Recommendation 5

HM Government Acknowledged

PHSO considers all the complaints we receive. For complaints about the NHS where the claimed impact on the complainant is less serious, for example a cancelled medical appointment that was frustrating but had no clinical impact, we will consider whether we can resolve the complaint promptly. If we cannot, then we will not take those complaints further. A proportional approach to deciding which cases to progress to investigation is common among the Ombudsman community. The Local Government and Social Care Ombudsman, as a matter of long-standing policy, only investigates cases that raise serious issues of injustice1. The Scottish Public Services Ombudsman brought in a proportionality test prior to the COVID-19 pandemic2. The Northern Ireland Public Services Ombudsman also take a proportionate approach to their consideration of cases, only focusing in their assessment on the “principal and contentious issues of complaint rather than minor breaches of policy and procedure which have little or no impact on the allegations made or where the injustice caused is minimal”.3 We do not apply a proportionality test to cases regarding Government departments and arms-length bodies, which are referred to us by Members of Parliament and which make up around twenty percent of overall case load. Pressures on public services, including the NHS, are going to continue for many years as a result of the pandemic. Focusing resources on matters that have much less serious impact on people and thereby delaying consideration of more serious matters is not a reasonable use of public funds. In Autumn 2022, PHSO’s Board commissioned an in-depth review into this approach and has since taken a decision to continue to focus on these more serious cases, in-line with the wider Ombudsman community. In doing so, it considered our casework data, the impact of our approach on case outcomes and feedback from complainants, alongside comparisons from other Ombudsman services. Between April 2021 and September 2022, we had approximately 1,700 health cases which we closed as not meeting the injustice threshold. This represents around 25% of health cases which we would previously have investigated. In 114 of these cases, we were able to come to a prompt resolution. An assessment shows that these cases would not generally have required a detailed investigation. Therefore the impact which could have been achieved for wider public services, had we taken these cases forward, is minimal. Feedback from complainants suggests general acceptance and understanding of why we have made the decision not to progress these cases. 1 Local Government and Social Care Ombudsman, Assessment Code, last updated July 2021 2 Scottish Public Service Ombudsman, Explanation of Terms, last updated September 2022 3 Northern Ireland Public Service Ombudsman, About our Service Information The Board concluded that our approach provides the correct balance between delivering the best service to complainants who have experienced a more serious injustice and maintaining our impact externally through casework. It also enables PHSO to deal with increased and sustained demand. We expect ongoing pressures in the NHS to result in sustained demand for an extended period. We will continuously review the methods we apply to the whole casework process as part of the commitment to ongoing improvement of our service. This includes implementing efficiencies, having a dynamic approach to casework that is able to adapt to the levels of demand for our service, using a range of resolution and investigation methods to achieve justice for complainants, and using improved technology and data to facilitate these activities.