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Annual Report 2014

Independent Adjudication

– agile, responsive, transparent and fair by Sally Williams, Adjudicator

ISCAS Independent Adjudication has worked hard during 2014 to demonstrate improvements in the way complaints are reviewed at Independent Adjudication and also in the approach taken by the independent healthcare sector to handling complaints. Detailed below are some of the main improvements we have made over the last year.

Stronger Independent Adjudication review The team of three Independent Adjudicators has worked with the ISCAS Management Team to improve our approach to reviewing complaints. This has included revising the documentation sent to complainants, standardising the approach to capturing the key heads of a complaint, and redesigning the way we instruct experts to provide expert advice.

We strive to keep both parties – the complainant and the provider – informed at each stage of the process and to make sure that information is shared openly. Where we seek the advice of clinical experts, the identity of the expert is made clear from the start and their advice to us is provided to both parties on completion of the adjudication.

Every complaint is unique and one advantage of having a small team of adjudicators is that we are well positioned to be agile and responsive to the needs of individual complainants. At the same time, it is important to demonstrate a consistent approach to adjudications and one that ensures every complaint is dealt with in a fair, transparent and timely way, and underpinned by a thorough review of the complaint.

During 2015, we will consolidate the improvements we have already made – and seek to understand their impact – and we will complete activity to revise our documentation. This will include reviewing:

• the format of adjudication decision letters;

• the mechanisms for giving advice to providers following a review of a complaint at the Independent Adjudication stage;

• how we signpost complainants who remain dissatisfied with decisions onto other organisations.

Clearer decision-making An important step forward has been the development of the Goodwill Payments Guide. Last year’s annual report highlighted a lack of transparency about the basis for determining the size of a financial award to complainants. The new Guide sets out the factors that Adjudicators may consider in deciding whether a goodwill payment should be awarded, including:

• compliance with the ISCAS Complaints Code of Practice; • the timeliness, tone and substance of responses to complaints; and, • the impact on the complainant.


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