Incident Management Policy and Procedure 652.0 KB - Oxleas NHS ...

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4.1 InformationVictims, families and carers need to have access to information on the investigation, and should:• be made aware, orally and in writing, as soon as possible of the process of the investigationto be held, the rationale for the investigation and the purpose of the investigation (that is, toestablish facts);• have the opportunity to express any concerns;• be consulted on the terms of reference for both internal and independent investigations;• be provided with the terms of reference;• know how they will be able to contribute to the process of investigation, for example by givingevidence;• be given access to findings of any investigation prior to publication and receive a copy of thefinal report and subsequent action plan;• be informed, with reasons, if there is a delay in starting the investigation or in the publicationof the final report;• be offered media advice, should the media make contact.4.2 AdvocacyIn order to ensure that victims and families are able to participate in the investigation process thefollowing potential needs should be considered:• need for independent advocacy – with the requisite skills to work with bereaved andtraumatised individuals;• diversity issues, for example language support, transport issues, disability;• support and assistance in participating in the investigation process;• provision of information;• ongoing support after the incident;• signposting to other organisations that might be able to provide support and information;• support in liaison with other agencies, for example the police.• The cost of providing any of the above could be considered as part of the overall cost of aninvestigation.4.3 CounsellingCounselling may not be an immediate need, but both short-term and longer-term potentialrequirements should be considered. This might include the need to signpost to organisations that canprovide bereavement or post-traumatic stress counselling.22
4.4 Treatment and supportIt is important to make sure that appropriate treatment and support is provided where needed.Decisions about treatment and care should be taken locally on the basis of a thorough, individualisedassessment of need, the evidence base, the client’s wishes and resources available.A copy of the report and action plan and an opportunity for feedback should be provided.If victims and families want a further meeting this should be arranged. Victims and families shouldalso be told how they will be kept up to date regarding the implementation of the action plan.Families should be advised on how they can complain if they disagree with the findings of theinvestigation.4.5 Engaging and supporting staffWhen a serious incident occurs which leads to serious harm or death there can be significant impacton staff who were involved in or who witnessed the incident. Like victims and families, staff will wantto understand what happened, why it happened and what can be done to prevent it happening again.Staff should have the opportunity to access professional advice from their relevant professional bodyor union, staff counselling services and occupational health services.Staff should also be provided with information about the stages of investigation and how they will beexpected to contribute to the process. Make it clear that the investigation itself is entirely separate toany disciplinary process.Support provided should be ongoing and not one-off and will usually be via the line manager, but insome instances (for example, disciplinary issues), provision of support by someone other than theimmediate line manager should be considered. In circumstances where a staff member is required togive a witness statement to the police, the coroners or in a court of law, support will be arranged bythe line manager and the Head of Incidents. If required, the staff member will be given the opportunityto meet with the Trust legal counsel.4.6 Service usersAny incident leading to serious harm or death may have an impact on and implications for otherservice users. If service users have witnessed the incident, appropriate support mechanisms shouldbe put in place: it may be advisable to review risk assessments and care plans to reflect any additionalneeds. If appropriate, service users who witnessed the event should be asked to contribute to theinvestigation process. If this is the case, the outcome of the investigation and the final report should beshared with them.5 Implementation and monitoring of action plansThe Board of Director’s Inquiry reports and draft action plans are presented to the Board at the earliestopportunity after completion. The Service Director will be responsible for drafting the action plan andensuring the recommendations are completed within the timeframe. The Board agree the actions andtimeframe for implementation. The Trust’s Patient safety group receives progress reports from thelocal service representative.An annual incidents management report, summarising incident data, outcomes of inquiries andlessons learned is presented to the Patient Safety Group and Quality Board.23
Page 2 and 3: VERSION CONTROLDocument LocationOxl
Page 4 and 5: PART AINTRODUCTION1.1 Oxleas NHS Fo
Page 6 and 7: to the Senior Officer within HR who
Page 8 and 9: Head of Safeguarding Children and L
Page 10 and 11: 2 REPORTING AND IMMEDIATE ACTION2.1
Page 12 and 13: Immediate Within 24 Hours Within 3
Page 14 and 15: HOMICIDEHomicideNHSLondongrade 2Imm
Page 16 and 17: 2.3 Reporting to external agenciesC
Page 18 and 19: 3 INITIAL SERVICE MANAGEMENT REVIEW
Page 20 and 21: - individual factors;- task factors
Page 24 and 25: Directorate investigations reports
Page 26 and 27: Type of incident Level 1NegligibleA
Page 28 and 29: Type of incident Level 1NegligibleL
Page 31 and 32: Appendix IIIIncident report form to
Page 33 and 34: Guidance notes for completing adver
Page 35 and 36: SERIOUS INCIDENTAppendix VPRIVATE A
Page 37 and 38: Date of discharge from most recent
Page 39 and 40: • Ensure that TOR’s and timesca
Page 41 and 42: Where the LSCB TOR includes service
Page 43 and 44: Appendix VIIIOXLEAS NHS FOUNDATION
Page 45 and 46: 5. CONTENT OF THE INVESTIGATION5.1
Page 47 and 48: Guidelines on writing witness state
Page 49 and 50: The following ‘‘do’s’’ an
Page 51 and 52: System owners may also be requested
Page 53 and 54: Strictly ConfidentialGreenwich Crit
Page 55 and 56: Strictly ConfidentialBexley Critica
Page 57 and 58: Strictly ConfidentialBromley Critic

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