Panto season came early to PACAC this year. Usually held in December the 2020 the annual PHSO scrutiny meeting was held on 23rd November. Unable to get our usual ring-side seats, members of PHSOtheFACTS watched remotely as the performance played out.
In a pantomime, those on the stage, share false illusions with the audience, to create a distracting farce. The leading man is clearly a lady in tights, while the Dames are men with false bosoms and by the end of the show, you find that both the goodies and the baddies were jolly good friends all along.
So let us set the scene for this year’s performance – entitled ‘We count in complex ways’.
Rob Behrens, Ombudsman and Amanda Amroliwala, CEO began their double act in April 2017. Three years into their ‘back to basics’ agenda the committee should expect to see progress towards their goal of delivering an ‘exemplary’ Ombudsman service. Courtesy of PHSOtheFACTS we provided the following data charts to the members of the PACAC committee via written evidence. To the average person, this may look like a decline in all services, but with a little bit of fairy dust, all is magically transformed.
In good adversarial style, William Wragg, Chair of PACAC lunged forward with the opening question:
Your 2017-18 annual report said that there were 2,348 investigations compared with 1,122 in 2019-20. Could you explain the reasons for that number?
With an immediate parry, Rob Behrens replied:
Yes, Chair, thank you. That is a misunderstanding of what we have been trying to do since Amanda and I joined the organisation in 2017. Investigations are not an indication of the work of the ombudsman service.
A gasp goes up from the audience at home. But wait, there is more.
In the last three and a half to four years we have tried together to modernise the system so that we make decisions that are appropriate for people at the appropriate time.
Apparently, a modern ombudsman can make decisions without bothering to investigate the facts. Mr. Behrens then explains what a modern ombudsman spends his time doing.
One of the things I noted when I came in 2017 was the complete absence of mediation or informal resolution of complaints, which are more effective and more satisfactory to complainants, because they are informal and more cost effective for resolutions. We have piloted mediation—as you will hear later perhaps—in a way that we can address issues before they have to go to a formal investigation.The core issue is that the demand for our service has not diminished in the last five years, but the point at which we address the issue has become earlier and earlier.
How come no-one ever thought to deliver early resolution before? Hold on a minute. Take a look at this.
Turns out there has been early resolution long before the arrival of Mr Behrens, the modern ombudsman. In fact, there were 557 in 2014/15, a figure yet to be replicated by the new management team. Then the villain of the piece inadvertently drops a truth bomb about his predecessors by suggesting that the so-called early intervention strategy,
… prevents us having to conduct long investigations that end up often being rejected, several thousand before we came, without any good reason except public expenditure.
So, all this time the ombudsman has been investigating then rejecting complaints for no good reason except to save on public expenditure. Surely William Wragg, committee chair, will have something to say about this revelation.
Chair: Thank you for clarifying those figures for the Committee.
As the audience hiss in disapproval, a hero emerges with a fresh attack. Committee member, Lloyd Russell-Moyle attempts to apply pure logic to the data.
Lloyd Russell-Moyle: You said in one of your earlier answers that you have taken more of a mediation approach, but the numbers for resolution and any action that is not an investigation per se, but a resolution that comes out anyway, is also going down. I do not understand how you can say that that is compensating for the lack of investigation.
Rob Behrens: I did not say what you suggested I had said. What I said was that we need to move to an approach that includes mediation in our attempt to make the right decision at the right time.
At this point Lloyd Russell-Moyle should have turned to the audience who were ready to call out ‘Oh yes, you did’. But Lloyd foolishly tried to rely on the data to win the day.
Lloyd Russell-Moyle: That is a nice answer for what you will do in the future, but that does not answer at all what you have done in the last year, which is what the question was.
Rob Behrens: I cannot hear the question, I am afraid. I am afraid there is a communications problem here.
Oh, no there isn’t – cried the audience.
Lloyd Russell-Moyle: The question that Mr Wragg put to you—not my question—was an explanation for why investigations seemed to be going down over the last few years. You answered with an answer that explained that you were moving to a mediation approach.
Rob Behrens: No, I did not, with respect. I did not answer that. I did not say that at all.
Oh, yes you did. Hisssssss
Lloyd Russell-Moyle: What is the answer to the reason that investigations have routinely gone down over the last few years? Resolutions that are queries and complaints that are resolved without investigation have also gone down over the last few years. Apart from people making complaints, all the numbers of what you have handled are going down. What is the reason for the reducing numbers?
Rob Behrens: What I said was, if I remember correctly, that we had moved away from investigations and adopted a whole range of other devices to try to resolve cases at the right time. That includes assessments and early resolutions. The work of the office has not diminished in any way. The number of investigations has diminished, as we have explained.
The obvious riposte was that both assessments and early resolutions had been in the ombudsman’s toolbag long before the ‘modernisation’ process began but our hero was starting to lose his way. He attempted a few more forays but was finally defeated by Amanda Amroliwala who deflected the logic of his question with the following statement.
Amanda Amroliwala: The first very important thing to say is that our job is not to uphold complaints. Our job is to independently assess a complaint and decide whether there has been a failing.
As Lloyd Russell-Moyle retreats under the tag-team onslaught, let us consider what it is that the modern ombudsman does during the time that the old-fashioned ombudsman was busy investigating complaints.
Well, they seem to spend a lot of time employing outside agencies to help them answer some pretty basic questions about their service. Such as;
Amanda Amroliwala: We have commissioned a project to look at all the presentation of our data so that for next year’s report we will come back with something that is much simpler in explaining the different categories and why we explain them in the way that we do.
Rob Behrens: .We commissioned ORS to have a look at why people question whether or not we are impartial. It has done a lot of focus groups and in-depth interviews on this.
So, PHSO management needs help to present their own data in a simple way for both the committee and the public to understand. We learn that the difficulty in displaying the data clearly is the fact that PHSO count in complex ways, as we discovered when Amanda Amroliwala answered this perfectly logical question from Tom Randall:
Tom Randall: In your letter of 12 October you wrote that you had received 31,365 complaints in 2019-20. The annual report and accounts says on page 31 that you had handled 31,895 complaints, of which 28,103 were new complaints recorded that year. Could you tell us where the figure of 31,365 comes from?
Amanda Amroliwala: The figures in the annual report are the end year figures. We count in a very complex way, as I have already explained. We count the number of complaints received and we count the number of complaints handled. Those numbers are different because we receive complaints and some of them are rolled over into the next financial year. The number of complaints we receive and the number we handle can often overlap two different years, so the preceding year and the subsequent year. Sometimes there is a slight variation in the numbers because of those differences, depending on whether you are talking about cases coming in or cases that we have considered.
We do not have in the annual report a figure for new cases received into the system. As I explained to Mr Wragg, this is one of the problems of why we are revising all of the data. The figures that have been historically rolled forward each year in the report are cases handled. That then does not give you a figure for the number of new cases that are created on the system and that is where the 31,000 figure comes from.
So that’s all clear then. It seems to have made sense to Jackie Doyle-Price.
Jackie Doyle-Price: That is helpful. Sometimes producing lots of material and data in the interests of transparency ends up being less than transparent. Reviewing how you are putting this data out to make it tell a better story at least offers us an opportunity for that kind of review. I am assuming that is the principle behind the delays also in producing the data for 2018-19, which has only been put on this month, I understand.
Presenting your data clearly becomes more complex if you are trying to ‘tell a better story’ without actually doing a better job. No wonder they need ‘experts’ to guide them. But when it comes to ‘peer review’ the ombudsman is keen to save public money.
Tom Randall: On the composition of that panel, because it contains, as I understand it, two ombudsmen and an economic expert to review an ombudsman, do you think there should be an auditor on the panel with experience of complaint handling organisations to provide a degree of independent assurance on the work?
Rob Behrens: We do not have a lot of money to commission management consultants to do it.
Mr. Behrens is something of an expert on peer-review.
In a study that I have just completed of ombudsmen in 38 countries around the world, we know that people do not properly understand what ombudsmen do.
Well I never. And so the curtain falls on another drama.
How did they miss the fall in the number of investigations and assessments carried out, and the fall in the number of complaints upheld? It’s like someone showing you the wreck of a car and saying how much they like the wing mirror!
Was the learning academy idea an attempt to reduce PHSO involvement in investigating complaints by passing responsibility to NHS trusts? The learning academy idea has been put on hold:
Could the move towards mediation be another attempt to pass responsibility for investigating complaints? Rob Behrens said that those who participated found the experience ‘rejuvenating:
“A profound effect in almost all the cases of the parties to the dispute in coming together having been appropriately prepared by trained mediators in our office to try and resolve issues that you can’t resolve through just formal investigations. And I have a lot of feedback from participants to the process who say that they found it rejuvenating and it built their trust in the health service by being able to talk to people face-to-face and to understand the challenges that members of the health service had to face in dealing with their case.”
Maybe looking to step in only to mediate when the trust concerned, which will have some new ‘independent’ complaint closing unit added and staff trained to PHSO standards, fails to close a complaint.
What ever improvements are coming they are always in the future. Like a carrot on a stick. Clip clop.
Recently published complainant feedback – Performance against our Service Charter:
Would you buy a used car from Rob Behrens?
Same old meaningless scores.
Thanks for the fine summary.
If you question the Ombudsman on its lack of investigations you demonstrate misunderstanding:
‘At the same time, the critiques put forward by the ombudsman watchers may highlight the way in which the public misunderstands the role of ombudsman schemes and may be indicative of an apparent gap between public expectation and what ombudsman schemes are set up to provide.’
It appears that our expectations should revolve around international ombudsman schemes and more opportunities for ombudsmen to comment on how well each other is doing. More ‘focus groups’ too, as well as academics willing to write helpful reports.
Thinking that an ombudsman might investigate your complaint is clearly erroneous. I wonder where the public get these crazy notions from?
” In a study that I have just completed of ombudsmen in 38 countries around the world, we know that people do not properly understand what ombudsmen do.”
Isn’t it strange? People who don’t understand something, in 1 country, would be a LOT of people. But in 38? Wow. Must be quantum physics level stuff. We are all waiting for Mr Behrens to enlighten all these millions of people around the world who don’t understand what the Ombudsman “does”.
It would seem that our Ombudsman does not count investigations as his core activity which must be confusing to all those people who submit complaints for investigation. So what is it that ombudsmen do? Perhaps we will find out next year.
A great summary of the panto that was the annual scrutiny of the Ombudsman. It doesn’t take much for the Ombudsman and the CEO to bamboozle the members of PACAC, since they aren’t really very interested in the PHSO and only go through the motions once a year with questions suggested and handed out by the clerks. Even though Lloyd Russell-Moyle made a brave attempt to get to the heart of the matter the ground gave way beneath him as he came under assault from both Rob and Amanda and had to back off. Perhaps one day a member of PACAC will be able to engage fully with the dubious and doubtful statements made by Rob and Amanda but I’m not holding my breath.
I recently made a Freedom of Information request to the Ombudsman regarding the shocking revelations concerning maternity cases at Shrewsbury and Telford Hospitals Trust. The enquiry conducted by Donna Ockenden revealed 1862 cases going back about 20 years. The Ombudsman’s response to the FOI revealed he completed just 4 maternity investigations regarding this particular Trust in the last 7 years – none since 2017-18. PACAC should be asking why people have opened up to the enquiry and not the Ombudsman. There is nothing complex about it
(should have deleted the “but not quite” part, sorry)
Meet Mr Behrens, the modern day sophist. The rest of his team is almost as good as him, but not quite.