Between 2014 and 2016, when Katherine Murphy was CEO at the Patients Association (PA) three damning reports were issued into the work of the Parliamentary and Health Service Ombudsman (PHSO). These reports have since been removed from the PA website but contain important evidence of serious service failure. In 2014 the Patients Association took the radical step of no longer advising complainants to take their case to the PHSO on the basis it would compound their stress rather than alleviated it.
The Patients Association says it has lost faith in the service and no longer advises callers who ring its national helpline to go to the PHSO. “As one of our recent callers said, ‘You may as well ask a poacher to investigate the missing pheasants,'” says the charity in its report on the topic. Prolonged investigations, which rely on families to produce all the evidence, can lead to patients or their families having to give up their employment to deal with the demands and inadequacies of the PHSO, it says. www.bbc.co.uk/news/health 2014
In April 2017 Rob Behrens took over as the Ombudsman and has issued a new strategy ‘delivering’an exemplary Ombudsman service Any progress made by Mr Behrens under this strategy should be measured against the standards outlined in the PA reports. For this reason, PHSOtheFACTS have listed here a summary of the reports compiled by the PA in their response to the new strategic plan and full copies of the original reports linked below.
Improvement can only be measured if we maintain public awareness of the damaging flaws
identified by complainants and recorded by the Patients Association.
Patients Association response to new strategic plan.
The Patients Association exists to listen to patients and speak up for change. For over fifty years we have campaigned for health and social care services that provide safe, high quality care. We want to see a culture where transparency thrives, where patients, their families and carers are valued as expert partners, and where they and staff are empowered to raise concerns. We believe that health and social care services should be accountable, and act on feedback in order to learn and improve.
In our work we advise people on aspects of health and social care that matter to them, often when things have gone wrong and they need to seek redress. We also work with NHS organisations and others to develop new ways to deliver improved patient care.
This document gives our response to the consultation by PHSO on its new strategic plan. Its contents were submitted to PHSO via their online form.
The Patients Association issued three reports from 2014 to 2016 in which we were strongly critical of PHSO’s performance in working on behalf of patients: (November 2014); The-Peoples-Ombudsman-How-it-Failed-us followed in March 2015 with PHSO-Labyrinth-of-Bureaucracy and a final follow-up report in December 2016 PHSO-Follow-up-report-FINAL-2016
As well as providing a thematic analysis of what patients were telling us about how they felt PHSO was letting them down, these reports set out in detail the human context for these problems: they occur when patients have suffered harm, and when they and their families are in distress as a result. In the cases we reported, this distress was often compounded by the organisation that was meant to identify what went wrong, and to pave the way to redress.
We found that the reports resonated: after the publication of the first one, we received a substantial volume of new contacts from patients who had been through, or were going through, the PHSO process and wanted to report their concerns and grievances.
We called for substantial changes to PHSO, and we therefore welcome its proposed new strategy as a mechanism for bringing these changes about. Its scope and duration demonstrate a seriousness of purpose about the task, and acknowledgement of its scale, that we are pleased to see.
We summarise below the key themes from our earlier reports, and in our answers to the questions on the proposed strategic plan we will consider its response to the issues we have identified in the past.
Theme 1: PHSO’s investigations are not thorough, accurate or timely
Our reports raised multiple concerns about the fundamental quality of PHSO’s investigations:
- Many patients reported to us that PHSO’s reports on their cases contained serious factual inaccuracies, appeared to ignore evidence that was key to the events under investigation, and rested on unclear or inconsistent reasoning; they expressed doubt that PHSO’s investigators possessed the skills necessary to complete their jobs to a high standard
- PHSO’s processes were also regularly reported to involve a slow pace and poor communication, with many patients and family members having to chase hard for any update, even after a gap of months
- Some patients also report that the scope of a complaint can be narrowed without any explanation.
Theme 2: PHSO’s investigations often appear to display bias in favour of the institution under investigation and against the patient
We also reported a common perception among patients that PHSO exhibited bias in favour of the body it was investigating:
- It often appeared to fall to patients to identify in what respect the Trust’s actions had failed to comply with best practice or its own procedures, as PHSO were unwilling to act without this justification, but also unable or unwilling to challenge the Trust and identify the nature of the error themselves
- Some patients reported feeling that they were simply disbelieved by PHSO; in other instances, PHSO insisted on having ‘impartial’ evidence, and disregarded family members’ evidence while accepting that of clinicians on this pretext.
Theme 3: PHSO’s processes are not patient-centred
It was strongly evident that PHSO’s processes did not make things easy for patients and families indeed, they appeared not to have been designed with much thought for what the experience of a complainant would be. The operation of these processes can often compound this problem.
- PHSO staff were reported as asking questions of patients and family members whose answers were to be found in paperwork that already existed; or, at times, questions that could only be answered with a great deal of effort by the complainant, or not at all
- Processes often rely on patients assembling evidence (although, paradoxically, sometimes this is disbelieved in favour of a Trust’s explanation, as noted above), while PHSO reportedly does not make rigorous efforts to uncover evidence itself
- Complainants are refused the chance to meet with the person investigating their case, in order to explain their concerns, agree the remit and terms of reference of the investigation, timelines and communication pathways
- In cases when a re-investigation is necessary owing to faults with the original, families are required to re-submit the same bulk of evidence again
- PHSO shares its draft reports with families, but gives them only a week to respond sometimes to correct very serious errors and issues instructions that the report must be kept confidential, which some families report finding intimidating
- After feedback on the draft report, the final version is agreed within PHSO the process returns into a ‘black box’ rather than involving any form of consensus-building or co-production (overall this process is often seen as being weighted in favour of the NHS body under investigation)
- A substantial minority of patients reported PHSO staff’s attitude to us as dismissive or condescending, and even that they made them feel like a nuisance for complaining.
Theme 4: PHSO’s reports and findings are not successful in securing change and improvement within the NHS
Although this problem extends beyond PHSO, it can be observed that the NHS often appears not to respond and improve as a result of PHSO’s reports and findings.
The PHSO Service Charter
Most of these issues are captured in PHSO’s service charter, against which it has begun publishing quarterly data on its performance. One striking feature of this data has been the often substantial gap between the performance reported by PHSO’s own internal assurance process, and the perceptions of patients though we are pleased to see PHSO publish both sets of data alongside each other, which represents a considerable measure of transparency.
Sometimes these gaps can be in the order of 10 to 20 percentage points: for instance, under the domain ‘We will direct you to someone who can help with your complaint if we are unable to, where possible’, the assurance process reported this as being done successfully in 98% of cases, whereas patient feedback reached a figure of 81%. These discrepancies may be partly inevitable: a patient who is unhappy with an outcome, even though all processes were implemented objectively well, may still report negative feedback.
However, on a few key measures, the discrepancies are large, and concerning: specifically, PHSO has a long way to go on domains 8, 9 and 11 (reproduced below), for two of which positive assessments by patients are running at only just over half the level that PHSO’s assurance process returns. These domains are among the most crucial to the problems identified in our reports although in one sense it is reassuring that PHSO’s own work has identified broadly the same weaknesses as we found in our reports.
|Service Charter commitment
|PHSO quality assurance
|8. We will gather all the information we need, including from you and the organisation you have complained about before we make our decision||99%||52%|
9. We will share facts with you, and discuss with you what we are seeing
11. We will explain our decision and recommendations, and how we reached them
PHSO is now clearly in the early stages of a period of substantial change, which we hope will remedy the many difficulties we have previously identified, and enable it to provide explanations and redress to patients and their families in often highly distressing circumstances. We are happy to offer help and support to PHSO in this period when we can, and will, of course, look for signs of improvement in the coming years.
The latest statement from the Patients Association concerning PHSO.
Patients Association PHSO Position Statement May 2020