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Annual Open Meeting 2019: Additional Q&A

We received a number of questions in advance of and during our recent Open Meeting that we did not get time to answer on the day. During the Q&A, we committed to responding to these on our website at a later date. You can read these responses below.

Q: Why is it not mandatory for organisations to produce an Action Plan to improve standards when a complaint has been upheld and share that plan with the complainants so they can see standards are being improved? 

A: Where appropriate, we ask organisations to produce an action plan setting out how they will tackle the failings we have identified and share this with the complainant. We also ask NHS Trusts to share our health investigation reports with the Care Quality Commission (CQC). This is so they can follow up on our recommendations, as well as any action plans which have been produced in their inspections. 

It is rare that organisations do not comply with our recommendations. When this happens we can bring the report to the attention of the Public Administration and Constitutional Affairs Committee (PACAC) by laying it in Parliament. They can then hold the relevant body to account.

Q: When the Ombudsman has considered a complaint and decided not to investigate, is it possible for the Trust(s) involved to be notified please? 

A: In some cases we contact Trusts if we need to gather evidence before we make a decision on whether to investigate. In these cases we will be notify the Trust if we decide not to investigate. In cases where we do not need to contact a Trust before we decide whether to investigate, we will not do so. This is in order to preserve the privacy of the complainant in line with GDPR.

Q: Is PHSO open to considering referrals direct following the completion of Duty of Candour?  Is the current system putting barriers up for patients/relatives who don’t want to further engage with Trusts following a serious incident?

A: We can consider complaints which relate to the Duty of Candour. However, our process usually requires that complainants have gone through the full complaints procedure before coming to us. We can put this to one side if we think there are reasons to do so, but there is a high bar for this. This is to make sure the organisation has had the chance to put things right itself. 

Q: Why does the Ombudsman not take it upon himself to apply to the High Court to remedy ‘quashed’ reports, rather than make the complainant or other parties go to the expense of instigating a Judicial Review?

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Were a PHSO Final Report to be quashed, are all known interested parties informed of the fact, and can a Trust continue to uphold a quashed report?

A: In considering a suitable way to remedy a complaint about a decision, we can consider whether we should quash our own report or decision. This means that we would treat the report as invalid and would make that clear to all affected parties.

We would only quash a report or decision we have made in exceptional circumstances. These circumstances are as set out in our Review and Feedback Policy.

The Ombudsman has the power to quash reports so there is no need to go to the High Court for remedy if the conditions set out in the policy are met.

Q: The Metropolitan Police state they are prohibited from investigating the Ombudsman and his staff for the offence of Misconduct in Public Office. Does the Ombudsman believe that crown servants in his employ should be exempt from such investigations?

A: We are confident that no current member of Ombudsman staff would commit Misconduct in Public Office. However, it is a matter for the Police to decide what they investigate. We would comply fully with any such investigation. 

Q: What steps has the PHSO taken to speed up the process of reviewing complaints?

A: We have employed more caseworkers to significantly reduce the time taken to allocate complaints. 

We have streamlined the way we manage complaints so that complainants now have a single point of contact for the time we look at their complaint. This makes our service more efficient and gives complainants a more personalised service. It means complainants have a caseworker they can talk to who has worked on their case from the beginning. This can help reduce the stress that often comes with making complaints.

Changes to our ways of working now mean that many complainants get an answer to their complaint much sooner. We are improving the way we resolve cases earlier through discussions and mediation between the parties involved. This means that 50% of complaints are now resolved within 13 weeks, with approximately 95% of complaints being resolved in under 12 months.   

Q: What evidence is there that PHSO investigations are impartial? I'm asking specifically for evidence and not about internal quality assurance. 

A: We are committed to handling all cases in an impartial way. We invest heavily in staff training to make sure our casework handling is fair and balanced. Our commitment to impartiality is subject to scrutiny from the Parliamentary and Constitutional Affairs Committee (PACAC).

We have also taken steps to open ourselves up to scrutiny from other sources. Last year, we carried out a review and public consultation on how we commission and use clinical advice. It was led by Sir Alex Allen, with independent advice from Sir Liam Donaldson, Patient Safety Adviser at the World Health Organisation and former Chief Medical Officer.

We are looking at ways to get feedback on how impartial people think our service is, so we can better understand the public’s perception. An independent research company ran the first focus group on this recently and further work is ongoing, including in-depth interviews with different complainants. 

Q: How can the PHSO ensure lessons are learned from complaints, to stop not only the tragic loss of lives and unnecessary patient suffering, but also to stop this terrible waste of money? 

A: Ensuring that organisations comply with our recommendations for improvement is a one of the ways we make certain that lessons are learnt from complaints.

We also call out poor practice by publishing insight reports. These reports gather evidence from our casework, and identify themes and areas where improvement is needed. They are laid before Parliament with the aim of improving public services.

In addition, we have published a number of health cases we upheld or partly upheld. Many of these cases have directly resulted in Trusts working to make improvements. We will further develop the way we publish our casework in the coming year. This will result in more of our casework being published online so that lessons learned from individual complaints are more visible.   

Further, we are looking to improve the complainant’s experience by working towards a comprehensive standards framework for complaints.

Q: Why are you not pursuing the SPA cases when the JR is not related?

A: Please see our separate statement on complaints about women’s state pension age

Q: Do you gather satisfaction data on people with resolved cases? Where is that data recorded?

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In your service charter data why don’t you ask the public if they consider the investigation/process has been impartial?

A: We gather and report on feedback via our Service Charter survey taken by a wide range of complainants, regardless of the outcome of their case. This includes an increasing number of cases that have been resolved for the complainant at various points during the casework process.

We are also running a 12-month pilot to trial alternative dispute resolution methods. This is so that we will be able to resolve more cases without the need to investigate. We are gathering feedback to measure the pilot’s success and will be reporting on its progress.

We know that feedback from complainants on impartiality can be heavily influenced by what outcome we provided. We also recognise that people can have different views of what is meant by being impartial or being fair. 

We are looking into the best ways to get this feedback through our focus group research. We are carrying out further interviews with complainants and seeking responses from organisations we investigate. We will be reporting on the outcome of this research in early 2020. 

Q: Do you expect the increased number of complaints from EU citizens living in the UK (as public services users) after Brexit? If so, are you ready as an organisation?

A: There is a great deal of uncertainty about what the impact of leaving the European Union will be. We have been talking to our Ombuds colleagues across the UK and Europe about the possible effects that may arise. 

Our successful change programme has made sure we are well placed to respond to increased demand for our service. We will continue to monitor complaints data to make sure emerging trends are spotted and addressed at the earliest opportunity. 

Q: Would PHSO be open to allowing healthcare providers to refer complaints to them once local resolution has been concluded?

A: Given complaints to PHSO are private and confidential, we would expect the individual complainant (or somebody authorised to act on their behalf) to bring their complaint about the NHS to us directly.

There must also be a remedy that we could provide to the complainant which has not already been offered. 

We regularly work with healthcare providers so they make complainants aware of their right to complain to the Ombudsman as part of their complaints process.

Under our legislation, some NHS organisations can refer a complaint directly to us in certain exceptional circumstances. However, these are very rare and the NHS organisation would still require consent from the complainant.