Just as we come to the end of the 5-year strategy of restructuring under Dame Julie Mellor the new Ombudsman, Rob Behrens, announced this week the launch of a 3-year ‘back to basics’ strategy for the Parliamentary and Health Service Ombudsman (PHSO) Before we explore the new package of promises bear in mind that PHSO is 50 years old. Enough time for 16 previous 3-year strategies to iron out any wrinkles in procedures. Also, take into account that Rob Behrens has to pull off some kind of miracle to deliver any change given that PHSO will suffer a 24% cut in funding, they have lost 70 experienced staff in the move to Manchester and taken on at least 25 new (untrained) recruits to fill the gaps and to top it all they are presently working with a significant backlog of cases waiting for assessment, investigation and review. Against this backdrop, Mr Behrens is promising to make PHSO an ‘exemplary ombudsman service’. Will this new strategy help to ‘manage our expectations’ or promise more than it can deliver? PHSO Strategy 2018 -21
Our strategy 2018-21
Delivering an exemplary ombudsman service
We want to be an exemplary ombudsman service – one that continually learns from the best of what others are doing, while contributing to improvements elsewhere across the public sector and the wider ombudsman sector. We also want to continue building public confidence and trust in our service. While the PHSO Service Charter tells us that a significant majority of people who come to us say they get a good service, we know that too many think this is not the case and there is more we must do to address this.
To improve the quality of our service, while remaining independent, impartial and fair
We will introduce new ways of working that resolve cases more quickly, improving both the quality and timeliness of our decisions and the overall experience of people making complaints.
We will invest in our staff so they are equipped to deliver a professional casework service that remains sensitive to the complex, often tragic, issues that are brought to us.
To increase the transparency and impact of our casework
We will publish more information about our casework online to help improve public services, while enabling complainants, the public and organisations we investigate to have confidence in what we do.
We will target our insight reports so that important lessons from our casework and systemic reviews contribute to raising standards in public services.
To work in partnership to improve public services, especially frontline complaint handling
We will strengthen our relationships with other ombudsman services, and collaborate with others to improve how the public sector responds when things go wrong, from sharing good practice to offering training to complaint handlers.
Drawing insights from our casework, we will work with those best placed to apply the lessons learned to improve public services.
Well, he did say to HSJ that he wanted to ‘get back to basics’ and these three objectives (as in targets to achieve) represent nothing more than the core function of any Ombudsman service. Did the management at PHSO considered the outcomes of the previous strategy before they started ‘going backwards’? Here is a summary of the 2013/18 5-year strategy with the ambitious title of ‘More impact for more people’. our-strategic-plan-2013-2018-delivering-more-impact-more-people
So there we have it. PHSO has only just completed overhauling its investigation model, setting high standards and improving productivity. Working with stakeholders and parliament to ‘shine a light’ improve complaint handling and save money along the way. So confident were they back in 2013 they gave the following prediction of success. This must be a great starting place for Mr Behrens, lucky man.
If more evidence of success were needed we can see from the much valued ‘Service Charter’ data that using these improved investigation models PHSO is able to make an impartial decision 100% of the time. Hard to improve on perfection so why does Mr Behrens feel the need to effectively negate the last five years of progress by restructuring the restructuring?
Certainly, some of the staff at PHSO feel that the continual imposition of new strategies is the very thing which prevents them getting on with their work.
There are of course some advantages to having ‘a never-ending change programme’, it means that when criticism comes your way you can promise that improvement is just around the corner and ask for patience as you put in place the glowing rhetoric of your current plan. The jam tomorrow message has worn pretty thin with those of us who have been following the ups and downs, well mainly the downs of PHSO since 2012.
But perhaps we are being unfair to Rob Behrens. He has introduced some radical new ideas. If we can just wait until 2020/21 we can all benefit from the new ‘mediation’ service for early intervention and know that staff working on our complaints are fully ‘accredited’.
In 2020-21 we will:
- Begin accreditation of caseworkers.
- Evaluate mediation and other dispute resolution pilots, implementing the most successful as part of our new ‘Ombudsman toolbox’.
- Build the approach from our pilots into our training and accreditation programme, so staff are fully equipped to use these methods.
These new tools for the PHSO toolbox require pilot studies and new measures to be created to assess success. This could take a lot longer than 2021 to be up and running particularly as PHSO has still to find a body willing to provide the accreditation. Still fifty years of muddling through without the core functions in place (apparently) what harm in taking the time to get things right?
Dame Julie Mellor, despite her grand 5-year strategy, failed to deliver in all respects. She presided over a huge backlog in casework performance, a dramatic fall in employee satisfaction, financial scandals at PHSO and resigned early from her post having acted inappropriately when informed that her Deputy Ombudsman Mick Martin had been named in court proceedings and was found to have colluded with a colleague to cover up a valid complaint whilst working in the NHS. She simply lurched from one crisis to another. how-do-you-solve-a-problem-like-dame-mellor
Consequently, both the Ombudsman and Deputy Ombudsman left the service before seeing the fruits of their labour. But what exactly was the legacy left for Rob Behrens to inherit at the end of her five-year change programme? A look at the last published Board Minutes for PHSO gives us some idea of what is going on behind the scenes and it doesn’t look good.
From September 2017 (latest published) we can see the following issues:
On the staffing issue, Amanda Campbell CEO confirmed the loss of 70 staff fro,m the London office.
9.6 Amanda Campbell acknowledged that staff had felt let down by the slow pace
of consultation and change. However some difficult decisions had been
made and only eight compulsory redundancies had been necessary, from a
reduction in staffing of over 70 posts.
Having survived the ‘cull’ there are issues with staff engagement.
9.10 The Board discussed the contents of the report. Ruth Sawtell said that it had
been disappointing to see the fall in staff engagement reported in the June 2017 pulse survey.
Amanda Campbell said that the survey had been taken in the middle of the collective consultation period at a time of maximum uncertainty. However a significant change was not expected in the October 2017 survey, as transition was still underway.
Always look on the bright side Amanda but you need to take the staff with you when sharing your vision of an exemplary Ombudsman service.
9.3 Amanda Campbell advised that there were now many changes happening
simultaneously and quickly. She said she wished to assure the Board that PHSO recognised and were managing the volume of activity across the organisation.
9.8 Amanda Campbell recognised that communications with staff about the change programme had been poor. As a result of this a weekly cascade was now in place that had received positive feedback from staff.
Oh dear, not managing change well was the same complaint from staff under the previous Ombudsman. Referring to the ‘training programme’ which is essentially the key to all the improvements put forward by Rob Behrens there was this comment.
9.12 Jon Shortridge commended the training programme but said that it must go beyond a ‘sheep dip’ approach. Amanda Campbell reported that, following the training, experienced staff should continue to support new staff. Staff were integral to the design and delivery of training, which was modular and was aimed at meeting the range of different needs. The training would eventually lead to accreditation.
No mention here that PHSO had just lost 70 experienced staff and taken on at least 25 new recruits in Manchester as their replacement. So the experienced staff must meet their targets to get the backlog down whilst supporting new arrivals who had received their ‘sheep dip’ training. However, it was recognised by Ms Campbell that the training of new recruits and the re-training of all current staff would have an impact on the backlog.
11.4 Unallocated assessments and investigations had both risen significantly since the end of Q1 and were likely to increase further as caseworkers were taken offline for training. Amanda Campbell tabled a chart showing projections that by the end of the business year there would be 788 unallocated assessments and 567 unallocated investigations. (A copy of the table is attached to these minutes at Appendix 2). The numbers would then reduce gradually, with assessments projected to be at or close to zero by August 2018, and investigations to be at or close to zero by December 2018. These projections were based on a mitigation agreed by the Executive Board on 27 September 2017, to recruit 25 caseworkers above establishment.
One minute it all relies on staff who are professional to accredited standards and the next it is deemed by the Board perfectly acceptable to take 25 people with no experience and with minimum training and have them manage complex cases where the complainant has already had a significant wait. Perhaps the following statement reveals how PHSO management ensure that staff (new and old) caught in the trauma of reallocation and restructure perform to a given target.
9.13 Julia Tabreham expressed concern about the reported rise in bullying in the pulse survey. Amanda Campbell replied that there was no increase in staff saying that they had personally experienced bullying. Rather there was a perception of bullying through performance targets and the way the consultation had been managed. The trade union side had been asked to provide evidence of incidents of bullying, but no direct evidence had been received. There was perhaps a need to be more clear about what was meant by bullying and harassment.
Ahh, just a ‘perception’ of bullying and staff not realising what ‘bullying and harassment’ really is. Well if you feel bullied I guess you would call it bullying but management know best and seem to have the only dictionary of terminology that matters. The title of their policy on casework does suggest rather a heavy hand.
11.2 Amanda Campbell tabled before the Board an extract from a presentation first made by Rebecca Marsh to the Quality Committee on 14 September 2017, on ‘Driving the Quality of Casework at PHSO’. (The presentation is attached to these minutes at Appendix 1). The presentation set out a list of areas where it was perceived that there were quality issues, and identified actions planned for dealing with three of these areas: Thoroughness,
Communications and Clinical Advice. Elisabeth Davies said that this paper had been discussed by the Quality Committee, who had focussed on the potential quality impacts of the Target Operating Model.
‘Driving the Quality of Casework’ does sound pretty hostile, particularly when you bear in mind that there is a major problem at PHSO with the technology available to do the job.
13.14 ICT was now a RED risk. A number of issues had arisen which had the potential to impact on service delivery in future. Mitigations had been agreed and were outlined in the risk register. It was recognised that PHSO now needed to carry out a full review of the ICT structure, looking at the robustness of service provision and how the systems delivered the Corporate Strategy.
Poor things, they have yet to receive all the new training and wisdom brought to PHSO by a real Ombudsman, Prof Behrens CBE but already they are being ‘driven’ to perform without the IT systems to support their work. And what of Mr Behrens the real Ombudsman, how did he share his vision with the Executive Board in order to lead the way to an exemplary service. Only one statement in the entire meeting was assigned to the man himself and you can see it below.
10.5 Rob Behrens highlighted his series of engagement meetings with staff. These had been very productive and the output from the meetings would be fed into the strategic plan for 2018-21.
Now that sounds familiar. Mr Behrens regularly has ‘productive meetings’ even if no-one else agrees with him. Can’t possibly be his fault then that the sickness levels at PHSO have gone through the roof.
13.2 The Board were concerned that PHSO were very close to the sickness absence
target. Gill Kilpatrick said that PHSO were looking at this very closely to understand the trend.
Mmm, Board has no idea why staff are going off sick. Could it possibly be linked to rapid and repeated change, loss of experienced staff, lack of essential IT resources and a hostile working environment? They will have to ponder on that one.
Given this is the current state of affairs at PHSO it is difficult to have any confidence that the new 3-year strategy will be any more successful than the previous 5-year strategy. But the real benefit of a change programme is that it helps to boost public confidence and stops critics in their tracks by saying ‘we are doing something’.
PHSO – a continual journey towards excellence
which never arrives.
You have to worry when the Ombudsman asks the citizens to explain the ‘point of complaining’ but let me set that in context. PHSO have actually asked film students to put together a 45-second film on the title ‘What’s the point of complaining’ and enter a competition to win a cash prize of £400. If anyone could educate the Ombudsman on this subject with a single 45-second film then it would be worth a lot more than £400. film-competition-whats-point-complaining Let’s see what the Parliamentary and Health Service Ombudsman (PHSO) have to say about their complaint handling service.
We were set up by Parliament to provide an independent complaint handling service for complaints that have not been resolved by the NHS in England and UK government departments.
We share findings from our casework to help Parliament scrutinise public service providers. We also share our findings more widely to help drive improvements in public services and complaint handling. about-us/who-we-are
So according to PHSO they provide an ‘independent’ complaint handling service for citizens with complaints about government bodies and the NHS. In fact, they are the only body who handle individual complaints apart from the occasional investigation by NHS England and the even more occasional public inquiry. They give resolution to citizens caught in a dispute with public bodies and they also ‘drive improvements’ by sharing the findings of their investigation reports and so preventing further harm. So far so good.
On Monday 26th March 2018 Southern Health Foundation Trust pleaded guilty to criminal charges of negligence and harm caused by a failure of its health and safety management systems. The trust accepted;
“It is a matter of significant regret that between April 2011 and spring 2016 the Trust did not adequately address the quality and safety, governance and assurance challenges it faced in a timely and robust way.” (28)
The court judgement concluded;
From the perspective of the Court, it is not merely a matter of regret but of very grave
concern that the endemic failures disclosed by the investigations following the
avoidable deaths of TJ and Connor were allowed to arise at all and to persist for so
long. That concern is heightened by the failure to have learned any lessons or to have
addressed the systemic failures adequately or at all between April 2012 and July 2013,
for which there appears to be no excuse at all. (29)
Southern Health Foundation Trust suffered from ‘endemic failures’ which caused actual bodily harm to patients in their care, for at least five years, for which no lessons were learned. So how come the Ombudsman (PHSO) didn’t detect and share these endemic failures with parliament to drive reform given the length of time it continued and the large number of people affected. (722 unexpected deaths over 4 years with only 272 properly investigated) bbc.co.uk/
During the time of endemic failures at Southern Health (2011 – 2015) the Ombudsman received 164 complaints from members of the public. These complaints should have raised concerns but PHSO investigated only 16 of these cases, (9.7% of the total submitted) and upheld to some degree just 5 (3.0%) This low uphold rate goes some way to explaining why issues at the Trust persisted for so long, causing avoidable death and suffering to many and why ‘no lessons were learned’.
In February 2018 another scandal broke this time concerning Liverpool Community Health NHS Trust (LCH) An investigation by NHS Improvement found that between 2010 and 2014;
Patients suffered “significant harm” because of multiple serious failings by a “dysfunctional” NHS trust… Liverpool Community Health NHS trust (LCH) provided poor, unsafe and ineffective care to patients, including inmates at HMP Liverpool, the scathing report concluded.
“Patients put their faith in the NHS, and they should be able to trust that dangerous and dysfunctional services will be dealt with immediately. Sadly that has not been the case here and it took the help of a local MP to sound the alarm, and many years for the full facts to emerge,” said Jeremy Taylor, chief executive of National Voices, a coalition of more than 150 health and social care charities.
Dangerous and dysfunctional services delivered by LCH without redress for at least a four year period. Surely some of the people who suffered would have made a complaint to PHSO. The table below shows that from 2010 – 2014/15 the public made 43 complaints to the Ombudsman. These figures demonstrate a steep rise from 2012 onwards yet the Ombudsman investigated just 5 cases (11.6%) and upheld none (0%) in this time period giving LCH an unblemished record. Since 2010 the Ombudsman has partially upheld only 1 complaint against LCH giving a green light for dysfunctional services.
In these two instances, the Ombudsman (PHSO) failed to provide redress for the vast majority of those who made a complaint. (97%+ with no uphold) But more alarmingly it failed to spot and rectify serious, dysfunctional bodies who were able to deliver harmful services to the public for prolonged periods without redress. In short, the Ombudsman failed in both the specific aims of its given remit. Which begs the question,
‘What is the point of complaining?’
and at a cost of £37m per annum,
what is the point of PHSO?
A primary responsibility of the state is to protect its citizens from harm. So what happens when the state is the body causing harm and those in authority collude together to cover up? In the UK we like to believe in ‘British fair play’; a somewhat bureaucratic but essentially benign system of checks and balances to put things right. After all, we have shared our model of democracy and our legal system across the world so who could doubt the efficacy of British rule?
Yet anyone who has made a complaint about a public service will have learnt that the machinery of the state is used against the citizen, not for the citizen. Those who have not made a complaint will not want to know this bitter truth and will not believe a word of it. And there is the dilemma. What right-minded person would go about telling all and sundry that various government authorities have conspired against him? Clearly, only a delusional trouble-maker would dream up such a tall story.
Meet Mr Hawkins. A brave campaigner for truth and justice who told such a story to his MP Andrew Gwynne, shadow minister for communities and local government. In an unusual twist of events not only did Mr Gwynne believe his constituent, he felt so strongly that Mr Hawkins had been let down by multiple agencies for over a decade that he brought it to the attention of parliament at a recent ‘backbench’ meeting in Westminster Hall. You can read the full details here
Sadly, I have to publicly outline how my constituent, Mr Hawkins, has been let down by public authorities. The law and NHS rules have been abused to avoid giving him the justice that is rightfully his. His attempts to seek that justice, along with some semblance of honesty and humility, have already passed the decade mark, so I shall be grateful for the Minister’s reply after I set out the case.
Did you get that – “…the law and NHS rules have been abused [by the state] to avoid giving him the justice that is rightfully his.”
Mr Hawkins was given surgery on his ruptured Achilles by a junior doctor instead of the allotted clinical surgeon in order to ‘meet government targets’ and following a serious clinical error which left him in great pain he was discharged too soon also to ‘meet government targets’.
Mr Hawkins immediately made a complaint through the hospital trust’s internal complaints procedures. He believes that on receipt of his letter of complaint, the trust should have called him in for an examination and a scan. It should have admitted that a serious problem had occurred and carried out a further operation to release the Achilles tendon from the rear of his leg. In Mr Hawkins’s mind, the matter would then have been resolved. However, the trust decided to take a different route: it instantly instructed Hempsons solicitors.
So easy to put things right at this early stage yet the state used public funds to protect itself against a genuine complaint. Clearly, Mr Hawkins wasn’t expecting this.
Although, obviously, Mr Hawkins is concerned about the clinical errors that have caused him lasting damage, he is rather more appalled by the actions of a variety of organisations afterwards. He believes that those actions were deliberately designed to cover up the fact that a clinical mistake had been made, caused primarily by the replacement of a consultant surgeon with a junior doctor.
“He believes that those actions [by the state] were deliberately designed to cover up the fact that a clinical mistake had been made…” Why would the state deliberately design such harmful action?
Now that the complaint is in the hands of a legal team Mr Hawkins has little option but to appoint his own solicitor who then uses him as a cash cow and appears to work in cahoots with the NHS legal team.
In 2008, Mr Hawkins instructed a solicitor, who requested disclosure of all full medical records. The trust passed his request on to Hempsons. However, in the immediate period after his request he received only a very selective number of his own medical files from Hempsons. Mr Hawkins’s solicitor failed to ensure that all full medical evidence was disclosed within statutory time limits and failed to apply for a court controlled disclosure, while knowing that the records he had listed were missing. Mr Hawkins’s solicitor instructed a clinical litigation medical expert, who produced a case-closing report that failed the objectivity test and was therefore invalid. The trust and Hempsons initially failed to disclose relevant medical records, doing so only after continued and considerable pressure from Mr Hawkins.
“Mr Hawkins’s solicitor instructed a clinical litigation medical expert, who produced a case-closing report that failed the objectivity test and was therefore invalid.”
State corruption provided lucrative work for ‘the legal boys’ who could act with impunity knowing that there is no effective mechanism for a member of the public to hold a solicitor to account.
In 2013, the trust eventually conceded and his remaining medical records were fully disclosed. On analysis of the records, it was plain to see that there were omissions and that pre-action protocol time limits had been exceeded. In response, Hempsons sought the opinion of a medical litigation expert. A report was produced, but it was based on the selected medical records that I mentioned earlier, as well as on the falsified information. Mr Hawkins believes that that report would fail any objectivity test and is therefore invalid.
Let’s just get this straight. The NHS Trust deliberately and willfully withheld medical records demanded under the legal pre-action protocol time limit and falsified other information. A criminal offence, yet no-one is held to account. Instead, the solicitors working [from the public purse] to protect the trust were able to produce a ‘whitewashed’ report in order to deny justice.
Withholding records is a breach of the Data Protection Act 1998 but the state body responsible for protecting the citizen from such breaches, the Information Commissioner’s Office is slow and cumbersome with no real powers of coercion.
Mr Hawkins also believes that the Limitation Act 1980 was breached from 2008 and that rules 31 and 35 of the Civil Procedure Rules 1998 were breached in compiling medical reports, because the medical experts failed in their duty to the court to be objective.
More breaches of the law and regulation by the trust and their legal team which required action from the state to protect the citizen but the body charged with finding against such ‘maladministration’ the Parliamentary and Health Service Ombudsman refused to investigate leaving him high and dry.
The delays in disclosure of information meant that Mr Hawkins’s complaint to the Parliamentary and Health Service Ombudsman was ruled out of time. My constituent believes that that makes a mockery of the trust’s failure to disclose his medical records within statutory time limits, which he believes the ombudsman ignored while upholding the strict time criteria regarding his making a complaint to the ombudsman. Mr Hawkins appealed the decision on several occasions when the evidence was retrieved through the Information Commissioner. However, he was unsuccessful in overturning their original view that a letter from the trust indicated that the complaint was closed in 2007, which he utterly refutes. Hempsons later apologised and admitted that that letter did not clearly state that the local complaints procedure was closed. However, the ombudsman still refused to investigate the complaint and, in doing so, Mr Hawkins feels that the ombudsman has assisted the trust to conceal the cause and effects of a clinical error.
The Ombudsman has total discretion to investigate a case which is outside the normal 12-month time limit yet it refused to do so and even refused to accept the evidence that their initial decision to time-out the complaint was flawed.
“However, the ombudsman still refused to investigate the complaint and, in doing so, Mr Hawkins feels that the ombudsman has assisted the trust to conceal the cause and effects of a clinical error.”
Unrealistic and inflexible NHS targets caused harm to the citizen. Then publicly funded legal teams dragged their heels, refusing to release records and fabricating evidence in breach of legal protocol. The Ombudsman then ‘assisted the trust’ by refusing to investigate clear breaches of policy and procedure.
Mr Hawkins then appealed to the NHS Litigation Authority only to find that they too were in cahoots with the trust and the legal team.
In 2013, Mr Hawkins wrote to the NHS Litigation Authority, as the trust was not reporting clinical mistakes. Initially, the NHS Litigation Authority would not get involved and requested my involvement, as Mr Hawkins’s Member of Parliament, which I duly offered. Two replies were received that indicated that the NHS Litigation Authority was involved in the case, despite previous assertions and written evidence that it was not involved. Mr Hawkins was notified in writing that the trust, on receipt of his letter of complaint, had instructed Hempsons in January 2007, with the NHS Litigation Authority directly instructing Hempsons and the trust from November 2007 to February 2009.
Hempsons was aware of a breach of the Limitation Act 1980 and the Data Protection Act 1998 when it disclosed to Mr Hawkins his missing medical records in October 2009. This means that the trust and Hempsons had illegally avoided disclosing all full medical records within statutory time limits and successfully passed the three-year limit for litigation. Mr Hawkins believes that indicates that the NHS Litigation Authority was aware that rules had been broken, yet failed to take retrospective action based on the strength of the evidence that he had disclosed to it in 2013.
“… the trust and Hempsons had illegally avoided disclosing all full medical records within statutory time limits and successfully passed the three-year limit for litigation.”
A state body and a state-funded legal team committed illegal actions in order to deny justice to the citizen with the support of the NHS Litigation Authority and the complicity of the Ombudsman.
The actions taken by the trust, assisted by Hempsons and the NHS Litigation Authority from January 2007 to December 2013, clearly indicate that the trust was covering up a clinical incident and its cause. With so much time having passed since my constituent first exited the operating theatre in the summer of 2006, I hope that today the Minister of State will be able to afford Mr Hawkins guidance and support in this matter, and finally bring to some closure what has been a dreadful episode for my constituent.
You may expect the Minister to be horrified that various state-funded bodies had conspired to deny justice to a citizen harmed by the state in the first instance but Stephen Barclay, Minister of the department of health and social care was having none of it. He used the usual caveats which allow politicians to show a clean pair of hands by stating that the NHS complaint system and the work of the Ombudsman are independent of government. Also, that it was not for the DoH to discuss individual cases.
If the bodies set up by government fail to protect the citizen who is to take them to task if they are deemed ‘independent’?
Then Mr Barclay casts aspersions on the validity of the claims and in doing so discredits the complainant.
As you are well aware … the NHS complaints process operates independently of Government, to prevent political bias in the handling of individual complaints. However, a number of points arise from the hon. Gentleman’s remarks, in respect of his contention that Mr Hawkins was let down by a number of individuals and organisations within the NHS. Specifically, it is alleged by Mr Hawkins that the hospital failed him by prioritising then Government targets, which delayed his operation; that the clinician failed him through clinical error; that the duty surgeon failed him by falsely reporting that his wound had healed; that the hospital failed him by not correcting the alleged mistake and by instructing lawyers; that Hempsons solicitors failed to disclose full records; that his own solicitors failed him by not obtaining his records; that his own clinical medical expert failed him; that the hospital failed him, regarding his report; that the Ombudsman failed him; and that the NHS Litigation Authority failed him.
Although the Department of Health does not comment on individual cases, and it is not for me to adjudicate whether all of those claims by Mr Hawkins are valid, it is worth noting that a very wide range of both individuals and organisations are alleged by Mr Hawkins either to have conspired against him or, indeed, to have failed him in this matter.
“… it is not for me to adjudicate whether all of those claims by Mr Hawkins are valid, it is worth noting that a very wide range of both individual and organisations are alleged by Mr Hawkins either to have conspired against him or indeed, to have failed him in this matter.”
Mr Hawkins provides us with a typical case study of state corruption and the misuse of power. This happens to thousands of people every year. But if they chose to speak out about the deliberate corruption and collusion of state bodies it marks them as a delusional fantasist or vexatious troublemaker. Who would believe that state-funded bodies would conspire in such a concerted and prolonged manner? Yet, to not speak out is to be complicit in the state violation of human rights. So the brave or the foolish speak out and become victims of the state all over again.
Let’s give the final word to the Minister, Stephen Barclay.
It is equally important that patients and their families are listened to and their concerns taken seriously and addressed.
That would be all the concerns which don’t indicate a deliberate cover-up and collusion by the state then Mr Barclay.
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.
Jeremy Hunt, the Health Minister used the Sunday Times to share his rebuke of Dame Julie Mellor, Parliamentary and Health Service Ombudsman for insensitive treatment of bereaved families when dealing with their NHS complaints.
Hunt added: “When sometimes things go wrong, we need a humane complaints system which provides redress and does not feel like a faceless bureaucracy.”
It is unusual for a Minister to publicly criticise the Ombudsman, an organisation set up to be independent and effectively self-governing. Mr. Hunt however felt so strongly that he has referred the matter to PACAC, the Public Administration and Constitutional Affairs Committee who monitor the work of the Ombudsman service.
He has demanded that Mellor make an unreserved apology to Titcombe and other bereaved families and has referred the ombudsman to the Commons public administration and constitutional affairs committee.
There is a good deal of finger wagging going on here, but as neither PACAC nor Mr. Hunt have the power to take any direct action it will be down to the Ombudsman and her team to put the matter right. The blind leading the short-sighted.
A dysfunctional organisation is incapable of reform
due to its own dysfunction.
The first step to reform is insight into your own strengths and weaknesses. This is sadly lacking at PHSO where recent negative feedback, collected in preparation for a new service charter, has been dismissed as delusional myth in their new #mythbusting project. Apparently you can make all the bad comments go away by using a toothy cartoon monster to cut them down to size.
Daniel Newman, business professor and best selling author, warns of the dangers of a dysfunctional management team who can literally suck the life out of any organisation.8-signs-dysfunctional-management Among the signs to look out for he includes;
- Narcissistic: When management (individual or as a whole) is obsessed with their individual success, it is a huge red flag. To lead, management must serve those on the front line. Upon driving performance, management will get their due recognition. However, when the sole purpose is to feed the ego and support the growth of management you can count on rampant dysfunction and less then desirable results.
If a sign of dysfunction is the growth of management to the detriment of front line delivery then this complex PHSO management chart screams a red flag warning. PHSO/Org-Chart-July-2015
Complex management structures diffuse decision making and accountability, resulting in no-one having the least idea who is responsible for what.
- Non-Committal: Strategy of the week, the day or the hour? It is a terrible feeling for an employee to feel like their direction is changing faster than the weather in Chicago. While change can be adapted more rapidly in a stronger culture, in a weak or dysfunctional culture the fragile nature of the employees can be broken by even positive change.
Both the Director of Strategy and Insight and the Director of Quality and Service Integrity were present at a recent PHSO meeting (April 2015) where staff concerns were discussed.
- Staff Engagement
- There have been listening sessions with the staff to do three things: say thank to staff, discuss our role and listen to what the workforce has to say
- A significant number of staff are dissatisfied about the way that change has been imposed at pace
- Some staff think we have lost sight of our role and core purpose
- The workforce wants us to explain how the new method and approach are supposed to work
- Staff want us to respond more robustly to the external criticism and ‘fight our corner’.
It is perplexing to find that the staff at phso do not understand how the new method and approach work given that they have been part of this change programme since 2013. Sharing a common understanding should be the starting point, not the end point. Not to worry though as the Director of Quality and Service Integrity is able to clarify the situation.
- The Director of Quality & Service Integrity presented his paper to the Board and advised that the underlying rationale for the Integrated Change Programme is that staff often feel that change is ad hoc and unplanned (even when there has been sound planning), so there is a need for something that is explicitly and demonstrably cohesive and integrated.
So that’s all good then. Until the Chair sums up with the statement that;
- Quality – we need to be sure what we’re trying to do before we can assess whether we’ve achieved it.
Which brings us back to the start, no wonder the staff are confused. Damning Staff Survey 2015
- Turn-Over: Are you seeing a revolving door of people coming and going? This is a really bad sign and something that needs to be quickly rectified. If employees are leaving, whether by choice or not, then you can be fairly certain that management is dysfunctional. Hiring is never an exact science and the elimination of low performers is important. However, companies with high turn-over are often seeing this due to weak culture and poor leadership. The rapid change of people is a Band-Aid by management to cover up for a much bigger problem which they can find in the mirror.
Staff turnover for public service organisations is generally less than 12% per annum. In 2013/14 the staff turnover for PHSO was 21.3%. Despite a pledge to address this issue from the Ombudsman herself, it remained at 21.7% for 2014/15. staff_turnover_at_phso
- Passive-Aggressive: Whether it is showing up late to meetings, forgetting to share important details, or consistent excuses for not getting things done. These behaviors are damaging in all cases. For instance, the late arrival to a meeting once can be an accident. Regularly showing up late is a sign of indifference and can likely be a sign that the person doesn’t care about or for what the meeting is about. In strong cultures this behavior is nipped in the bud, but in a dysfunctional environment this can be seen throughout the workplace.
Failure to meet deadlines is a common occurrence at PHSO. At the end of the financial year, they release their annual report and accounts. Each year the wait for the data grows increasingly longer. According to the April minutes the first draft was ready in early May. It is now September and the final draft has yet to emerge from the intricate layers of management and bureaucracy.
Mr. Hunt was right to point out that PHSO was failing to deliver a humane complaints system. It is also failing to investigate complaints in any robust manner, failing to improve service delivery and regularly failing to deliver to an agreed time scale.
If PHSO were a failing school the government would not hesitate to remove the entire management team within a week.
Words are good Mr. Hunt, action is better.
Following the Kirkup Inquiry into events at Morecambe Bay Maternity Unit where mothers and babies died unnecessarily; James Titcombe and other members of MBIA called for the resignation of the Ombudsman, Dame Julie Mellor. morecambebayinquiry James writes on his blog;
“We must also mention that of all the organisations involved in the events at Morecambe Bay, the Health Service Ombudsman have been by far the most incompetent. The Kirkup report refrains from strong direct criticism of the Health Ombudsman, but a careful review of the report by anyone knowing the full history of their involvement reveals some damning truths. Time and time again we feel that the Ombudsman’ Office has shown the wrong culture and has acted in an indefensible way.”
“Today our families wish to lead the call for Dame Julie Mellor to resign so that new leadership can start to change this culture and recover the shattered creditably of this organisation. The many patients who have been forced to experience this tier of the NHS complaints system deserve nothing less.”
Before the ink was dry, more damning revelations were put in the public domain by Shaun Lintern from HSJ. Which can be read in full here: phsos-capability-questioned-after-morecambe-bay-report
A particularly telling quote from Bernard Jenkin, Chair of PASC stated that:
“There is absolutely no dispute that there is a lack of capacity for immediate, objective, independent and confidential investigative capacity into clinical incidents. The capacity simply does not exist and there is confusion about who is responsible for what.”
“The PHSO was never set up with clinical incident investigations in mind. It is not a system we are going to recommend that patient safety relies on.”
James continues with;
“If it wasn’t for the Kirkup inquiry the decision of the Ombudsman would have been the final word. It would have vindicated the individuals involved and their behaviour as well as reinforce the poor culture. That is the opposite of what the PHSO is supposed to do and increases the chance the same thing will happen again. It is dangerous and only a few weeks ago the Ombudsman said in a statement that they stood by the quality of their investigations. The actions of the PHSO are disgraceful. They have revised their statement only after Bill Kirkup intervened. I think Dame Julie should consider her position.”
So is Dame Julie Mellor a fit and proper person to lead PHSO through its modernisation programme?
Let us look at the evidence.
A member of the establishment with an entry in Debretts Julie Mellor was awarded a DBE in 2006 and took office as the Ombudsman in January 2012 following a partnership at Price Waterhouse Coopers (2005 – 2011) wikipedia
“Julie has a reputation for strong leadership, including turning around failing public bodies and supporting staff teams to deliver more effectively and efficiently.” (From CV to PASC) publications.parliament
She was to be a ‘new broom’ brought in to replace Ann Abraham whose tenure had been tainted by events at Mid Staffs Julie Bailey comments on PHSO and suggestions of collusion with CQC over baby deaths at Morecambe Bay.
So what has Dame Julie achieved in the last three years?
Starting with ‘listening to customers’ it is not clear what progress was made between January 2012 and April 2013, presumably discussion took place concerning the newstrategic-plan which was announced in November 2012. The central thrust of this plan was to provide ‘more impact for more people’ and it was decided that PHSO would investigate up to 10x more cases; a plan launched on 1st April 2013. more-investigations-for-more-people
By the end of 2013 with news that PHSO were investigating 4 x more cases Dame Julie released this update;
“As well as carrying out more investigations, another of our aims is to make sure that we have a strong voice in the debate about the reform of the complaints system across the public sector. “ end-of-year-message-from-the-ombudsman
Shame that this ‘strong voice’ was not in evidence during a recent Radio 4 interview on 7.2.15 Following the disclosure from PHSO that 40% of NHS investigations were inadequate, Dame Julie was asked by James Naughtie what should be done about poor NHS complaint handling and she replied,
“Ultimately up to the health sector to explore and understand why these investigations are not happening and work together to make sure they can get more consistent investigations in the future.”
By February 2014 it was announced that the Ombudsman was now handling 8 x more complaints than the previous year and in May 2014, as we entered a new financial year, there was a promise to virtually double the previous number of complaints investigated which stood at 2,199 for 2013 – 14.
“Our ambition is to investigate around 4,000 cases a year by the end of 2014-15.”
This was an ambitious target indeed given that the numbers of front-line staff had actually decreased from 131 to 122. investigative_staff_levels
Latest figures show that Dame Julie is on track to meet her target with 3,085 investigations completed in January 2015. januarys-performance-statistics However this push to carry out more investigations has come at a heavy price. There appears to be a major rift between management and front line staff which was clearly highlighted in the 2013 staff survey where confidence in senior managers fell from 60% to 19%.
Although required to adopt new ways of working and a significant increase in workload, front line staff were not allocated any specific funds for training as part of the strategic plan. money_spent_on_training Instead under the stewardship of Dame Julie £120,000 was spent on board development and leadership coaching for three senior members of staff. This contract was awarded to Rosemary Jackson Consulting, a previous colleague of Dame Julie and led to a rap over the knuckles from the NAO. health-ombudsman-was-investigated-over-contract-failings
There continue to be questions raised about how contracts are awarded and finances monitored at PHSO, as revealed in these FOI requests. whatdotheyknow.com/request/silver_bear_ltd and whatdotheyknow.com/request/phso_individual_directorate
Dame Julie Mellor also set up a new ‘Unitary Board’ on arrival at PHSO.
“The Ombudsman has chosen to appoint executives and non-executives to a unitary, decision-making Board to provide robust governance and assure Parliament of the effectiveness and efficiency of the organisation. The core purposes of the PHSO Board are to lead, provide stewardship, and to preserve and build our reputation.” the-board
The board consists of 8 members, four senior staff and four non-executives and is chaired by Dame Julie herself. board-members She has ultimate control over the board which scrutinises the work of PHSO.
“The Ombudsman is accountable to Parliament through the Public Administration Select Committee. To reflect her statutory accountability the Ombudsman has the right to disagree with the Board’s decisions but will do so as a last resort and put her reasons in writing to the Board.”
This whole set up smacks of cronyism and effectively puts Dame Julie in charge of holding herself to account.
When Steve Jobs was asked to go back into Apple to save the company from bankruptcy, one of his first moves was to request that everyone on the board resigned. He bluntly stated that he could either turn the company around or ‘wet nurse’ the board but didn’t have time to do both.
We need a ‘Steve Jobs’ as our new Ombudsman and if this public body is ever going to radically reform its service delivery then the entire board and most of the senior management, (who let’s face it have stood by mute) must resign along with Dame Julie.
The scrutiny board should be capable of scrutiny and should consist of front line staff, representatives from the union, advocacy group representatives and interested lay people in a 50 – 50 split with senior staff.
It could be argued that Dame Julie has hit her target,
but has she missed the point?
Personal opinion on the new Ombudsman Service Charter: Della Reynolds coordinator of the PHSO Pressure Group.
Last Monday I attended the third user panel meeting to contribute to the new Service Charter aimed at bringing PHSO in line with the expectations of today’s citizens. This project is being supported by OPM, an independent, not for profit, research organisation who plan to leave no stone unturned.
- There are two panels one for complainants and one for advocacy groups. Each panel meets four times.
- There is a targeted survey sent to customers, staff, organisations the PHSO investigate and consumer advocacy groups.
- Six in-depth interviews with customers to understand their complaint journey.
- Four customer workshops in London, Birmingham and Manchester.
- On-line surveys and discussion of key issues.
- All wrapped up in an interactive, dedicated website; ombudsmanservicecharter.org.uk
At this third meeting we were asked to describe what ‘good’ looks like and write ‘positive’ statements onto little sticky notes. To be honest the negatives crowded my mind more easily, but I was happy to partake of a little ‘blue sky thinking’ if it would help drag this organisation into the 21st century. Soon the sticky labels started to pile up, yellow, orange, green; packed with cliché they included words such as ‘independent’, ‘impartial’, ‘evidence based’, ‘transparent’ ‘honest’ …. I’m sure you get the picture. Our ideas were then discussed, categorised and collated onto wall charts; all part of the journey towards a fair and accountable complaint handling service.
As I went home on the train, tired but satisfied that I had done my bit for the greater good, I started to read ‘My expectations’ otherwise known as the PHSO ‘Vision Report’. Published in November 2014 this document was produced in response to the government’s ‘Hard Truths’ which in turn came on the back of the Francis’ inquiry into the failings at Mid Staffordshire. PHSO along with LGO and Healthwatch England set about creating a vision which, “…aims to align the health and social care sector on what good looks like from the user perspective when raising concerns and complaints about health and social care.” Mmmm, sounds familiar.
In order to produce this ‘outcomes framework’ PHSO employed the services of ESRO Ltd esro.co.uk to carry out the primary research and analysis. ESRO set about the task by consulting widely on the issue with;
- Unique primary research with over 100 patients and service users.
- Input from representatives from over 40 different organisations across the health and social care sectors.
- A desk-based examination of live complaints systems in various settings including hospitals, GP surgeries, local authorities and care homes.
- Exploration of best practice in the commercial sector.
- In depth interviews and discussion with pre-existing patient and service user groups.
- Workshops for front-line staff, complaints service managers, policy makers and executives.
No doubt all were encouraged to imagine what ‘good’ looked like as they wrote ‘I statements’ on coloured sticky notes.
“These statements present a model of good outcomes that can be easily understood by all patients and service users, as well as by staff at all levels within an organisation.”
So there we have it. Just last year this particular wheel was honed to perfection, yet here we are re-inventing it from scratch. Let’s take stock and see what ‘good’ looks like in this context.
We are very good at;
- Employing glossy, private companies to carry out research.
- Asking questions.
- Collating answers.
- Writing reports.
- Making recommendations.
- Spending money.
We are in fact exceptionally good at all of the above. Let us review some of our progress so far:
- NHS Complaints Reform: Making Things Right (2003)
- Principals of Good Complaint Handling (November 2008)
- Complaints about privately funded and privately arrange adult social care. (2011)
- Aiming for the best – using lessons from complaints to improve public services. (2011)
- Principals of integrated care (2011)
- What people think about complaining. (2012)
- Patients First and Foremost (March 2013)
- The NHS hospital complaints system. A case for good treatment. (April 2013)
- Fear of raising concerns about care. (April 2013)
- Designing Good Together (2013)
- A Review of the NHS Hospitals Complaints System: Putting Patients Back in the Picture. (October 2013)
- Improving the health and social care complaints systems (November 2013)
- Good practice standards for NHS Complaint handling (2013)
- Hard Truths (January 2014)
- My Expectations (November 2014)
So why are we still asking what ‘good’ looks like? We know what it looks like even though we rarely see it in practice.
The missing link is the ability to turn any of these heartfelt words into action.
There is, however, one significant difference between the Service Charter and any of the previous reports which makes this process worthwhile. This is the first time that the Ombudsman service has been put under the spotlight. Generally good at wagging a finger from the shadows, the role of the Ombudsman has been painfully highlighted by the Patients Association damning report PHSO-The-Peoples-Ombudsman-How-it-Failed-us the work of the Pressure Group phsothefacts.com and James Titcombe’s continual search for answers as to why PHSO refused to investigate the death of his baby son at Morecambe Bay in 2010. patientsafetyfirst.wordpress.com The Kirkup Inquiry, due to report soon, will undoubtedly provide further insight into the way PHSO contributes to this dysfunctional complaint process.
Once the Service Charter is complete the real work begins of bringing these words to life and the enemy is inertia.
“Every body continues in its state of rest, or of uniform motion in a right line, unless it is compelled to change that state by forces impressed upon it.” Isaac Newton
PHSO must be compelled to change through public outcry, media spotlight and the active participation of parliamentarians to finally deliver a ‘People’s Ombudsman’ fit for a modern, democratic society.
Well that’s what ‘good’ looks like to me.