Casework publications

During Quarter 1, we published details of several cases we investigated.

We investigated a complaint following the death of Adrian Munday, a vulnerable adult who was murdered in October 2015 by a person on probation and under the supervision of the Community Rehabilitation Company (CRC). We found the CRC did not prepare a Victim Summary Report (VSR) at the correct time or make it available on request. We also found the CRC presented a draft copy of the report containing errors to the family of Mr Munday, which caused unnecessary delays. We found there were delays in communication and poor complaint handling by the CRC. We recommended the CRC apologise in writing, provide an updated report and take action to address the failings we identified.

We investigated a complaint brought to us by Mr K, a personal trainer. Mr K underwent surgery at Manchester University NHS Foundation Trust in December 2016. Following surgery Mr K was told that two lipomas (painful lumps) in his leg and back had been removed. However, our investigation found that the Trust had failed to remove the lipoma in Mr K’s back. This caused Mr K unnecessary pain and stress. Mr K also had to take time off work and have follow-up surgery to remove the lipoma in his back. We recommended the Trust write to Mr K to apologise and pay £1,000 in recognition of the pain and stress caused by its failings.

In June we published ‘Missed opportunities’, an investigation report into the deaths of two vulnerable young men at the North Essex Partnership NHS Trust. Our report alerted Parliament to systemic problems in the care and treatment of patients with acute mental health problems at the Trust. The Trust accepted our recommendations and has committed to making improvements. The Public Administration and Constitutional Affairs Committee also held a follow-up session examining the report. The Committee heard from representatives from NHS England, NHS Improvement, the Department of Health and Social Care, and the Minister for Mental Health. The Committee also questioned witnesses on progress made on the key issues raised in the report.

You may have missed…

During Quarter 1 2019-20 we published:

a blog about the first meeting of the Health and Social Care Regulators’ Forum and our work to create a system-wide Complaints Standards Framework, setting out a unified vision of best practice in complaints handling for the NHS
updated guidance for organisations we investigate on good complaint handling and good leadership and complaints
updated guidance on our three-step process for dealing with complaints, explaining how we reach final decisions on unresolved complaints
an episode of our Radio Ombudsman podcast with Rosemary Agnew, Scottish Public Services Ombudsman, on the benefits of being a Complaints Standards Authority
our submission to the National Audit Office investigation into healthcare penalty charge notices and our submission to the Health and Social Care Select Committee NHS Long-term Plan legislative proposals inquiry
our submission to the Public Administration and Constitutional Affairs Committee follow up inquiry into our 'Ignoring the Alarms' report and a blog on the oral evidence sessions held as part of the inquiry.

Other organisations

Other publications included:

the UK Administrative Justice Institute published a blog by Richard Kirkham setting out a manifesto for legislative reform of the ombudsman sector
the Scottish Public Services Ombudsman published their annual statistics for 2018-19
the Office of the Ombudsman in Ireland published their annual report for 2018-19
the Northern Ireland Public Services Ombudsman launched an ‘own initiative’ investigation into Personal Independence Payments
the Northern Ireland Public Services Ombudsman published their Case Digest for Spring 2019
the Public Services Ombudsman for Wales Act 2019 came in to force
the School of Law at University of Glasgow published Being Complained About guidelines
the Ombudsman Association launched an Ombudsman Case Law Database.

Download our report on Complaints about the NHS in England: Quarter 1 2019-20 [PDF 2.22 MB]