt. I am director
of AWP Associates and of WP Medical and Professional Services
Ltd., and I am a Non-Executive Director of Northumberland, Tyne
and Wear NHS Foundation Trust. I am author of "Conciliation
in Healthcare: managing and resolving complaints and conflict",
foreword by Sir Liam Donaldson, former Chief Medical Officer (Radcliffe
Publishing 2008). I have been involved in healthcare conciliation
since 1997 and I have experience as a conciliator in relation
to both primary and secondary healthcare.
2. I make this response to the Health Committee
Inquiry in a personal capacity.
3. The headings under which I am submitting evidence
are:
—— The
effectiveness of the constituent parts of the complaints system
— Encouraging
the use of mediation before litigation is instigated.
4. To this submission I append the following
articles I have written,[18]
which highlight best practice in complaints handling, including
the use of conciliation:
Ward Platt A. Handling complaints. British Medical
Journal 2010;340:98-9.
Ward Platt A. Say you want a resolution: conciliation
in general practice. Management In Practice 2008;14 (with permission
from Campden Publishing).
Ward Platt A. The new complaints procedure in general
practice. Management In Practice Web Exclusive. 20 April 2009
(with permission from Campden Publishing).
THE EFFECTIVENESS
OF THE
CONSTITUENT PARTS
OF THE
COMPLAINTS SYSTEM
5. The Ombudsman's office is now receiving more
than twice the number of complaints compared to the period before
April 2009, which suggests that problems remain with resolving
complaints at a local level. I would like to suggest that wider
use of independent conciliation could be instrumental in preventing
the escalation of complaints to the Ombudsman. The current NHS
complaints arrangements remove the need for a rigid timetable
to be applied to handling complaints, and in principle this greater
flexibility should also enable the wider use of conciliation.
6. The potential value of using conciliation
within both primary and secondary healthcare is not sufficiently
recognised in the UK. However, conciliation is already used extensively
in relation to healthcare complaints in a number of other countries;
I have highlighted examples of best practice in "Conciliation
in Healthcare: Managing and resolving complaints and conflict".
7. Complaints often originate from situations
that are distressing for all concerned. Where these occur following
the death of a patient, an adverse event, a side-effect or reaction
arising from clinical treatment, or where mistakes have been made,
conciliation offers an opportunity for the issues to be addressed
in a way that is supportive for both the complainant and the clinician.
The process can enable more effective communication between the
parties, which may in turn facilitate resolution of the complaint.
8. Conciliation can provide a supportive process
for staff as well as for those making a complaint. Complaints
can have a deleterious effect on a health professional's clinical
practice, particularly if they are engaged in a long and protracted
complaints process. If not properly managed, seemingly minor issues
can escalate and have far reaching consequences. Some doctors
practise more defensively and others lose their enjoyment of work,
and these effects can still be evident in the long term, with
consequent damage to patient care.
9. Key aspects of conciliation are:
- 9.1 It is undertaken by a neutral intermediary
who is independent of the parties concerned.
- 9.2 It is a voluntary process, and the parties
can withdraw at any time.
- 9.3 It is a confidential process (so conciliators
need to comply with the relevant NHS guidance).
- 9.4 It allows for apologies to be made.
- 9.5 Further explanations or information can
be provided, which may include independent clinical advice.
- 9.6 It can be used in relation to complex
clinical complaints as well as complaints involving the attitude
and manner of healthcare staff.
- 9.7 It is not essential for the parties involved
in the complaint to meet together during the conciliation process
unless a desired outcome is a restoration of the relationship
between them.
- 9.8 Where appropriate, redress may be agreed.
- 9.9 Service improvements can be identified
or other actions can be taken as a direct result of the complaint.
- 9.10 It is cost effective, as expensive litigation
is often avoided.
ENCOURAGING THE
USE OF
MEDIATION BEFORE
LITIGATION IS
INSTIGATED
10. Where appropriate, the use of mediation/conciliation
in relation to claims can be invaluable. It is worth bearing in
mind that some claims have their origins in a poorly handled complaints
process; some claimants pursue litigation because they have not
received satisfactory explanations, particularly where there has
been an adverse clinical outcome.
11. Although there are some variations in the
models used in different contexts, conciliation and mediation
share these characteristics:
- 11.1 The use of a neutral intermediary who
acts as an impartial and independent facilitator using specific
skills aimed at bringing about a resolution of the dispute to
the satisfaction of the parties concerned;
- 11.2 the process is based on an agreed framework
or code of conduct;
- 11.3 any information that is disclosed during
the process is "without prejudice", which means that
it cannot normally be used in any subsequent court proceedings;
- 11.4 the parties agree to take part in the
process voluntarily;
- 11.5 the parties can withdraw at any time;
- 11.6 the mediator or conciliator does not
impose a solution on the parties;
- 11.7 the private sessions between the mediator
or conciliator and each party are confidential (within certain
limits), and only such information as is agreed is passed on to
the other party;
- 11.8 there is opportunity for joint sessions
involving both parties;
- 11.9 the process provides a "safe"
environment in which the participants can express their feelings
and emotions;
- 11.10 the outcome may include apologies;
explanations; evidence of organisational change (for example,
action plans); evidence of individual change (for example, learning
or re-training); or restoration of relationships between parties;
as well as financial settlements where provision is made for this;
and
- 11.11 the outcome is not legally binding,
but where the process is being used as an alternative to a court
hearing, the parties may agree subsequently to a legally binding
contract.
RECOMMENDATION
12. I hope that the Committee's Inquiry will
recognise that the potential benefits of conciliation are considerable,
and that conciliation/mediation should be widely promoted as an
effective means of resolving complaints and claims.
REFERENCES
1. Ward Platt A. Conciliation in Healthcare:
Managing and resolving complaints and conflict. Oxford: Radcliffe,
2008. Foreword by the Chief Medical Officer, Sir Liam Donaldson.
2. Ward Platt A. Say you want a resolution: conciliation
in general practice. Management In Practice 2008;14.
3. Ward Platt A. The new complaints procedure
in general practice. Management In Practice Web Exclusive. 20
April 2009.
4. Ward Platt A. Handling complaints. British
Medical Journal 2010;340:98-9
December 2010
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