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Select committee: Public Administration and Constitutional Affairs Committee

Third Report - Parliamentary and Health Service Ombudsman Scrutiny 2022–23

HC 198 Published 4 March 2024

Public Administration and Constitutional Affairs Committee Parliamentary and Health Service Ombudsman Scrutiny 2022-23 Report on parliament.uk ↗

At a glance6 recommendations and 7 conclusions · Government response published 23 May 2024 (deadline 14 May 2024)

The government's response

Summary written by Accountability Index from the government's response. It is not the government's own words.

The Government states it "remains supportive of the PHSO" but is "not convinced that fundamental reform is a priority at the current time" and would "stop short of mandating" the Complaint Standards.

  • On mediation, the Government says NHS England "agrees that mediation can support the resolution of a complaint" and "will work with DHSC and NHS Resolution to encourage the medical profession to engage in mediation".
  • On legislative reform of the PHSO, the Government is "not convinced that fundamental reform is a priority at the current time" but is "content to keep this under review" and to look at specific proposals "on a case by case basis".
  • It notes that it recently introduced legislation to remove the MP filter for victims of crime and says it "will be important to review the impact of this in the year ahead".
  • On the Complaint Standards, it "remains supportive" and says the Cabinet Office should play a role, "assuming that the Standards are shown to be working in practice", but it would "stop short of mandating their use" and prefers to "strongly encourage" take up.

Read the government's response ↗ Report an error

Sources

Recommendations and conclusions 13

  1. 1
    Outline proposed steps to address service provision concerns for disabled and elderly complainants. Conclusion · paragraph 13 Conclusion (the committee's words)
    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.
  2. 2
    Differentiate case resolution times by separating COVID-19 backlog figures from post-pandemic cases. Conclusion · paragraph 16 Conclusion (the committee's words)
    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.
  3. 3
    Provide methodology details for setting case resolution targets and review for greater realism. Conclusion · paragraph 17 Conclusion (the committee's words)
    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.
  4. 4
    Outline collaboration with stakeholders to increase mediation emphasis in NHS and Government complaint standards. Conclusion · paragraph 23 Conclusion (the committee's words)
    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.
  5. 5
    Outline government collaboration with NHS England to promote mediation culture and training for staff. Recommendation · paragraph 24 Recommendation (the committee's words)
    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.
  6. 6
    Publish criteria for reviewing the 'severity of injustice' approach to PHSO case management. Recommendation · paragraph 30 Recommendation (the committee's words)
    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.
  7. 7
    Detail steps to improve PHSO scores for information gathering, decision explanation, and communication. Recommendation · paragraph 36 Recommendation (the committee's words)
    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.
  8. 8
    Assess steps to reduce PHSO staff turnover, reviewing hybrid working policy by summer 2024 Conclusion · paragraph 44 Conclusion (the committee's words)
    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.
  9. 9
    Publish PHSO digital ambition progress update and financial savings analysis in Annual Report Conclusion · paragraph 51 Conclusion (the committee's words)
    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.
  10. 10
    Require government to reconsider PHSO legislative reform and set out plans before election Recommendation · paragraph 58 Recommendation (the committee's words)
    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.
  11. 11
    Outline lessons learned and best practices adopted from PHSO collaboration with other ombudsmen Conclusion · paragraph 63 Conclusion (the committee's words)
    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.
  12. 12
    Publish PHSO Complaint Standards training proportions and targets for NHS and government staff Recommendation · paragraph 68 Recommendation (the committee's words)
    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.
  13. 13
    Outline departments adopting PHSO Complaint Standards and present plan for full implementation Recommendation · paragraph 69 Recommendation (the committee's words)
    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.