Outline:
The national average for the time taken for NHS trusts to receive and settle claims for Clinical Negligence between 1/10/17-30/9/18 was 4.39 years from the date of incident to the settlement of the claim whereas the Trust’s Legal Affairs team had closed them within 2.29 years.
The trend is downwards, with the same period for 2016/17 claims settled by the trust a year ahead of the national average. The trust’s Legal Affairs team under Associate Director Jane Quinn work tirelessly to ensure the No Blame culture is understood and integrated across all services within the trust, allowing staff to feel genuinely valued.
The outstanding management of litigation is made possible because when incidents occur investigations are carried out transparently in a spirit of co-operation and a genuine desire to solve problems due to a shared culture that focuses at all times on ensuring a constantly improved experience of care for service users.
The trust works hard collectively to ensure investigations into violent assaults are carried out efficiently and staff have the relevant information so cases can be conducted quickly and efficiently.
Challenges:
Central to reducing time spent in litigation is the trust wide ambition to improve the patient & staff experience overall, which means making sure all staff and service users feel they are valued and fully involved in managing the delivery of care themselves.
The goal to reduce time spent in litigation cases meant a concerted effort to target a reduction in violence across all Trust Adult Mental Health services was piloted, and is ongoing. Historically, violence and aggression on the wards was a major contributor towards litigation procedures being initiated.
Legal costs can be directly linked to incidents of violence, and these showed a £31000 cost in 2014–15 and £700 cost in 2015–16. The trend downwards continued into 2017-18. The Violence Reduction initiative along with the People Participation service being fully embedded in all trust services, both community and mental health, has contributed to an upturn in staff morale and allowed for a shift towards a truly meaningful No Blame culture.
The Legal Affairs team’s dedication in developing transparent procedures in managing the complaints process has been central to this.
Outcomes:
The goals set are Trust wide - to deliver an improved experience of care for staff and service users. The outcomes measured against this are the reduction in money spent on court cases as well as the reduction in time spent.
The challenge is to develop trust wide strategies to deliver improvements across all services and to embed a permanent culture of service-user participation and a work culture where staff feel valued and have autonomy.
The Legal Affairs team approach to supporting both groups when investigations take place has been part of this process. By ensuring that a routine of transparency is applied to investigation processes, problems are solved before they turn into legal claims.
By ensuring that staff are encouraged to learn from experiences by promoting Quality Improvement events both within the trust and nationwide the emphasis is on a Learning culture.
Spread:
Trust values are embedded in conferences and seminars for new clinicians such as the Core and Higher Trainee Conference 2018, where the procedure for how the Trust supports staff in investigation processes is explained by the Legal Affairs team. The team delivered a paper at The NHS Resolution’s ‘Mental Health Matters’ conference on the nature of good advice in 2018; Impact has been made at the Royal College of Psychiatrists support service on the same themes.
It is Trust practice to ensure Learning Sessions take place after each Serious Investigation, in line with the Trust’s desire to ‘keep learning to get better’ and to fully embed a No Blame culture.
The trust will be embarking upon a period of consultation with another trust in 2019 to help embed this good practice in order to help them move them out of special measures.
Value:
By involving the legal team early in the process of an investigation, by ensuring that a good reporting culture is embedded across all services, staff know that responses to investigations will be balanced and fair.
The Trust legal team go above and beyond what might be expected in preparing and supporting staff in the run-up, during and after court cases. Qualitatively, value can be measured by the feedback from clinicians: ’Standing in the coroner’s court in the wake of a tragic incident is a very isolating experience.
Jane was absolutely amazing in the level of support she gave’, said LM, a Trust Consultant Psychiatrist. Dr. FJ with similar experience of a Litigation process says: ’The Legal team are honest in a kind way to untangle the truth.
They really help to manage stressful situations. They study cases in depth and the preparation they do is incredible.’ Value is also provided to the NHS in that the legal team provide support to other London trusts in some court cases.
Involvement:
A Freedom to Speak Up Guardian was appointed to the Trust in summer 2018. Her role is to work to enable staff and service users to fully engage in processes where their voices can be heard in a range of ways, in order to facilitate good practice and embed a culture of constant improvement.
On the work the Legal Affairs team does, she says: ’I think the work the Legal Affairs team do is very important especially thinking about how they work closely to support staff, families and patient affected.
My experience of their work is how they support staff to give expert advice and reassurance when things have gone wrong. The No Blame culture in which they work with our staff, service users and families makes it easy for the Trust and those involved to learn from situations.
People are more likely to be open if they feel that the process is about learning from mistakes. I think what really works well with Jane and her team is also rebuking the Trust process when things haven’t gone well- this allows us to separate systemic issues from individual when things go wrong.’ All data
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