Select Committee on Public Administration Minutes of Evidence

Examination of witnesses (Questions 20 - 42)




  20. Can I just pick up one theme that Michael has raised with you and go back to what Andrew Tyrie was asking you earlier on about the extent to which your remit is to improve administrative systems inside bits of Government, or whether you stop short before that. If you take the area that you referred to in your report here, this question of GPs removing patients from their list, this is something that you have reported on before and this Committee, or its predecessor, discussed with you before. You say although there is new guidance from GMC and elsewhere, there are GPs happily disregarding this and just getting rid of patients in the same old way. Does your remit not go so far as to say that in terms of administrative practice it is unacceptable for an organisation to behave in such a way without giving good reason or without, for example, providing an appeal mechanism? I wonder how far down the line you think you can go to clean up people's acts?
  (Mr Buckley) It is a fair question. I would have to begin by saying that the essence of what we are for is to deal with individual complaints. I say that very strongly because we are the only people who can do it. There is an overlap with the courts which we were discussing earlier. There are many organisations which are concerned with inspecting and auditing the Health Service, the NAO, the Commission for Health Improvement, the Regional Offices of the NHSE and so on, but we are the only people who are actually independent of the NHS and dealing with individual complaints and that has to remain the heart of what we do. Of course we always try to maximise the value of what we are doing. If we do see things where we think we can make general recommendations to whoever then we do so. To take the particular case of removal from a GP's list, it seemed to me clear that some of what was going on was actually contrary to the guidance issued by the GMC, well, that is a matter for the GMC. I have said that it is not acceptable, as far as I am concerned, for GPs simply to remove patients from the list without really trying in any way to sort things out, to give an explanation and to give a patient a chance to put their view. Indeed, I have said, also, that if a GP were to have a patient removed from his or her list for no other reason than complaining, leaving aside vexatious complaints and so on, but simply, as has happened, "You made a complaint, therefore I am going to remove you" or, even worse, "I am going to remove your family" then I would publicly name that GP. Ultimately the GPs are operating within the terms of service laid down in statutory regulations and it seems to me that is the point at which it becomes a matter for the political process. It seems to me the sort of thing the Committee should take up with the Department of Health. I think that is the proper place for debating this sort of issue, not for me as an unelected office holder to start saying "I am going to modify or insist on there being modifications in GPs' terms of service".

  21. I understand. The problem is that you keep coming back to us with the same kind of cases and we have the same kind of conversations. Whereas perhaps if you had gone a bit further and had pronounced upon what you regarded as, I think, administrative malpractice that ought to be stopped, not to set up an alternative but to lay down some basic procedural principles, because you are the expert on maladministration and you know what is not right and, therefore, by extension you know what is right, but not to do that means that we go round the circuit yet again.
  (Mr Buckley) With respect, Chairman, I think I would disagree with you. I think I have made my position perfectly clear. I cannot force people to accept it. Similarly, if we are looking at maladministration, time after time we suggest to a Department that it would be a good thing to answer correspondence in good time, it is not a very good idea to lose the file, and so on and so forth. I cannot actually wave a magic wand and turn this world into a world in which files are never lost and in which correspondence is always answered on time. As long as there is no legally enforceable obligation then one has to say that it is just a matter of people sometimes, I am afraid, going their own way and there being ultimately no sanction other than public discussion.

Mr Turner

  22. I want to come back, if I may, to the CHCs and the broader issue of the complaints procedure because you are, if you like, at the apex of that. I was a little bit surprised you had not been asked about your views on the reorganisation. Would you be prepared to give your views were they to be asked for?
  (Mr Buckley) Certainly. I would say what I have said to the Committee, it is not for me to say whether the CHCs are a good or bad thing but what I can do is to draw attention to the lessons of the experience of my office which is that people who want to make a complaint do need help. The NHS complaints procedure requires people to be articulate, a lot of it is in writing, formal procedures, they need help there, and it is a procedure which requires a good deal of stamina. One of the main criticisms that is often made about the way in which the NHS handles complaints is that people do not accept that, for example, convenors are independent of the bodies that are being complained against. These are issues which need to be addressed. They come out clearly in the work of my office and that is the sort of thing I would say.

  23. One of the indications I am getting from my constituency is that people are a lot more willing to complain and take those complaints further than they have done in the past, which is putting a lot of pressure on the NHS trusts and the health authority to satisfy that and bring things to a conclusion. Is that your general view or do you think that is specific to my constituency? I think it may be.
  (Mr Buckley) Interestingly enough, the NHS Executive does every year publish statistics for the number of complaints. The number of complaints against NHS trusts in England has fallen for two successive years, which is interesting.

  24. Has it really.
  (Mr Buckley) They have gone up against the Family Health Service but they have fallen, complaints against the NHS trusts. Of course one then says, well, that is counting, what about weighing, maybe the complaints are more serious or more difficult? I just have no means of assessing that. We do only see a very small proportion of cases.

  25. Can I just go on to one other area which you touched on in relation to Healthcall. It is becoming more prevalent that the private sector is a provider of health care, even though it is the Health Service which is the payer of that. That must cause difficulties for you because whilst you can have some greater influence over a public body and how that responds to complaints, it must be more difficult with a private sector body even though that private sector body is being paid for by public sector funds. Do you find that is the case or do you see it will be a difficulty in future?
  (Mr Buckley) I will ask Hilary to say something on this. We have not found that as a difficulty so far at all. In all fairness to Healthcall, they co-operated fully with our investigation and they made no difficulties at all. They were very ready to put things right. I would say also independent providers under arrangements with NHS bodies will have to operate in accordance with the terms of whatever contract they have. If we find shortcomings in the arrangements then we can perfectly well say to the NHS body concerned "Look, you need to tighten up the contract in this, that or the other area". I have to say so far we have not found any obstructiveness from independent providers.
  (Ms Bainbridge) In fact, several of the original Healthcall cases which we investigated were actually ones I dealt with. I can still remember sending off the first letter to Healthcall saying we were going to investigate a complaint against them—it was the first one we had sent off to an independent provider—and thinking that what I was going to get back was a lawyer's letter saying "Nothing to do with us". It did not happen. As the Commissioner said, we got co-operation, they provided documents when they were asked, they arranged interviews when we asked, they were very receptive to suggestions we made in the report we produced, and that has been my experience with the one or two other cases I have had since. I have had one recently which is still under way of a private ambulance service providing a service to the NHS and, again, so far we have had excellent co-operation from them. Having seen the opposite side I did see a case recently where an NHS trust had commissioned services from a private sector body and, because of the way things were set up, they should have been taking responsibility for dealing with complaints about them and, in fact, they had not been, and we had to go back to them and say, "We think you should be". I had expected resistance in the private sector, but I have not seen any evidence of it.


  26. Had you had a lawyer's letter back what would have happened then?
  (Ms Bainbridge) I would have checked out things with our lawyer. I was pretty sure we were on safe ground before we started. I would have double checked it with our lawyers, and unless our lawyers said, "You have it completely wrong", we would have carried on.

  Chairman: Good.

Mr Tyrie

  27. I would like to ask this on behalf of people in the United Kingdom who use the NHS and are happy with it, indeed the taxpayer generally. There is an interesting little paragraph where you said, "I also bear in mind that investigations by myself are expensive. They impose a considerable burden on the NHS body concerned and its staff". Every hour you spend burning up staff time is an hour people have to come off patient care. Health care is rationed in this country, nobody likes saying it, but it is, therefore you reduce the available supply. Have you made any estimate of the cost of your investigation in money terms on the NHS?
  (Mr Buckley) We have some rather rudimentary figures at the moment of the cost of investigations, which we are hoping to improve. I think that we would not, even with a more accurate figure, approach this in cost benefit terms, the opportunity costs of clinicians' time, and so on and so forth. If there was a genuine complaint we thought needed to be investigated, we would do so. That is what the statute implies.

  28. I was asking you to estimate the costs.
  (Mr Buckley) There is a benefit to the complainant in terms of having their complaint resolved, we hope, satisfactorily.

  29. There is also, of course, the prospect of improvements in shortcomings, which we have been discussing earlier, in the management of a particular NHS body or, perhaps, more widely. It is really something that we need to be aware of in deciding marginal cases. If it looks like a relatively minor complaint which will probably not come to anything in the end, we must be mindful there are costs attached to it. If you think it is a soundly based complaint, could you put those in the public domain?
  (Mr Buckley) Certainly. We put a memorandum of evidence to the Committee last year on our costs.

  30. Not your costs, on the cost burden imposed on the people you are investigating?
  (Mr Buckley) We have not made a estimate of the costs to the NHS, these are something that we are aware of in general terms.

  31. Do you not think it might be worth a look at that? I am not suggesting that you should not do the studies, I am suggesting you should be aware of what we are forgoing in terms of what is taken out of the NHS in order to conduct the study. This is a reasonable matter of public interest.
  (Mr Buckley) We will take that away and look at it.

Mr Trend

  32. Can I ask a question about your own staff? Sir Humphrey called it very brave to admit you are handling an increased work load with fewer staff. Do you say you have suffered from a considerable turnover of experienced staff? Is that related to your increased workload or are there other factors? You said you are getting on with doing something about it.
  (Mr Buckley) It is always very hard to know what the reasons are for staff turnover. I think also one has to remember that we are a small office, so what looks like a large change in the percentage turnover rate may represent small numbers. I think one of the factors that is coming into play is that some three years ago we changed our policy regarding the employment of staff. Previously they had been on loan or short-term contracts. We changed that in 1997 and we have a significantly higher proportion of staff on indefinite term contracts. We have a significant number of people who have been with us for some years and feel it is time to move on. I would have some misgivings about people that want to be in an Ombudsman's Office for 30 or 40 years. We do try quite hard to assess these things. We have exit interviews. I make a point of seeing every member of staff who leaves, because that is probably one of the occasions when they might be willing to give me a frank account of what they think of me and the way I am running the office. I cannot say there any very strong feelings coming through. We are concerned about pay. We are operating in the London market, it is not an easy employment market. People feel they want to move on. It is not the sort of office where you can offer much of a career structure, there are caseworkers and some management, not much further. What we are doing is partly, of course, recruiting more staff, that will not only bring in more staff but help relieve the burden on existing staff. We are also reviewing carefully what we are asking of caseworkers, whether we have the job description right and whether we should, perhaps, be asking a little more of them in return for more pay. We are looking at this in a fairly fundamental way. I cannot say that the problem is this, and that is the way we are going to solve it.

  33. Is it not that there has been an increased workload?
  (Mr Buckley) I do not think so. Staff are not saying, "This is an intolerable place to work, the workload is too high". My staff are highly motivated people. They feel they are doing a good and important job. They found it more frustrating when we over-recruited, and they were sitting around without enough to do. That was much more demoralising than having a full workload. There comes a point at which people say, "I cannot take any more".

  34. I do not know how you disseminate more resources. Who do you go to and say, "We are stretched, we need three more caseworkers"? How much will it cost?
  (Mr Buckley) If we needed to it would be a matter of going to the Treasury. We are funded in the same way as a Government department. At the moment I think I have adequate resources. That is something, of course, we can look at.

  35. Have you been to the Treasury in the last year to ask for further resource of any sort?
  (Mr Buckley) We have managed to live quite well within our budget in recent years.

Mr Tyrie

  36. The Treasury will note that.
  (Mr Buckley) Mercifully we now have a better system than in the past, we can carry forward underspends, so we are able to do that. It will be tight next year, but we think it will be all right. That is something which we will need to look at in the light of each period.


  37. Before we finish, you made a throwaway remark about competing with the London market, there is no reason why the Ombudsman has to be in London, he could equally be in Cannock or Wigan, both are convenient for the M6. Why do you have to sit in London and have competition for staff here?
  (Mr Buckley) That is an excellent question and that is why we are reviewing our accommodation. It is a perfectly valid question. It is a question that we know perfectly well we have to address. Not only is the London market difficult but London accommodation is extremely expensive. We need to look very hard at the trade-offs, what we will save, what the extra expense will be that we may have to incur. It a valid question which we are addressing. I would say that even if we were not thinking that we might merge with the Local Government Ombudsmen, who do have a regional organisation. That strengthens the case, it is not the only reason for doing the review we have in hand.

  38. Finally, you do mention in your report a spat you are having with the Department of Health about the costs involved with the NHS part of your work. Part of the answer to that would be that the effect of investigations is to produce a tension that ought to be put right. It only works if the improvements get disseminated or your findings get disseminated. You did refer to the fact that there has been the change in practice by the Department. They used to circulate under a circular the notes of your investigation and that then changed, did you resolve that or is this problem still there?
  (Mr Buckley) Not wholly, I have to say. I must say in fairness to the Department, there is a good deal of co-operation. What we do is to e-mail the chief executives of trusts, health authorities and Community Health Councils to draw attention to our publications and tell them how to access the publications, particularly we put them on our website. Also, I understand the department is now mentioning the cases in their weekly bulletins to chief executives and they refer to the publications in their own website where there is a link to mine. I cannot say I am entirely satisfied with it, for precisely the reason you give. It is rather paradoxical that the Chief Medical Officer produced a report in June, one of the findings of which was that the NHS was not very good at using the information that it has within the system from complaints and litigation. That is a wider problem. My investigations are only a small number of the investigations and resolutions of complaints which go on the NHS and the NHS has its own problems to solve in disseminating information that it gets from its own procedures. It does seem to me extraordinary that the Chief Medical Officer is saying "We need to make better use of information from complaints" when the one high grade, readily accessible material which my office produces the Secretary of State then says "Well, sorry, I am not going to circulate it". I can only report that as the situation. We are doing our best by our own publicity methods but I would prefer that there was more done within the Health Service to draw attention to this.

  39. If the Committee was to drop a little line to the Secretary of State saying that we are not too thrilled about what is happening, that might not be unhelpful?
  (Mr Buckley) I would not disagree for one moment, Chairman, or seek to dissuade you.

Mr Tyrie

  40. Can I ask something very, very quickly. You kindly agreed to take a look at this question of the cost burden imposed on those investigated, particularly in the health field, perhaps it might apply more generally as well. When you have had time to examine and think about it and how you might go about that, would you be prepared to drop the Committee a line?
  (Mr Buckley) Certainly. I cannot promise more than a very broad brush exercise because investigations obviously vary so much.

  41. Stage one would be to think about how one might go about doing it.
  (Mr Buckley) There is an opportunity cost but you do know what is happening. We all know perfectly well that clinicians do things over and above their hours and so on. There is an argument for saying it is all a free good, I would not go that far but you can see the complications.


  42. I think we should end there. Thank you very much indeed for coming along and giving us evidence, as ever instructive, and we go away with further ideas about aspects of your work. I think we would like also to take this opportunity to thank you for all the work that you do in the office on behalf of the people you represent and Parliament too.
  (Mr Buckley) Thank you, Chairman. May I say in turn how much we value the support and the ability to discuss these things with the Committee.

  Chairman: Thank you.

previous page contents

House of Commons home page Parliament home page House of Lords home page search page enquiries index

© Parliamentary copyright 2001
Prepared 5 March 2001