Select Committee on Public Administration Minutes of Evidence



  1.  In my Annual Report for 1999-2000 I provided information about the activity of the office and work underway to develop our practice. I also dealt with three key issues: themes arising from cases, the handling of complaints in the NHS, and recommendations and redress. Previously my Annual Reports covered Scotland and Wales as well as England: following devolution I now issue separate reports in respect of my Scottish and Welsh responsibilities. The Annual Report for 1999-2000 therefore covers England only although, where appropriate, I have also quoted figures for Scotland and Wales for comparative purposes.


  2.  In April 2000 the Review of Public Sector Ombudsmen in England reported. I await with interest the Government's conclusions following the subsequent consultation process. However, I have already made changes in the working methods of my office in response to evidence submitted to, and views espoused by, the review team, especially about the length of time taken to investigate and the proportion of complaints investigated.


  3.  During 1999-2000, my office began a review of its working practices, with a view in particular to eliminating unnecessary delays, developing a wider range of approaches to cases (focused on meeting the needs of complainants in a cost-effective way), and making best use of internal and external clinical advice. Our processes and systems are under regular review; and changes have been made in order to speed up the investigation process. For instance, with experience we have found that there are a number of cases in which we can reach a satisfactory conclusion without interviews, simply by examining existing documents, and where the appointment of external clinical advisers may not be necessary as appropriate advice can be provided internally. Such cases can be completed significantly quicker than when interviews and external advisers are needed. A Director of Clinical Advice has been appointed and is pushing forward developments in the way we obtain and use that advice.

  4.  It had become clear that in clinical cases complainants could not so easily provide prima facie evidence of particular failings, as we had generally expected them to do in administrative cases before we agreed to investigate. We therefore shifted the presumption further towards investigation, if we could not feel confident that treatment had been appropriate and that complainants had had an adequate response to their concerns.

  5.  The effects of that began to be felt during 1999-2000, when the take-up rate of investigable cases (ie those which in principle I could investigate because they were in jurisdiction and had exhausted the NHS complaints procedure) increased to 19 per cent, from 12 per cent the previous year. The proportion has continued to rise: for the first six months of this year the take-up rate was 30 per cent. The outcomes of the additional investigations suggest that they have been worthwhile, in providing better information for complainants, and in identifying failings which would otherwise have been missed.

  6.  This change in practice has inevitably lead to an increase in the number of investigations in hand: from 97 at the start of 1999-2000, to 175 by the end of that year and to over 250 by the end of November this year. the proportion of investigated cases which are clinical, and therefore generally more complex, has also continued to rise: in 1999-2000 it went up from 52 per cent to 77 per cent. By 1 September 2000 83 per cent of investigations in hand were clinical.

  7.  In 1999-2000 I completed 128 English investigations—a significant increase on the previous year. By the end of November this year I had completed 107; and my target is to complete 210, an increase of over 60 per cent on last year. This very large increase in investigation workload and output is almost entirely attributable to the increase in take-up rate, as the number of new complaints received has increased only very slightly over the last 18 months.

  8.  Unfortunately, at the same time my office has suffered from considerable turnover of experienced staff, which means that at present we are actually handling the much increased workload with fewer investigative staff than at the same time last year. A major recruitment exercise is underway. That will not only replace staff who have left but also lead to the creation of two more investigation teams (in addition to the present six) to help cope with the extra work. That will be essential as, if we are not to develop an unacceptable backlog of work, we will need to issue over 300 reports next year: more than doubling our output within two years.

  9.  I have been extremely pleased by the response of my staff to the large increase in their workload. As can be seen from the information above, productivity has increased significantly. Last year we exceeded our target of replying to 75 per cent of correspondence within 18 days, achieving 81 per cent. So far this year, staff have still managed to hit a target of 80 per cent. However, the rise in the number of investigations, and an increase in complexity as shown by the increased number of clinical cases, has inevitably had some effect on throughput times. In 1999-2000 we nearly met our target of completing investigations in 48 weeks, and set a more ambitious target of 43 weeks for this year. For the first six months of this year the average was nearly 48 weeks: and we have to recognise that we are unlikely to achieve the target. It is very difficult to predict the number of reports we will issue, but it may fall slightly, but only slightly, short of the target of 210 of reports issued. Next year will be a very demanding time: existing staff will have to manage not only the increased workload but also help train the cohort of new staff, who will not become fully productive for some time.


  10.  One of the topics on which I commented in my Annual Report was out of hours general medical services. This arose from three complaints I investigated about Healthcall, an independent sector organisation which contracts with GPs to provide cover for their patients out of hours. Each of the complaints, from different parts of the country, was upheld fully or in part. They revealed some worrying features, including inadequately trained staff dealing with patients on the telephone, and serious delays in visits by doctors. Healthcall accepted the criticisms and assured me that problems would be addressed. The concerns I identified have also been taken into account in the recent report commissioned by the Department of Health on out of hours services.


  11.  During the year the NHS issued additional guidance to conveners: which took account of many of the issues I have raised previously. The Department of Health's evaluation of the NHS complaints procedure is now nearing completion and the Government have already said that they will reform the complaints procedure to make it more independent and responsive to patients. I await with interest developments in this area, which could have a significant impact on my work.


  12.  It is important that the public can feel confident that recommendations I make will be implemented. In 40 cases organisations agreed to take action to resolve complaints, without a need for a full investigation. Many more recommendations for action were made in reports of investigations, (and followed up three months later). Those included: improvements in clinical practice, record keeping and systems for complaints handling, and also financial redress (in four cases where patients had suffered financial loss).

  13.  In my role as Health Service Commissioner I have not generally recommended financial redress more widely (eg for pain and suffering), as I believe it is the responsibility of Ministers and the NHS Executive to develop policy and practice in this area. However, in a small number of very serious cases, in which the more usual recommendations would have been inadequate, my office has explored with the NHS body what additional redress, not necessarily financial, might be provided.

  14.  It is important that both the public and NHS staff should know about the recommendations I make. During the last year I have changed the format and timing of publications produced by my office. I now produce summaries of completed cases three times in a year, rather than twice. The new format for this publication—a slim volume of short reports and summaries and a larger volume comprising the full text of selected cases—has been welcomed. I understand that readers find the material more accessible, not least because of the reduced costs involved. For the first time this year, I produced an occasional newsletter. Again, this was warmly received and from the feedback, seems to have found its way to staff at all levels. I shall continue to explore ways of making my publications accessible and useful.

  15.  I am not helped, however, by a change in practice on the part of the NHS Executive. Until last year, the chief executive of the NHS circulated my Annual Report and reports of completed investigations to NHS organisations under cover of a health service circular. Quite suddenly, and without warning, that practice ceased. Although I have found other ways of bringing the attention of this important audience to my publications, I think that this change in practice sends quite the wrong message. The NHS makes too little use of information about things that go wrong already: to restrict circulation of material that might encourage better practice seems perverse. I welcome a recent invitation to discuss this further with the NHS Executive.


  16.  My office has continued to develop its relations with clinical professions and regulatory bodies. Staff have regular contact with the GMC and the Local Government Ombudsmen's offices. Established contacts with the Mental Health Act Commission have continued and relations have been developed with the Commission for Health Improvement and the Data Protection Commissioner. We have regular meetings with representatives of advisory and voluntary bodies.

Michael Buckley
Health Service Ombudsman

6 December 2000

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