Foreword
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1.1 On 16 December 2009 I published Sharing and Publishing Information about Complaints. The purpose of this consultation document was to seek the views of a range of stakeholders on my proposed approach, as Health Service Ombudsman for England, to sharing and publishing information about complaints.
1.2 The impetus behind the consultation was the increased focus on the importance of information about complaints following events in Mid-Staffordshire and elsewhere. Recent changes in the NHS complaints system, particularly the abolition of the Healthcare Commission as a second stage complaint handler, had also given rise in some quarters to unrealistic expectations of the volume and scope of information that the Ombudsman can and will make available, considering the legislation that governs our work.
1.3 As was set out in the consultation, we need to protect the privacy of our casework and, at the same time, share the learning from complaints with those who are likely to benefit from having access to that information. That includes the public at large; MPs; organisations providing advice and advocacy; regulators such as the Care Quality Commission, Monitor, the General Medical Council and the Nursing and Midwifery Council; and, of course, the NHS itself.
1.4 The Health Service Commissioners Act 1993 (the Act) is the substantive legislation governing the Ombudsman’s work. It includes a number of provisions which are relevant to the issue of information sharing:
- Section 11(2) of the Act says that an Ombudsman investigation must be conducted ‘in private’.
- Section 14 of the Act says that when the Ombudsman investigates a complaint, the investigation report must be sent to the complainant (and their MP if the MP has assisted them); to the NHS body or practitioner complained about; to the NHS body or provider responsible for providing or commissioning the service; and to the Secretary of State for Health.
- Section 14 of the Act says that when the Ombudsman decides not to investigate a complaint, a statement of reasons (usually described by the Ombudsman as a ‘decision letter’) must be sent to the complainant (and their MP if the MP has assisted them).
- Section 15(1) of the Act says that information obtained by the Ombudsman ‘in the course of or for the purposes of an investigation’ shall not be disclosed except in very specific and limited circumstances, the most significant of which is for ‘the purposes of the investigation and any report to be made in respect of it’. This is known as the ‘statutory bar’ on disclosure of information and has been described as a ‘quid pro quo’ for the Ombudsman’s extensive powers to obtain information.
1.5 The challenge for the Ombudsman is to act within the legislation that governs her work, and balance the need to protect the privacy of personal and other information given to the Ombudsman in confidence, with the potential benefit of sharing more widely information that can help drive improvements in healthcare and inform public policy. The approach I set out in the consultation sought to address that challenge.
1.6 I am extremely grateful to everyone who responded to the consultation. The breadth of responses that we received displayed the passion and commitment that there is, both within the NHS and in the broader health landscape, to learn from complaints and drive improvements in the quality of healthcare. This report provides an overview of the responses to the six consultation questions and explains how they have influenced the approach we will adopt from April 2010 and beyond.
1.7 I am especially grateful to Sir David Nicholson, NHS Chief Executive, and Sir Hugh Taylor, Permanent Secretary at the Department of Health, for their very full and supportive joint response to the consultation. Their response makes it abundantly clear that understanding and acting on patient feedback, including complaints, is crucial to the efforts of the NHS to improve patient experience, as one of the three elements of high quality care. Their response also sets out what is expected of Boards of NHS organisations in monitoring patient feedback and complaints as part of their core business, and how data about complaints features in the broader context of Quality Accounts. It seemed to me that their response would be of general interest and, with their permission, I have reproduced it as an Annex to this report.
1.8 My conclusion in this report is that overall, respondents to the consultation were very supportive of the approach to sharing and publishing information about complaints which was set out in the consultation document. There was one specific area where respondents wanted more information than the consultation document proposed and that was about complaints that the Ombudsman decides not to investigate. The strength of respondents’ views on this issue has persuaded me that we need to review our practice in relation to the information we share with NHS bodies and practitioners about complaints we decide not to investigate.
1.9 The thorough and challenging responses that we have received to this consultation have given me the opportunity to take into account the views of a wide range of stakeholders in developing and refining the approach that we will adopt to sharing and publishing information about complaints. We will carry out that review of our approach over the next few months and publish the outcome of it as soon as possible. We will continue with our current practice in the meantime.
Ann Abraham
Health Service Ombudsman for England
