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ANNUAL REPORT 2013 Adjudicating Complaints for the Independent Healthcare Sector

Table 6: Heads of complaint upheld by Independent Adjudication

48% heads of complaint were upheld under Independent Adjudication: Medical

33% of all medical complaints were upheld

Nursing Allied health professional Administrative Expert Clinical Advice

The use of expert advice is essential when a case involves a clinical matter that an Adjudicator needs to make a decision about, and demonstrates to the complainant the evidence and rationale the Adjudicator has relied upon. This year saw a rise in the number of cases requiring expert clinical advice from just 1 of the 28 cases last year to 8 of the 38 cases in 2012/13. The total costs associated with the expert advice came to £6,646.

Costs of adjudication

Since 2009 the cost of adjudication has reduced. However, during 2012 the overall cost rose slightly, which is shown in Table 7. There are a number of reasons for this. There has been an increase in the total number of cases coming to adjudication (Table 7). As noted previously, the cases coming to stage 3 adjudication are increasingly complex in nature, which has resulted in an increase in the resource required to complete an adjudication. ISCAS had for five years made no increase in the fees paid to the adjudicators and 2012 saw a reasonable increase in these fees. Such costs are met by the ISCAS members and adjudication remains free to complainants, as is the case with the Health Service Ombudsman.

Table 8: Goodwill payments

Goodwill payments made

Cases in which payments made

% of cases attracting a payment

Total cost payment £

Averrage cost payment £

2008 14 72% 7,450 573 2009 21 78% 15,000 714 2010 17 77% 12,150 714 2011 16 57% 10,906 390 2012 19 50% 11,500 605

43% of all nursing complaints were upheld

42% of all AHP complaints were upheld

66% of all administrative

Table 7: Year on year adjudication costs The Code has a focus on learning and improving from complaints although it does allow the Independent Adjudicator to make a goodwill payment in recognition of inconvenience and distress. Table 9 shows there has been a slight decrease in the number of cases where a payment was made (down from 57% to 50%). The average cost of a payment was higher in 2012 compared with 2011, but was less than in previous years. The maximum payment that can be awarded is £5000, although the majority of cases that attract the payment are between £150 to £500. The maximum awarded for a single adjudication case was £3000.


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