Parliamentary and Health Service Ombudsman Scrutiny 2021-22

The Committee considers the objectives of the Parliamentary and Health Service Ombudsman (PHSO) Strategy for 2022–25 to be appropriate to achieve the aims of “becoming an even more modern and vibrant Ombudsman service”. This includes promoting greater awareness of the PHSO’s services, providing a high quality, empathetic and timely service, and continuously improving the organisation. We welcome the reference to international benchmarks in the Strategy for the first time, the emphasis on data, and the organisation’s plans to gather direct feedback from service users and members the public. However, while it is included in the 2022–23 Business Plan, the absence of any reference to how the organisation will cope with the ongoing impacts of Covid-19 and high levels of cases brought to the PHSO is regrettable. The ambition to promote awareness and accessibility of the PHSO’s role and service is positive and welcome, but the Strategy does not set out how the organisation would cope with potentially increased service demand.

We agree with the Peer Review Panel that the PHSO should provide clear reporting in an accessible format on delivering the Corporate Strategy for 2022–25 and that the PHSO should put in place detailed plans for dealing with the potential service demand implications of its increased public awareness and accessibility. In its response to this Report, the PHSO should provide further information on how an empathetic and timely service will be delivered if service demand increases due to such measures. The PHSO should also provide an update on its progress in establishing a panel of users and members of the public to provide feedback on the PHSO’s services, including how regularly the panel will be consulted and its expected outputs. (Paragraph 16) PHSO casework and productivity

The Committee recognises that the PHSO has made significant efforts to cope with the huge pressures placed on its services as a result of the Covid-19 pandemic. We note that the backlog of cases has been reduced significantly and welcome the ambition to completely clear the queue of unallocated cases by the end of the 2022–23 business year. Equally, we are encouraged by the ambitions of the casework improvement programme and implementing the end-to-end review of casework processes to drive efficiencies and improve service quality. However, whilst we cannot generalise from individuals’ experiences with the PHSO’s service, there were a number of pieces of written evidence received by the Committee during this inquiry highlighting that perceived poor handling of cases remains a significant concern from service users. This includes details of lengthy investigations, poor communication by complaint handlers, sudden change of caseworker mid-investigation, loss of records, and issues with the complexity of the complaints process. The changes resulting from the end-to-end review of casework process, including changes to complaint forms, while positive, are relatively minor compared to the scale of these perceived issues. (Paragraph 33) Parliamentary and Health Service Ombudsman Scrutiny 2021–22 35

In its response to this Report, the PHSO should provide a detailed account of the changes being taken forward as a result of the end-to-end review of casework and the casework improvement programme, with examples of how this will improve a complainant’s ‘user journey’ and how it will review what further improvements may be required.

The Committee accepts that some mechanism for prioritising the number of health complaints is needed and notes that there is international precedent for doing so. Nevertheless, we remain concerned with the continued approach of not processing complaints at Levels 1 and 2 on the severity of injustice scale, and the lack of ambition to return to the previous patterns of complaint-handling. We note that in the past 18 months around 1,500 cases have not been taken forward as a result of this approach and that the PHSO has decided to continue with this prioritisation method until the end of the business year 2022–23

We are concerned by the number of Level 1 and 2 cases that are not being considered by the PHSO due to the approach of prioritising health complaints using the severity of injustice scale. We recommend that the PHSO sets out in its response to this Report the evidence base for continuing with this approach for another business year and provides detail on how this decision compares to other ombudsman institutions, both domestically and internationally. Furthermore, we request that an explanation of the criteria being used to make a final decision on the future approach at the end of the business year is provided to the Committee.

The Committee welcomes the improvements the PHSO has made to its website to give clarity on how complaints will be considered using the severity of injustice scale. However, as indicated in the PHSO’s response to the Committee’s PHSO Scrutiny 2020–21 Report in May 2022, the PHSO should report back to the Committee in its response to this Report on whether more detailed information could be provided on its website to give members of the public and Members of Parliament an indication of how long it may take for a case to be considered.

The increased use and focus on developing the PHSO’s mediation capacity as a means to speed up casework is extremely welcome. However, considering the Ombudsman said that there is the potential to resolve 25% of cases by mediation rather than investigation, the scale of its use in the 2021–22 period to resolve less than 0.1% of cases is very disappointing.

The Committee appreciates that there are issues to address with the use of mediation, such as the fact that the PHSO cannot publish the details of parties’ engagement through private mediation. However, finding solutions to these issues should be a priority for the PHSO in order to improve its overall efficiency and quality of service. The Committee should develop a plan for how mediation capability will be built up within the organisation, with a target date for when the PHSO expects to be able to resolve 25% of cases by mediation.

The Committee is concerned by the fact that the PHSO has not met any of its targets for the overall section Service Charter scores in the 2021–22 financial year. The Committee had previously understood that the scores were expected to improve as waiting times for cases to be allocated and closed were reduced. However, during 36 Parliamentary and Health Service Ombudsman Scrutiny 2021–22 the oral evidence session in November 2022, it was reiterated that the main driver of higher customer satisfaction is whether a case has been upheld regardless of the quality of customer service. If the latter is true, it is clear that the current mechanism for collecting customer feedback through the Service Charter is unsatisfactory.

The PHSO should update the Committee on the outcomes of the review of how the PHSO obtains feedback from service users, including the Service Charter, and what changes will be put in place as a result. The Committee understands that the PHSO is awaiting data from an independent research agency to determine whether survey data can be split by those cases upheld and not upheld; we would urge this work to be prioritised, and expect an update on both these areas of work in its response to this Report. (Paragraph 41) Staff management and training

The Committee commends the pace in which the PHSO has increased its number of caseworkers across 2021–22 and developed a 10-month training academy to support their induction and development in these roles. The Committee welcomes the continued investment in training and development opportunities across the organisation, including the accreditation scheme for senior caseworkers, the establishment of four Parliamentary focus teams, and the ongoing Quality Programme to continuously improve casework management. However, we also note the slight increase in staff turnover in 2021–22 and believe this should be monitored closely. Furthermore, we agree with the Peer Review Panel’s conclusion that further changes should be put in place to improve casework management, including how staff communicate with complainants.

In light of the increase in staff turnover in 2021–22, we reiterate our call from the Committee’s PHSO Annual Scrutiny Report 2020–21 for the PHSO to consider other development opportunities to encourage staff retention. Whilst the development of a 10-month training academy for new caseworkers is welcome, the PHSO must ensure there is minimal loss to institutional knowledge and the quality and pace of casework management is not impacted by staff turnover. The Committee would welcome further information on how the newly-established four Parliamentary focus teams mentioned in the Annual Report and Accounts for 2021–22 will improve performance in handling Parliamentary cases. Furthermore, while the Ombudsman told the Committee in November 2022 that the Peer Review Panel’s recommendations in relation to casework management will be implemented incrementally, in its response to this Report, the PHSO should set out exactly what changes will be put in place and to what timetable.

The Committee welcomed in its PHSO Scrutiny 2020–21 Report the positive steps that the PHSO has taken to improve the use of clinical advice in investigations. It is encouraging to see that this work has not lost momentum, with 23 of 25 of the recommendations from the “Donaldson Review” now implemented, and the development of a Clinical Advice Quality Framework underway.

The PHSO should clarify how the Clinical Advice Quality Framework will improve trust and confidence in the quality and standards of the PHSO’s casework, what changes Parliamentary and Health Service Ombudsman Scrutiny 2021–22 37 have been made to date, and how success will be measured. Furthermore, whilst we acknowledge the challenges associated with the outstanding recommendations from the Donaldson Review, the PHSO should reach a decision as soon as possible on whether to take forward naming clinical advisers in decision reports and sharing provisional reports with advisers, given the review was published four years ago.

The Committee welcomes the positive results of the staff survey, which saw increases in scores in headline areas, such as leadership and managing change, inclusion, and learning and development. The only headline score to deteriorate was related to pay and benefits, which the Committee recognises reflects similar trends across the public sector and wider economy, alongside difficulties in recruiting in areas such as digital and programming. The Committee also welcomes the continued positive statistics on the diversity of the PHSO’s workforce, particularly in terms of gender and Asian, Black, Mixed Ethnicity and Other Ethnicity Group representation, and the culture of diversity and inclusion the leadership team are seeking to embed in the organisation. However, we note the under representation of employees aged over 50 compared to the population benchmark.

The PHSO should report back to the Committee on how the organisation intends to continue to attract and retain staff, including those in technical digital roles and those who are over the age of 50, in light of wider trends across the public sector and economy relating to pay and benefits and labour market demographics.

The PHSO should report back to the Committee in its response to this Report on the viability of breaking down a wider variety of staff diversity data by grade in its Annual Report and Accounts, as it already does for the gender of senior managers. (Paragraph 58) Value for money

The Committee is pleased that the PHSO was able to secure an increased budget in the 2021 Spending Review to cope with the increased demand on its service as a result of the pandemic. This has had a positive impact on its casework improvement programme. However, we are concerned that the wider economic pressures across the public sector are likely to impact the organisation and urge the PHSO to consider potential mitigations for any real-term reductions to its budget for 2023–

The PHSO should put in place robust plans to deliver further efficiencies across the organisation and report back to the Committee next year on any work taken forward in this regard.

In the Committee’s PHSO Annual Scrutiny Report 2020–21, we called for a Peer Review of the PHSO to be undertaken as soon as possible. We are pleased that this took place in 2022 and reported before our annual scrutiny session. The Committee welcomes that the PHSO was the first body to undergo a review by an accredited Panel, and in line with our previous recommendation, the Panel included a member with auditor experience. The Committee notes the positive results of the Peer Review, as well as areas identified for improvement. Although the Peer Review Panel 38 Parliamentary and Health Service Ombudsman Scrutiny 2021–22 did not provide any in-depth value-for-money analysis of the PHSO’s service, it has helpfully identified areas where the organisation is performing well and where it could improve in the future. We therefore support and encourage the continued use of periodic peer reviews to assess the effectiveness of the PHSO.

The Committee was disappointed to learn that some of the data provided by the PHSO to inform the Committee’s PHSO Scrutiny 2020–21 Report had been revised unjustifiably ahead of this year’s inquiry, preventing easy comparability between reports. For the Committee to accurately fulfil its responsibilities to assess the performance of the PHSO, it is vital that the PHSO collects and publishes accurate and consistent data going forward.

It is unsatisfactory that data provided to this Committee has been subsequently revised. The PHSO should report back to the Committee on what steps it is taking to quality assure its data before it is published and used by the Committee.

The Committee notes the benefits that hybrid working has brought to the PHSO, notably the ability to increase its workforce by 20% without expanding its office footprint. However, the impact of hybrid working on organisational productivity, culture, and employee wellbeing should be continually monitored, and the requirement to be in the office 40% of the time revised as necessary.

The PHSO should provide an update in its response to this Report regarding what tools and infrastructure have been upgraded to support hybrid working, as mentioned in the Business Plan for 2022–23. The Committee would also appreciate information on what the PHSO is doing to continually monitor the impact of the requirement to work in the office 40% of the time on organisational productivity, culture, and employee wellbeing.

The Committee firmly agrees with need for legislative change of the PHSO. It has been seven years since the draft Public Service Ombudsman Bill was presented by the Government. Given that there is widespread consensus on the need to reduce the complexity of the ombudsman system in England and to bring the legislation in line with international best practice, the Government’s reluctance to address this long-standing issue is unacceptable.

The Government has delayed legislative reform for too long and the Committee is particularly disappointed by the Government’s refusal to set out a legislative timetable before the end of this year. Regardless of other pressures on the Government’s legislative programme, ombudsman reform needs to be prioritised. Work to introduce a Bill should not have to wait until the next Parliament. (Paragraph 82) Impact on other organisations

The Committee welcomes the PHSO’s progress in developing the NHS and UK Central Government Complaint Standards, in close collaboration with partner organisations. We are encouraged by the number of organisations that have volunteered to adopt the Standards. We agree that the Complaint Standards initiative has the potential to significantly reduce pressures on the PHSO’s services Parliamentary and Health Service Ombudsman Scrutiny 2021–22 39 by addressing more complaints on the frontline. We look forward to hearing from the PHSO on good practice, as well as areas for improvement as the Standards are adopted into the working practices of organisations.

The Committee is encouraged by five organisations that have volunteered to adopt the UK Central Government Complaint Standards. We urge the PHSO to continue to engage with Government Departments and public sector organisations to increase this figure, and to report back to the Committee on how proportionate monitoring and reporting on the Standards could be delivered. As an early adopter of the Standards, the Cabinet Office should play a role in working with other Government departments and public bodies to sign up to the Standards by the end of 2023.

The PHSO’s ability to lay reports before Parliament regarding thematic failings and instances of non-compliance with its recommendations should be a powerful mechanism to bring cases to the attention of parliamentarians, and for the subjects of those reports to be properly and fully held to account. However, it seems that this system is not working effectively if PHSO reports laid before Parliament are ignored by the addressees of such reports.

Whilst the Committee discharges its scrutiny role by examining the overall administration of the PHSO and its Annual Report and Accounts on a regular basis, it should be for departmental Select Committees to scrutinise the relevant thematic PHSO reports laid before Parliament that relate to their subject areas.

We recommend that the PHSO increases its engagement with departmental Select Committees to encourage them to scrutinise PHSO reports laid before Parliament, particularly when those reports relate to findings against individual departments and public bodies under their remit.

The Committee supports the PHSO’s work in promoting its services within vulnerable and marginalised communities. We welcome the PHSO’s ambition to identify barriers to access, offer guidance to organisations, and increase awareness of its services with MPs and stakeholders. We support the suggestion from the Peer Review Panel to publish details of the PHSO’s outreach work.

Ahead of the next annual scrutiny hearing, the PHSO should provide an update to the Committee on progress with its outreach activities and any evidence of its impact on the diversity of complainants and types of complaints it receives. We would welcome clarification on whether complainant diversity data in the Annual Report and Accounts could be used to assess whether correlations exist between complainants’ backgrounds, the types of complaint they make, and their routes to complain.

We also welcome the PHSO’s efforts to engage with MPs and their staff on the use of its services, but we believe that still more could be done in this space. The PHSO should increase its engagement with staff based in MPs’ constituency offices in particular to improve awareness of its services amongst those who deal directly with referrals, including providing relevant training on mediation services. (Paragraph 103) 40 Parliamentary and Health Service Ombudsman Scrutiny 2021–22 7 Priorities for Scrutiny As in our previous reports, this section sets out the Committee’s priorities for scrutiny of the PHSO for the year 2021–22. Table 2: Areas of scrutiny Area of scrutiny Example of expected Areas of particular interest evidence PHSO Corporate Strategy Written evidence from the Organisational priorities, for 2022–25 PHSO and service users. and how these compare to previous years. PHSO Corporate Strategy Delivery of the Strategy, PHSO Business Plan assessed alongside the annual Business Plan and Peer Review Report Covid-19 recovery. PHSO casework Casework and staff data Impact of Covid-19 on performance in the Annual Report and service delivery and Accounts casework management. Service Charter scores Quantity, quality, and timeliness of investigations. Written evidence from service users and Implementation of the organisations casework improvement programme Peer Review Report Mediation capabilities Changes in Service Charter scores Staff management and Staff survey scores Numbers of staff and training turnover Written evidence from the PHSO Training opportunities available to staff Annual Report and Accounts, employee data Staff views on learning and including diversity development Diversity of the workforce Use of clinical advice Value for money PHSO Annual Report and Findings of the Peer Review Accounts Changes in budget and Peer Review Report spending Written evidence from Impact of hybrid working PHSO and service users Modernisation and reform Parliamentary and Healt