Parliamentary and Health Service Ombudsman Scrutiny 2022-23

We have heard praise of the PHSO’s handling of casework, but we have also received evidence of concerns with some aspects of its service provision. The PHSO told us that it would reflect on the concerns about the service it provided to people with disabilities while outlining the measures it takes to meet the needs of complainants. In its response to this report, the PHSO should outline to us the steps it proposes to take to address the concerns we have heard in our written evidence, in particular in relation to service provision to people with disabilities and the elderly.

We welcome the fact that the PHSO has worked hard to reduce the backlog of cases created by the COVID-19 pandemic and met its target for making initial decisions about cases within seven days. However, we remain concerned by the fact that the PHSO has missed its targets on deciding cases subject to further consideration. The PHSO attributed this to the lag effect of closing cases that had been in the queue for a long time and expect that the time taken to complete further consideration will drop dramatically once the backlog has been cleared. In order to clarify how far the work being undertaken to clear the backlog of cases is the main cause of the length of time taken to resolve cases subject to further consideration, the PHSO should find a way to present the information on the time involved in case resolution by giving separate figures for those cases which are part of the COVID-19 backlog and those others which have been received since the end of the pandemic.

We do not accept the Ombudsman’s argument that we would have been critical of the PHSO for setting lower, yet more realistic, targets for case resolution. The setting of unrealistic targets leads to them being missed, and draws unwarranted criticism where realistic targets would not do so. Rather, we are of the view that targets should be simultaneously ambitious and realistic, to allow the public and us to assess the performance of the organisation more clearly. In its response to this report, the PHSO should provide details of the methodology it uses for deciding its targets for how quickly it should resolve cases subject to further consideration, and outline any steps it will take to review that methodology to arrive at more realistic targets to be used in the future.

We welcome the increase in the number of cases resolved by mediation and PHSO’s ambition to widen the range of cases resolved by mediation in 2023/24. The PHSO stressed that the cultural attitudes of stakeholders, notably in the NHS, were a barrier to increasing the number of cases resolved through mediation. The PHSO should outline how it is working with stakeholders to place a stronger emphasis on mediation in the Complaint Standards for the NHS and for Government. The PHSO should also write to us before our next annual inquiry into the PHSO, setting out whether it has matched its ambition for 2023/24 to maintain the number of cases resolved by mediation and to appropriately widen the types of cases resolved to include more complex cases and cases beyond those focused on healthcare. It should also set out what its medium- and long-term aims are for mediation and the measures it is intending to take to achieve those aims. (Paragraph 23) 28 Parliamentary and Health Service Ombudsman Scrutiny 2022–23

The potential barriers presented by training and culture among NHS staff to increasing mediation cannot be overcome solely by the PHSO. Other stakeholders, including the Government, have a role to play in promoting mediation. The Government should outline how it is working with NHS England and other relevant stakeholders to promote a culture and training that is supportive of mediation among NHS staff and those working in government departments.

We reiterate the concerns we expressed in our 2021–22 report about the PHSO’s continuation of the ‘severity of injustice’ approach to case management which means certain cases are very unlikely to be resolved and are not subject to detailed investigation. This was introduced as a temporary measure during the pandemic. The PHSO have stated it intends to review its future approach when the backlog of cases caused by the COVID-19 pandemic has been dealt with, with this likely to take place towards the end of the 2023/24 financial year. We reiterate the recommendation from our 2021–22 report that the PHSO should set out publicly the criteria it will use during the review to determine its future approach.

We welcome the PHSO’s actions following our previous recommendation, resulting in reforms to how it conducts its Service Charter survey and differentiating the data depending on the outcome of a complaint’s case. However, we remain concerned that these changes do not address the underlying problems revealed by missing the targets for the three KPIs, and by the persistently low scores related to gathering information, explaining decisions, and making and communicating the final decision to complainants in a timely fashion. The PHSO should set out in its response to this report the steps it is taking to drive continual improvement in its scores in these key areas. (Paragraph 36) Staff management and training

We note the welcome increase in the PHSO’s number of staff, especially its new caseworkers. Likewise, we welcome the fact that it has retained specialist workers and has increased the amount of training it delivers to staff. This increase in training means it is even more important for the PHSO to retain staff, given the additional investment now being made in them. The Ombudsman and Chief Executive suggested current levels of staff turnover could be the result of a lack of opportunity for career development and the PHSO’s different policy on hybrid working compared to other ombudsmen. We welcome the PHSO’s intention to review its hybrid working policy next year. The PHSO should separately assess whether there are further steps it can and should take to reduce staff turnover, including how far its hybrid working policy is leading to higher turnover than other ombudsmen. The PHSO should look to complete its reviews of hybrid working and the factors causing staff turnover by the summer of 2024, and share its findings with us ahead of our next scrutiny session for the 2023/24 period. (Paragraph 44) Value for Money

We welcome the PHSO’s digital ambition and believe that this is a sensible way to increase value for money. We request from the PHSO a further update on progress Parliamentary and Health Service Ombudsman Scrutiny 2022–23 29 towards achieving these aims, along with a detailed analysis of any financial savings expected to be made as a result, with both to be included in the PHSO’s next Annual Report and Accounts.

We renew our call for legislative reform of the PHSO, the principle of which enjoys widespread support among stakeholders and the ombudsmen that would be directly affected. The PHSO have outlined to us some concrete examples of the operational issues that are being caused, and exacerbated over time, by the lack of reform. Reforms are long overdue, and we do not agree with the Government that this is not an urgent issue; rather it has been neglected too long and further delay is no longer tenable. The Government should reconsider its position on reforms and set out its plans, ahead of the general election. It should consult with a wide variety of stakeholders, including different ombudsmen, parliamentarians and PHSO service users. All political parties should include a commitment to reforming the legislation relating to the PHSO in their upcoming manifestos ahead of the next General Election, coupled with a commitment to introduce such legislation early in the next Parliament. (Paragraph 58) Impact on other organisations

We welcome the PHSO’s continual collaboration with ombudsmen in other countries and across the UK, along with its collaboration with other organisations. In its response to this report the PHSO should outline the lessons it has learnt and best practices it has adopted because of its collaboration with other ombudsmen.

We welcome the progress that has been made in developing and rolling out Complaint Standards for the UK Government and the NHS. These Standards have the potential to improve the quality of public services and the handling of complaints. Ensuring that staff know about and act on these Standards is critical to achieving these goals. In its response to this report, the PHSO should set out both the proportion and number of all relevant NHS and UK Government staff who have been trained in its respective Complaint Standards, broken down by department where appropriate, and inform us of its targets for training over the 2023–24 financial year.

We reiterate the recommendation from our previous report that the Cabinet Office should strongly encourage Government departments and public bodies to sign up to the Government Complaint Standards. In its response to this report, the Government should outline how many departments and public bodies have now signed up to the PHSO Complaint Standards, and set out its plan and timetable to introduce these Standards across all departments and public bodies. (Paragraph 69) 30 Parliamentary and Health Service Ombudsman Scrutiny 2022–23