London, 22 May 2018
Overview
Our second open meeting was attended by over 130 delegates, including a diverse mix of complainants, complaint handlers and representatives of national bodies.
The meeting followed the launch of our new three-year strategy.
Presentations
The day began with a series of presentations starting with the the Parliamentary and Health Service Ombudsman’s Chief Executive, Amanda Campbell, who spoke about how over the last 12 months we have been on a journey to improve the quality and consistency of our service, while at the same time having to make demanding 24% reductions to our budget.
She described how the complaints we investigate are often seen through very different lenses as to what went wrong and why, but added that we all share the same concerns about our National Health Service.
Amanda also discussed the importance of preserving our independence and impartiality. She explained how we are moving towards publicising all our investigation reports online, adding that everybody will have to understand that whatever they say or provide as evidence would then be in the public domain.
Amanda was followed by a very powerful speech from James Titcombe, father of Joshua and now a patient safety campaigner. James talked passionately about the need to fully understand and learn from serious incidents.
We need an NHS where we don’t blame people for human error but we do act quickly. We need to separate complaints from serious patient safety incidents, which shouldn’t be going through the complaints system.’
James Titcombe
Attendees also heard from government complaints champion and HMRC Customs Director General Customer Services, Angela MacDonald. She spoke of the value of having the organisation’s best people working in complaint handling, and the importance of acknowledging that as complaint handlers, while you won’t always make all your customers happy, you can treat everyone with dignity and respect. She also advised against setting complaints reduction targets and stressed the importance of focusing on communicating well.
After a quick coffee break, Parliamentary and Health Service Ombudsman, Rob Behrens addressed the room.
Rob shared his vision for delivering an exemplary ombudsman service by returning the organisation to its core role. He said that although it was now time to focus on the future, there were big historic legacies which have undermined public trust in our service. He said there was no ombudsman golden age and no blueprint for how ombudsman schemes should operate.
He told the audience that you cannot be an ombudsman without being independent and that as the Ombudsman we have to be impartial to those in jurisdiction, which also means we cannot be the people’s champion.
Rob talked about some of the ways we are making progress against our strategy, through, for example, the production of insight reports such as our recent publication on mental health.
He also talked about how we want to use our unique role in examining complaints from across health and government systems to promote and share best practice.
Q & A session
The afternoon featured a lively questions and answers session, expertly facilitated by our senior non-executive Board member, Elisabeth Davies. The panel included the opening speakers and Bernard Jenkin MP, Chair of the Public Administration and Constitutional Affairs Committee. There were challenging questions from a good cross section of the audience, with complainants passionate about changes they want to see. Those delegates attending from health and government bodies spoke of the professional service they receive from PHSO colleagues.
We live streamed the speeches and the Q&A session on the day. You can can watch it here:
Optional breakout sessions
The day concluded with two breakout sessions to discuss ‘improving complaint handling’ and ‘early and alternative dispute resolution’, each a key aspect of our new strategic plan. The following is a summary of the ideas discussed in these sessions.
Innovation and good practice in public sector complaint handling: the journey to better service
Our new three-year strategy makes a commitment to support the organisations we investigate to improve complaint handling and increase the resolution of complaints at a local level through tools, training and guidance.
We are also taking significant steps to improve our own complaint handling. This session asked what innovation and good practice looks like in the public sector and included presentations followed by panel and audience discussion.
Andrew Medlock, Assistant Director of Customer Experience at PHSO, was joined by David Heap, Patient Complaints Manager at Sheffield Teaching Hospitals NHS Foundation Trust and Sidonie Kingsmill, Customer Director at HM Courts and Tribunals Service (HMCTS). The session was chaired by Alex Robertson, Executive Director External Affairs and Insight at PHSO.
Andrew shared PHSO’s perspective as the final stage for complaints about the NHS and Government departments. He highlighted the critical importance of trust in decision-making, including that PHSO is seen as making impartial decisions, and individuals and organisations have an opportunity to input into decisions before they are made. It was also fundamental that people could see how their feedback had been considered by us, with their needs and concerns taken into account.
Andrew noted that the Ombudsman sets out good practice for public organisations in a range of guidance. However, he stressed that, it is just as important for PHSO to follow that guidance and that, ultimately, trust 'has to be earned'. In the last few years PHSO has taken action to build trust and demonstrate transparency by developing our Service Charter, and reporting publicly on how well we are performing against this.
David Heap talked about the work Sheffield Teaching Hospitals has undertaken to improve complaint handling. Following a 2014 audit of the quality of its complaints service, the organisation made fundamental changes to the Trust’s approach to frontline interaction with complainants. PALS was removed as the first point of contact for complainants with clinical teams making the first contact within 48 hours. The ethos is 'engage complainants first, and complaints second'. Timeliness in responding to complaints significantly improved. The Trust also developed a board game for staff, which tackles a range of issues about complaint handling in a fun and interactive way.
Sidonie Kingsmill highlighted improvements to how HMCTS writes final response letters to complainants, including them being more clearly structured, so that the outcome of the complaint and the next steps are clear, as well as using plain English. Sidonie also explained that HMCTS had developed a complaints analysis tool to generate greater insight into the themes and learning arising from complaints. This enables complaints to be coded and analysed according to their severity, for example, the impact the failings complained about had on the complainant.
Alternative dispute resolution in the public sector: expanding the Ombudsman’s toolbox for resolving complaints
Our new three-year strategy commits us to exploring ways of introducing early dispute resolution and alternative dispute resolution into our service. To inform how we approach this strategic commitment, this session looked at how alternative dispute resolution works in practice, and its limitations. The session was chaired by Warren Seddon, Director of Public Affairs and Insight at PHSO.
Delegates heard from Rachael Russell, Assistant Director of Intake at PHSO; Chris Pinnell, Head of Casework Support and Resolution at the Office of the Independent Adjudicator (OIA) and Carys Williams, Assistant Investigation Manager at the Public Service Ombudsman for Wales (PSOW).
Rachael Russell explained how we are already using early resolution in our casework. A pilot, applying this approach to approximately 80 cases at an early stage of our complaints process, has been generally well received by complainants to date.
Rachael noted that organisations could be reluctant to not go down the formal investigation route and may need to be reassured that they have 'permission to do things differently'. However, complaints managers also welcomed early resolution, finding in some instances that it helped to reinforce decisions that may have initially been rebuffed by senior management. This point was reinforced from the floor during the Q&A.
Chris Pinnell explained how the OIA always gives consideration to whether a case can be resolved early and are open to resolution throughout the process. He said early resolution can be less stressful for all parties, more cost efficient and can help providers avoid the embarrassment of having a complaint upheld and publicised.
However, it can sometimes lead to complainants 'shifting the goalposts' if organisations make initial offers for financial remedy. There is also a risk of a loss of impartiality if caseworkers are focused solely on early resolution and that wider lessons can be missed if there is not a full investigation. He emphasised the need for balance noting that approximately 90% of OIA cases still go to full investigation.
Carys Williams explained that early resolution was specifically set out in the PSOW’s legislation and that PSOW can seek to resolve some elements of a complaint while investigating others. In her experience early resolution was particularly suited to resolving cases about poor complaint handing, often prompting a response from organisations that satisfied complainants. It could be less effective for complex health cases because PSOW can only access full medical records when commencing investigations.
Carys also noted that complainants can sometimes feel that organisations are being let off the hook if they are not subject to an investigation. She emphasised that early resolution was not 'a get out of jail card for organisations'. PSOW’s legislation ensures that the outcomes of resolution should be treated in the same way as recommendations from a final investigation.
Delegates raised a number of issues including whether:
- 'early resolution' was an appropriate term for complainants who have already had to go through the local complaints process
- the PHSO’s offering of early resolution might have adverse effects on bodies’ initial response to complainants
- the current NHS complaint regulations should place greater emphasis on conciliation.
The speakers concluded that early resolution must be treated as an option rather than a requirement, as its success depends on the willingness of all parties to engage in the process and be flexible about outcomes.
Warren summarised the session by noting that it had provided useful food for thought for PHSO as we begin exploring how it can introduce different methods of dispute resolution into its service.