Guest blog from phso-thefacts member
In 2013 PHSOthefacts formed and has grown significantly since that time, with the influx of more and more disgruntled and distressed complainants searching for answers. Complainants who did not receive justice through PHSO and were left more harmed, through taking their complaint to that final stage, in an attempt at redress. In discussion, PHSOthefacts members have discovered over time, that the same communication tactics have been used by not only the body they complained about but PHSO itself. There is clearly a format to fobbing off and side-lining complainants and some of these stock tactics are listed below.
The new Ombudsman, Rob Behrens, promises improvement and change, we want to test these promises and see if people continue to receive the same stock handling, as we continue this journey to justice. This post, therefore, constitutes an open letter to the new Ombudsman, who we will benchmark for his performance against these communication tactics:
- discrediting you – this can take the form of the following type of phrases “I do not find your point/claim relevant” (implying you are being frivolous or confused), “I disagree with your opinion” (implying you are incorrect or deluded), “it is unreasonable/impossible to expect” (self-explanatory and we don’t have to deal with this expectation because we have labelled it thus) or “please do not make false statements” (you are lying/being unprofessional/vexatious, which is a thinly-veiled threat to cease communications and they have now documented the excuse), “Person X’s expert opinion is” (you are a dumb Joe Public and cannot possibly know more than the alleged expert so you are clearly delusional);
- statements of I/we are willing to listen/learn/be transparent – you won’t get the resolution/response you are seeking, I/we want to look good in the public eye or when a third party oversees me/us, so a show will be made of holding meetings or seeking your feedback in writing and thanking you for it (but summarily disregarding it) so I/we can document it was done (i.e. a process was followed) and you just need to get over it and move forward, because this is a firmly closed door;
- ignoring evidence from reliable sources – you may have done Freedom of Information requests or gone over documented information with a fine tooth-comb and can prove what you say, but the facts you present will be glossed over, explained away, or most likely, simply strategically ignored in the response;
- padding and diverting – the communication will expend a minimum of one lengthy paragraph and often more, to pad out the response by stating the exceedingly obvious, such as what the body’s purpose is and what it does, in an attempt to divert from the fact that they have paid lip service to their remit and may include a paragraph telling you to approach someone else/another body in the ‘not in my remit’ game;
- strength in numbers/intimidation/bullying – stating that x, y, z person/body/group (especially those with alleged stature or kudos) ALL think differently than you, so you are just an insignificant little nobody and no-one else will agree with you. Otherwise known as circular assurance as each body closes your case down without proper investigation;
- apportioning blame/psychological warfare – apologising for YOUR opinion, view or feeling on the matter, so at first glance appearing conciliatory, but in fact denigrating YOU as being at fault for having said opinion or feeling, because clearly they have done nothing wrong and you are at fault for whatever it is you are communicating with them about;
- promises of changing/improving – this is another deflection, trying their arm at telling you things will be better in future, in the hope you will forget the issue YOU are contacting them about, because really you should just be satisfied with their glossy promises;
- taking control – authoritative statements about what will happen next, making it clear they have all the power and you just have to go along for the ride, may also include their version of minutes of any meetings that have taken place which you know to contain incorrect statements as you were present, designed to confuse and outrage you and make you feel it’s a battle not worth fighting;
- making false statements – sometimes this is simply incompetence, but more often this is to document factually incorrect information and has the added bonus of making you despair still further, so are more likely to give up or expend more time and effort responding to the inaccuracies which deflects you further and further from your initial point. Once it’s documented, the falsehoods grow and the runaway train is harder to stop;
- copying in third parties as a threat – gives the illusion that the author of the communication is ultra-confident in their missive and that they have friends (often in high places) who will back them up so you had better back off as their army is oh so much bigger than you.
PHSOthefacts are a group of valid complainants who seek reasonable outcomes. Learning can only truly come, when cases have been fully and honestly reviewed, to identify what went wrong and remedy what can still be put right. PHSO made the decisions not to investigate or not to uphold and only PHSO can correct those actions. PHSO needs to gain credibility, this won’t happen until it admits its own wrongdoing and provides redress, only then can it criticise and become an exemplar for the bodies it investigates. We await your future communications with interest (and score chart at the ready), Mr Behrens.
We all like to put a positive gloss on things and none more so than a government Minister. Jeremy Hunt is working hard to put out the message that the NHS is improving under the watch of the Conservatives and despite facts and figures which suggest the opposite the media message is clear – the NHS is safe with us. When you have the media on-board it is easy to maintain this central narrative as you need to see both sides of the story to understand the truth behind the headlines. On the surface, this recent announcement looks like nothing but good news.
Hunt To Pledge Independent Investigations For Families Who Endure Stillbirth
But when you dig a little deeper you have to ask yourself why are these independent investigations not already commonplace? After all the Health Service Ombudsman has been in existence since 1993 with wide-ranging powers to investigate such instances. Interestingly, in all the articles citing this recent announcement, none of them mentions the work of the Ombudsman in this area or how the new Healthcare Safety Investigation Branch (HSIB) will carry out so many independent investigations when it is only funded for 30 investigations per year. None of them except this one by Bruce Newsome and published in Reaction on 28.11.17 – so read on to get the bigger picture before you make your mind up. health-secretary-still-doesnt-understand-risk-management/
Hospitals need to be accountable to someone other than themselves: here’s why
Bruce Newsome, Ph.D.
PHSO are once again in transition. The recent loss of both the Ombudsman, Dame Julie Mellor and the Deputy Ombudsman Mick Martin under a cloud of collusion has left the reputation of the Ombudsman’s office somewhat dented to say the least.
Public confidence is essential to public services.
No matter what chaos is happening on the ground the public must remain confident that the organisation is working for the common good. Rule number one in Sir Humphries Rule Book.
Rob Behrens took up the role of Ombudsman in April 2017 and is in charge of the new strategy to be launched in 2018 and last until another new strategy is introduced. His first priority has been to listen to critics, learn lessons and with improvements in place, restore public confidence in the Ombudsman service.
Fortunately, for PHSO most of the public are ignorant of their existence. They rarely manage to score above 20% on public awareness surveys. Equally, there is very little media coverage of the Ombudsman’s work apart from that released by their own media team. A media team who appear to be on something of a campaign to restore public confidence despite the fact that the hard work of making the service fit for purpose has yet to be done. There are mixed messages here. In August Mr Behrens informed Shaun Lintern from the Health Service Journal that standards had not been adequate and substantial reform was required to make PHSO an exemplar service. It was, in his own words, ‘a big job but the transformation has begun.’ mr-behrens-makes-promises-of-change-for-the-future-but-what-about-the-past/
But just a month later and the media team are publishing letters in local papers such as the one below from The St Ives Times and Echo (27.9.17) encouraging people to make a complaint to the Ombudsman, despite the fact that just a month earlier Mr Behrens had stated that, ‘critically, we have not yet found a way of relating to complainants so that we understand their cases and that relationship is key to a good outcome for the process whether or not we find for them’
THE NHS provides excellent care to thousands of people day in, day out. We all have an understanding of the pressures the NHS faces, but this should not stop people from speaking up when things go wrong.
Data published last week by NHS Digital revealed that there were 208,400 complaints about the NHS in 2016-17. However, all too often, patients and their families are not fully aware of their rights. The NHS Constitution states that everyone has the right to complain, to have their complaint about NHS services acknowledged within three working days, and to have the matter properly investigated.
It is important that patients are also aware that if they are dissatisfied with the way in which their complaint is handled, they have the right to bring their complaint to us the Parliamentary and Health Service Ombudsman (PHSO) for an independent and impartial view.
Where the PHSO upholds complaints, we recommend that the NHS puts things right by offering an appropriate remedy. This might be an apology, a financial remedy, the creation of action plans to ensure mistakes are not repeated, the introduction of additional staff training, or changes to policies and procedures. Throughout our work, we see a wide variation in the quality of NHS complaint handling so it is imperative that people know their rights and are not afraid to complain when mistakes are made.
ROB BEHRENS Parliamentary and Health Service Ombudsman
You may indeed have the right to complain to the Parliamentary and Health Service Ombudsman but you do not have the right to an investigation. That is up to the Ombudsman’s discretion. In 2016-17 about 25% of the complaints made were assessed, only 13% made it to investigation and a tiny 4.7% achieved any type of uphold. For 95% of the people submitting a complaint, it was nothing but a frustrating, waste of time.
It would appear that PHSO are focusing on restoring public confidence when they should be focusing on restoring a service fit for purpose. In the 2017-18 Business Plan
By default, the media coverage will be positive when we all have something good to say, but it would appear that PHSO aims to meet the criteria without necessarily achieving the success.
PHSO regularly release positive statements on Facebook demonstrating the values of their organisation. Comments are then made by members of the public and in my experience, these comments tend to be negative. In fact, I have never read a positive one yet. On recent postings, I’ve noticed that it is possible to see the number of comments made but for some reason, the comments themselves will not open. Mmmmm – very curious. The same is true for PHSO posts to twitter. The comments are hidden from public view. Why would this be?
Meeting the media target requires close monitoring of social media but it shouldn’t include censorship.
The PHSO media campaign is, however, in full swing and this month Mr Behrens has launched Radio Ombudsman in order to engage the public in dialogue. Guests will be invited where PHSO decide they are ‘informed or interesting’ and questions are selected from Twitter. Where is the locus of control in this arrangement? Firmly in the hands of Mr Behrens who chooses both the guests and the questions. I listened to the first podcast which was an interview between Mr Behrens and Scott Morrish a previous complainant. soundcloud.com/scott-morrish/phso-get-better-at-learning
To open, Mr Behrens stated that the Ombudsman is ‘independent’ and ‘impartial’ yet there is no evidence to support this view but that of the Ombudsman himself. The Patients Association, phso-thefacts and submissions to PACAC repeatedly cite bias towards the public body under investigation. But no doubt Mr Behrens would disagree with that. He disagreed on a number of points made by Mr Morrish but did not substantiate the reasons why. Is this a genuine attempt to listen and learn or just a masterclass in PR spin?
Disagreement without good reason is just denial.
On August 13th Bruce Newsome posted a raw and undoubtedly negative account of the way PHSO fail to manage risk on the Conservative Home website. conservativehome.com/platform/2017/08/bruce-newsome-the-key-problem-with-the-nhs-not-resources-not-culture-but-a-lack-of-accountability
Mr Newsome is a lecturer in International Relations at the University of California, Berkeley and an expert in risk management. His aim was to draw attention to the lack of accountability for the work of PHSO and as previously articulated on this site, without accountability you get impunity. https://phsothetruestory.com/without-accountability-you-get-impunity-and-that-leaves-all-of-us-at-risk/
Within two days of publication, Conservative Home received a complaint from PHSO regarding the accuracy of the article. No doubt PHSO would have been delighted for the piece to be removed or amended to their satisfaction. Fortunately, Mr Newsome did neither. But this is all very worrying.
When you achieve your media target by controlling the media coverage you have clearly missed the point.
My advice to Mr Behrens would be to get on and deliver a customer focused Ombudsman service, hold authorities to account and make sure that learning is acted upon. Let the positive media coverage follow all by itself and be a true measure of his success. I would be delighted to publish a good news story on phso-thefacts, I just don’t have one yet.
On 22 August, Shaun Lintern from HSJ released two interviews from Rob Behrens, the new Health Service Ombudsman. You can read the first one here
Mr Behrens talks in the first interview about the failings of PHSO and the need to invest in training in order to ‘professionalise’ the staff. In the second, reported in full below, he says much the same about NHS managers and complaint teams. In a move away from previous Ombudsman responses, which preferred finger wagging to intervention, Behrens offers to extend training to NHS staff to improve complaint handling at the first-tier level. Improvements here would clearly save time, money and great distress for all parties as complaints stretch out over years without resolution. The only question is, given that neither the PHSO nor the NHS presently has the expertise, who is going to carry out the training? Just a thought. Della Reynolds phsothefacts.com
NHS managers think admitting mistakes is wrong, says PHSO
By Shaun Lintern22 August 2017
Senior leaders in the NHS have believed owning up to mistakes was not the right thing to do for too long, the new health service ombudsman has told HSJ.
Rob Behrens, the new head of the Parliamentary and Health Service Ombudsman, warned that the NHS was still too defensive about mistakes and that it failed to invest in proper complaint handling.
In a bid to show that the PHSO was willing to help the NHS, Mr Behrens said it would offer training to NHS staff next year on how to better handle complaints. He also promised no “negative press releases” but instead there would be constructive criticism and sharing good practice.
Mr Behrens said: “We have a very defensive NHS culture. We have complaints handlers in the NHS who don’t have the skills or the authority or seniority to do their job to the best of their ability, and we have an absence of flexible resolution techniques to deal with issues. These things will need to change.
“This is a big issue and I don’t have easy answers but I think one of the problems for the NHS has been a senior management view that to own up to a mistake is not a good thing to do. I don’t think the real world is like that.
“No one is saying the NHS is not a prized national asset; no one is saying that professionals don’t make mistakes, and I think with greater confidence and with a more supportive collegiate environment it is possible to create a culture in which you can deal with complaints in a less defensive way.”
He said trusts needed to understand that the PHSO was “not gunning for them” but wanted to provide redress for people unfairly treated. He added: “It is not about trying to rubbish organisations. We need to talk to people to explain that and to encourage them to take a more transparent view of these things.”
Mr Behrens said neither the NHS nor the PHSO used mediation and early resolution actions to deal with complaints, which he wanted to see introduced.
He added: “In order to contribute to the development of complaints handling in the NHS, through our strategic plan, which will come out in March 2018, for the next three years we will offer a limited capacity to complaint handlers in the NHS to uplift their skills and to demonstrate good practice to them so they can use it in their own organisations.
“It’s not nailed down yet. There’s a lot to discuss because we can’t do it on our own. What we want to do is to provide a limited amount of that training so that other people could copy it and use it themselves. I think we have the knowledge, commitment and skills to kickstart something important and that’s what I want to put on the table.”
Mr Behrens accepted that in the past the PHSO had not offered as much practical advice and examples of good practice as it could.
He said: “You won’t see any negative press releases from me. You will find me to be endlessly constructive in the context that there are examples of maladministration and poor service that have to be addressed, and I know that from talking to and looking at cases personally where things have happened that should not have happened. We won’t shy away from that but we will balance that with examples of good practice so that people can understand and take pride in things when they go well.”
A refreshing statement here from Mr Behrens, new Parliamentary and Health Service Ombudsman, courtesy of Shaun Lintern HSJ. There is an acceptance that standards have not been adequate and substantial reform is required to provide an ‘exemplar’ Ombudsman service. So far so good. But missing from this account is how Mr Behrens plans to address the damage done by years of poor performance and rectify matters for those with badly handled but now ‘historic’ cases. Listening and learning is a start but it’s not enough. Action Mr Behrens, action is required to put right the damage caused by the now accepted poor investigation processes. We watch and we wait.
Regulator chief promises new
‘rigour and consistency’
22 August 2017
The new head of the Parliamentary and Health Service Ombudsman has admitted the regulator still struggles to relate to complaining patients and families, but has pledged to bring “rigour and consistency” to its work.
Rob Behrens took over the ombudsman role in April after Dame Julie Mellor and her deputy Mick Martin were forced to resign. Their departures followed revelations by HSJ that Mr Martin had helped to cover up the sexual harassment of an NHS director and Dame Julie took no action when she was warned about his behaviour.
Whistleblowers at the PHSO had also raised concerns over the management style and “toxic” culture at the ombudsman, which is the final arbiter of complaints against NHS organisations.
Mr Behrens told HSJ the regulator’s recent history had damaged staff morale and led to a loss of confidence and defensiveness, which he was determined to tackle.
He promised to invest in staff training to “professionalise” the handling of complaints and in recent months had personally overseen complex and lengthy complaints, which he accepted took too long to close.
Mr Behrens said: “We still take too long to close cases… and critically, we have not yet found a way of relating to complainants so that we understand their cases and that relationship is key to a good outcome for the process whether or not we find for them.
“The experience of the PHSO is variable; there have been bad experiences but there have also been some excellent experiences and we have to bring a rigour and consistency to what we do to make sure where we act well that is replicated, and where we don’t act so well we address that very quickly, as we ask other bodies to do.”
Mr Behrens, who previously led the Office of the Independent Adjudicator for higher education complaints and was complaints commissioner at the Bar Standards Board, said he was confident the PHSO could be turned around.
He said: “Change had not been handled well in the organisation and this has had an impact on staff morale and one of my earliest challenges has been to talk to everyone in the organisation, to listen to their experience and to take a view about what the way forward is, given the history of the organisation. Some of that history has created a loss of confidence and a defensiveness, which we are addressing and need to turn around.
“I know from the staff surveys what the staff have thought about the leadership of the organisation. [Chief executive] Amanda Campbell and I constitute a new leadership team but this is not something that can be done by two people at the top of an organisation; it has got to be worked through, although the leaders have to set the tone for it. On the basis of what I have seen the executive team has got integrity, skill and a determination to transform this organisation. As long as they show that – and the people who work for them show that – we can move forward.
“I am confident, together with colleagues, we have what it takes to move forward and address the need for this organisation to be an exemplar of ombudsman services not only in the UK but around the world.”
Mr Behrens said in November that the PHSO would hold the first of two annual public meetings bringing together complainants, stakeholders and staff “to discuss the progress of PHSO in a public way. We have never done that before.”
There will also be £300,000 invested in training PHSO staff to help improve complaints handling, despite the ombudsman facing £24m in budget cuts over the next four years.
He said: “We have to professionalise what we do in terms of our investigative process. Amanda and I are jointly united in agreeing that there will be investment at the front end of our organisation, a big training and development programme for all staff, particularly case handlers, to reassure ourselves that we have in place a skilled team to deal with complaints.
“If we don’t do that properly, how can we have moral authority with the bodies in our jurisdiction when we are encouraging them to improve their complaint handling process?”
He added: “This is a great national institution that needs investment and needs to return to the DNA of its ombudsman roots. This is not a fairy tale; this is a big job but the transformation has begun.”
Open letter to James O’Brien LBC
I heard your frustration and absolute disbelief as you asked the question about what systems exist to hold Kensington and Chelsea council to account following their decision to close a meeting regarding the Grenfell fire because the media were in attendance. You articulated the commonly held belief that as public servants there must be means by which they are accountable and asked members of the public to phone in with suggestions. Unable to contact you at the time I have written this open letter to put you in the picture. The simple truth is there are no effective mechanisms by which any public servant can be held to account.
I heard you read out The Nolan Principles of public life, of which number four is indeed ‘accountability’ but when did you last hear of a public servant being held to account for a breach of the Nolan Principles? Never, they are not worth the paper they are printed on. In order to hold anyone to account you must have an independent body with the authority to investigate and the powers to apply sanctions. That body does not exist.
I noticed that no-one suggested going to the Ombudsman as a solution. The Local Government Ombudsman (LGO) handle complaints about local council provision and the Parliamentary and Health Service Ombudsman (PHSO) handle complaints about all government departments and the NHS. These bodies are free to use and supposedly provide an unbiased arbitration service to protect the public from the abuse of power. Except, they don’t.
In 2015/16 LGO received 19,702 complaints from the public. They investigated 4,464 cases (22.6%) and upheld 2,260 cases (11.4%). Many of the upheld cases will be for minor issues – not full uphold. Is it worth taking the trouble to make a complaint to LGO when nearly 90% result in no uphold? http://www.lgo.org.uk/information-centre/news/2016/jul/ombudsman-upholding-more-complaints-about-local-government
PHSO are even worse. In 2015/16 PHSO received 29,046 complaints, investigated 3,938 (13.5%) and upheld 1,543 (5.3%) Just a 5% chance of uphold for all your time and effort. https://phsothetruestory.com/2017/04/19/welcome-mr-behrens-here-is-your-starter-for-10-question/
Most people discover this unpalatable truth after suffering a traumatic injustice. They turn to the authorities for protection and remedy only to suffer further abuse as those in authority manipulate the facts and collude together to avoid accountability. Many have described using the Ombudsman as more traumatic than the original event. It engenders a feeling of helplessness which can trigger post-traumatic stress disorders. Imagine thousands of ‘Hillsborough’ victims all fighting their own lonely battle for year after year with no worthwhile outcome.
The Ombudsman has no powers of compliance so must ‘reach agreement’ with the public body under investigation when applying sanctions. The Ombudsman does not follow up on any recommended action plans so even when the case is upheld no-body knows whether any improvements have been made. The Ombudsman only has the funds to investigate a fraction of the cases presented (13.5% for PHSO and 22.6% for LGO) and bends over backwards to avoid uphold. Clear breaches in guidelines are passed off as ‘shortfalls’ rather than ‘maladministration’ keeping uphold rates down. It is a farce James – it would be laughable if the complainants were not vulnerable individuals already reeling from injustice.
The media have continually failed to show any interest in this national scandal but perhaps now that we can all see how easily the wheels fall off in the Grenfell Tower case more questions will be asked and the ineffective and biased Ombudsman should come under the glare of publicity as a complicit organisation which protects the guilty at taxpayer expense.
It would appear that Mr Behrens who took up his appointment as new PHSO Ombudsman at the beginning of April is ready to hear from ‘service users’ as he starts (yet another) programme of reform.
In all of this, we need to keep listening to people who use our service and be flexible, but not unprincipled, in response. I know that this is exactly what Amanda Campbell, our Chief Executive, and the Executive Team are working towards.
Keep your eye on the ‘unprincipled’ part of this response. It could well be the loophole through which PHSO will escape any obligation to deal with poorly handling historic cases. For instance, would it be ‘unprincipled’ to reopen a case against an authority where they have previously closed it without uphold? Would it be ‘unprincipled’ to hold to account individuals who may not have been at the organisation when your complaint was handled 3, 4, 5 years ago? Would it be ‘unprincipled’ to cause distress to public sector employees who have already been told they have not acted with maladministration or hold to account PHSO workers who have now left the organisation?
We must give Mr Behrens the benefit of the doubt – for now.
You can read his full statement here and do let him know exactly what you think of PHSO – after all, he is looking forward to hearing from you.
Towards the end of May I’ll be taking part in a Twitter Q&A through the @PHSOmbudsman Twitter account. If you have any particular questions or topics you’d like to us to focus on, please email them toDigital@ombudsman.org.uk
If you have any questions regarding an individual complaint please email Phso.Enquiries@ombudsman.org.uk
I look forward to hearing from you.