Coalition of Health Campaigns visit the BBC

Joint Press Release from PHSO the Facts and Heal the Regulators. 

Several senior journalists at the BBC international headquarters in the New Broadcasting bbc-logo-oHouse responded to invitations from two major campaigns, PHSO the Facts and Heal the Regulators, and met with their senior representatives in three separate meetings on Thursday 22 May 2014 (Super Thursday) regarding the Ombudsman and the regulators.

The journalists concurred with the two campaign groups that the high profile issues have wide public significance which affect all 65 million British people.  The serious issues are numerous, but can be grouped into three key ones:

1. The Ombudsman and the regulators have failed a large number of citizens

2. The Ombudsman and the regulators have failed a large number of professionals and practitioners

3. The Ombudsman and the regulators needs to be reformed (as stated in various reports from the Parliament, including the most recent one published by PASC, which suggested a People’s Ombudsman).

Senior professionals commented that in the history of campaigning, it seems that PHSO the Facts and Heal the Regulators are the only groups who managed to meet with the “heavyweights” in national press and media all in one day. The senior professionals felt that this milestone was achieved because the issues are of national importance and they hoped that the Prime Minister and Government Minister will soon be willing to meet with the campaign leaders as well.

Since Super Thursday (22 May 2014) at the BBC international headquarters, various national newspapers, TV stations and radio stations are becoming interested in PHSO the Facts and Heal the Regulators. We have a new meeting at the BBC (with another “heavyweight”) and a meeting with the Evening Standard next week.

What is unique about the two campaign groups, PHSO the Facts and Heal the Regulators, is that they are run by highly qualified, widely published and well-connected senior professionals. This is quite unique in the world of campaigning. This fact, combined with the fact that these two campaign groups promote compassion, kindness and wisdom, means that their work will flourish and last for decades to come. Compassion, kindness and wisdom will always exist and can never be destroyed, no matter how strong the bullying and victimisation.

 

 

Members of PHSO Pressure group attend D.o.H stakeholders meeting.

Stuart Finch from phsothefacts and Peter Walsh from AvMA

Stuart Finch from phsothefacts and Peter Walsh from AvMA

On 21st May two members of the PHSO Pressure Group attended the Department of Health’s stakeholder meeting to discuss the proposed legislative changes to the regulation of Health and Social Care professionals.

 

The regulatory bodies within the remit of the project include:

  • General Chiropractic Council
  • General Dental Council
  • General Medical Council
  • General Optical Council
  • General Osteopathic Council
  • General Pharmaceutical Council
  • Nursing and Midwifery Council
  • Pharmaceutical Society of Northern Ireland

The project also covers the legal regulation of the Professional Standards Authority, which oversees the work of all nine regulators.  None of these bodies come within the remit of the Parliamentary and Health Service Ombudsman.

Here is our summary of the meeting:

It is obvious that the healthcare professionals come to complaint handling from a different perspective when they use terms like ‘complaint disposal’ without flinching.  They give the impression that although the regulatory system isn’t perfect, by and large it works quite well dealing with the complaints that reach investigatory panels.  What they ignore is the dam which holds back huge numbers of valid complaints from coming anywhere near scrutiny.  They state with certainty that ‘not everyone can have an investigation’ without considering for one moment the damage caused by turning complainants away with no acknowledgement and no remedy.  
It became clear that the professional lady in our discussion group, who carries out some regulatory work for the GMC, approached the task with two certainties.  That the vast majority of healthcare professionals were competent and decent people and that the regulatory system operated with integrity.  On that basis, the only conclusion to be drawn was that the complainant was probably in error and her job was to look for that error and dismiss the case.  It could be that the complainant misunderstood the responsibilities of the healthcare professional; the complainant may be emotionally overwrought or possibly just vindictive and vexatious.  It was as if complainants acted like ‘hoodies’ just wandering round the regulatory system looking for trouble.
If you turn the whole thing on its head and start with the perception that the complainant is likely to be a genuine person who has a valid concern, then the spotlight for investigation falls upon the system and why this complaint has been escalated without resolution.  It also falls on the healthcare professionals; whether they managed expectations appropriately and delivered to a professional standard.  It just depends on which side of the table you sit on, which view you take.  So it was a good job we were there to put the other point of view.  Stuart has first hand experience of being turned down by every single organisation in his quest for justice and remedy.  As each new regulatory body was drawn from the hat and offered as a solution, Stuart was able to give the reasons they used to deny him an investigation and remedy.  I think this came as a bit of a surprise to some in our group.  
Peter Walsh from AvMA was in our discussion group, he stated that it was a waste of time to ask regulatory bodies to review their own decisions.  He wants the Professional Standards Authority (PSA) to have the power to investigate individual complaints and carry out reviews.   Peter stressed the importance of getting it right at the start of the process and the risk to patient safety if issues were not dealt with appropriately.  The PSA could have an active role in resolving individual complaints where people felt they had not received a fair hearing, if they were given the powers to investigate complaints. They also need the power to make binding recommendations for this to be effective. This could come through the proposed legislation and would be a major improvement. 
In the draft bill there is a ‘duty to cooperate’  clause which requires all regulatory bodies to share information.  Stuart and I had talked about falling through the gaps, where no single body had the remit to investigate your complaint and you were bounced around the system like a pinball machine.  The professional representative determined that the duty to cooperate meant that it would now be necessary for the regulatory bodies to work together and disclose information in order to resolve cases. She determined that with this in place the complainant could hold them to account if they refused to do so.  Simple as that.  She did not recognise the scenario I presented of regulatory bodies not cooperating but colluding together to prevent scrutiny of valid complaints and deliberately withholding key information.  She just did not believe that this would happen. 
As our group discussion drew to a close we talked about the issue of advocacy.  Peter Walsh was in agreement that all complainants need to be guided by an independent advocate and offered the services of AvMA. Many valid complaints are not given a fair hearing because the complainant has not provided a structured account of the events with key issues raised and supported with evidence.  Although we all agreed on this point, it was unclear whether this could be addressed by the proposed legislation. 
At the final plenary, Peter Walsh raised the issue of the five year rule which prevented older cases being investigated.   A lady from the midwifery council remarked on a case which had blighted their profession when a grieving parent continued to make complaints against a midwife ten years after the original event.  It was very unfair, in their opinion, for this person to be able to ask for another investigation when her matter had been dealt with.  They described the unnecessary stress this had caused to the midwife concerned.  Although it is understandable that a returning complaint must be a nightmare, the question has to be asked as to why the complainant returned ten years later.  Because she didn’t agree with the previous decisions, came the reply.  So for the mother, there had been no satisfactory outcome, no resolution and consequently no closure.  The professional solution is to firmly enforce a five year time limit which protects the professional staff from continued stress, but does nothing to alleviate the pain suffered by the complainant, who is now shut out of the system.  The real solution, for all parties, should be to improve the complaint handling service to find proper solutions at the outset.  No one wants to drag a complaint on for years.  We do it because the delay, deny, defend culture forces us to. 
More meetings will follow this initial gathering and we will be able to attend and continue to influence this legislation in the making.  
Your comments are welcome. 

PHSO Pressure Group meet with Rosie Cooper MP

 

On 29th April two members of the PHSO Pressure Group met up with Rosie Cooper MP at Westminster to discuss the dire state of the present Parliamentary and Health Service Ombudsman.  We informed her that the continued failure of PHSO to deal with complaints fairly to provide justice and remedy was causing widespread suffering as people struggled to find closure.  When you have lost a loved one unnecessarily or suffered personal injustice you do all you can to prevent that happening to others in the future.  The Ombudsman, who should protect the public from the abuse of power and ‘put things right’ deliberately defends public bodies and NHS trusts by denying and manipulating the evidence to find no case to answer.  It is time for this to stop.

PHSO pressure group meet MP

Stephen Greck and Rosie Cooper at Westminster

Below is our follow up letter to Rosie Cooper MP explaining why there needs to be legislative reform of the Parliamentary Ombudsman and a complete overhaul of the current system.  We are also calling to be represented at the Cabinet Office inquiry into complaint handling and public Ombudsmen services.  Any inquiry into complaint handling should start and end with the complainant.

Dear Rosie Cooper MP,

Thank you for meeting with members of the PHSO Pressure Group recently to discuss the appalling state of the present Parliamentary and Health Service Ombudsman.  This body is not fit for purpose and has been corrupted from its original intention, which was to protect the citizen from the abuse of power.  Perversely, the Ombudsman serves to protect the public bodies from genuine complaints, resulting in a failure to address key issues and improve service delivery.  This was brought to public attention at the Mid Staffordshire Hospital inquiry, where none of the complaints were investigated by the Ombudsman during the period under review, including that presented by Julie Bailey.

The dire state of the Ombudsman service was recognised in 2011 by the Health Select Committee when they called a complete overhaul of PHSO.  http://www.parliament.uk/business/committees/committees-a-z/commons-select/health-committee/news/11-06-28-clreoprt-substantive-/  Chair Stephen Dorrell stated that,  “The legal and operational framework of the Health Service Ombudsman should be widened so that she can independently review any complaint which is referred to her following rejection by a service provider.  The Ombudsman’s current terms of reference prevent her from launching a formal investigation unless she is satisfied in advance that there will be a ‘worthwhile outcome’. We have concluded that this requirement represents a significant obstacle to the successful operation of the complaints system. Patients should be able to seek an independent review of the findings of internal reviews by care providers; the terms of reference under which the Ombudsman works prevent her from properly fulfilling this role. This needs to be changed.”

We are a group of individuals who have all suffered injustice at the hands of the Ombudsman.  By coming together and sharing our experiences we can prove that PHSO deliberately deny or manipulate the evidence to avoid carrying out a full investigation.  Even those members of the group who have had investigations are not satisfied with the service.  The Ombudsman strategically focuses on minor issues and allows major breaches to go unattended, they are inaccurate in their reports altering the facts of the matter and any sanctions or action plans are minimal with little account of the suffering caused.  These action plans are then left unmonitored by PHSO as this is not within their remit and for all we know may never be implemented by the public body concerned.  The whole process is corrupt and allows public bodies to treat complainants with impunity knowing there is little chance of sanction by the Ombudsman.  There is no public confidence in the present Ombudsman service and we are calling for the complete overhaul recommended by never delivered in 2011.

The present Ombudsman Dame Julie Mellor is publically encouraging more people to make complaints as part of an initiative to raise the profile of PHSO, but this action is viewed by members of the Pressure Group as a slap in the face and gross hypocrisy when PHSO consistently fail to investigate the vast majority of complaints which are already presented to them. 

‘Older people should be encouraged to complain and should be taken seriously when they do. But my fear is that too many older people are suffering in silence.’ 

We may be ‘seeing the tip of the iceberg’, she said…   (Dame Julie Mellor, Mail Online 6.4.14)

Dame Julie Mellor’s statement in the same article that,  Complaints are a gift to the NHS because that is how improvements are achieved””  is particularly galling as many  offer similar ‘gifts’ to the Ombudsman only to have them returned unopened.  She certainly does not practice what she preaches and the data will confirm that.

In 2012-13 (latest available figures) PHSO received 4,889 complaints which needed to be reviewed.  For 3,914 (80%) no action was taken due to Ombudsman discretion.  Only 384 received a full investigation (7.9%) and 230 were upheld (4.7%).  For the vast majority making a complaint made no difference.   

The Pressure Group are aware that from 2013 a new initiative, ‘More impact for more people’ has been implemented which is designed to provide more investigations and improve feedback to organisations.  We do not have confidence that this programme will deliver robust, impartial investigations and believe that it is simply a rebranding exercise where previous ‘assessments’ are relabelled ‘investigations’ in order to meet targets.  The reason for our concern is that following a FOI request PHSO revealed that only 30% of their staff currently carry out investigations whereas 54% are in management roles and the average time for completion of an investigation has fallen from 162 days to 39 days this year.  PHSO are attempting to do more for less and we cannot see how they can complete quality investigations of complex issues without a proper commitment to staffing and time allocation.  Only 42% of these new investigations are being upheld compared to 85% previously.  This would suggest that the extremely high threshold of evidence against the public body has simply been shifted to the investigation stage from the assessment stage.   This will not satisfy the complainant or put things right.

Continued denial of justice and remedy can lead to severe and on-going emotional trauma.  Without justice there can be no closure and many people who have already suffered a painful bereavement, continue to struggle with additional psychology damage due to the failure of PHSO to acknowledge and properly investigate their concerns.  The complaint methodology used by PHSO means that complaints as made are never actually addressed. To add insult to injury many Pressure Group members have experienced imperious, arrogant, patronising and dismissive attitudes from caseworkers. There is a high price to pay for society and for the NHS as people become ill due to the stress of a long and fruitless fight for justice.

The Ombudsman does not represent good value for money.  At £34m per annum each investigation (2012-13) costs just short of £87,000.  The Ombudsman is unaccountable to members of the public.  It is impossible to win at judicial review due to the total discretion enjoyed by the Ombudsman, so it is inaccurate to say that the Ombudsman is accountable under the law.  The Public Administration Select Committee (PASC) have no real powers to sanction the Ombudsman or hold her to account and they cannot intervene in individual cases.

PASC themselves accept that the Ombudsman service is ‘outdated’ in their recent report ‘Time for a Peoples’ Ombudsman’ and calls for a strengthening of accountability for PHSO by appointing a Minister for Complaints.  Bernard Jenkin MP, Chair of PASC stated that,

“We have to make these changes.  PHSO is part of our service to our constituents, and its way behind the times.  Our voters have a right to complain about public services when mistakes, misunderstandings and maladministration occur. We so often see that people complain not for their own benefit, but to ensure lessons are learned and the same mistakes are not inflicted on others. As we recently reported, the disaster at the Mid-Staffs hospital is a tragic example of what happens when the complaints system does not work.”

The report calls for changes in legislation to be decided by the Cabinet Office following their review of complaint handling and the role of the public sector Ombudsmen.

Guy Horsington, Private Secretary to Oliver Letwin stated in an email to phsothefacts that,

“As you are aware at the end of last year the Minster gave a commitment to explore further some of the issues that the Public Administration Select Committee (PASC) had raised by undertaking two further pieces of work:

  • to investigate how public services can make best use of complaints, and ensure complaints are welcomed as a valuable source of information about where improvements are required; and
  • to take a wider look at the role and powers of the public sector Ombudsmen.

Both pieces of work are being taken forward by teams based in the Cabinet Office, working with Departments and key stakeholders.”

The decisions made during the Cabinet Office Inquiry will be crucial to developing an effective Ombudsman service which works for the people to protect them from the abuse of power.  Complainants are ‘key stakeholders’ in this process and should be represented at the discussions.  Complainants have used the system from top to bottom and hold the ‘gold dust’ knowledge apparently valued by those in authority.  We are the end users and as tax payers we pick up the bill.  The PHSO Pressure Group are therefore requesting a seminar with members of the Cabinet Office and other key stakeholders so that we can contribute to the final decision. 

This should be in keeping with Oliver Letwin’s own views as he stated to PASC that,

‘Valuing complaints and supporting people who feel the need to complain should be at the heart of the values which drive public services.  The importance of leadership cannot be overstated.  Complaints must be valued from the very top of an organisation and seen as something to be welcomed.”  (PASC Report – More Complaints Please!)

So far, we have not felt ‘welcomed’ by Mr. Letwin or the Cabinet Office, but hopefully there will be a realisation that we have a great deal to offer each other.  The PHSO Pressure Group has first hand knowledge of the problems encountered by complainants and suggestions for ways forward.  I have enclosed a copy of our summary report which gives some information in this regard.  A full and detailed report will be sent via email.

Our hard work and experience could save a great deal of time for the Cabinet Office committee.  Improving services for complainants must start and end with the complainants themselves.

We hope that you and other MPs will see the value of our contribution as experienced and committed members of the public looking to improve complaint handling for those who follow in our footsteps.

Yours sincerely,

PHSO Pressure Group