Source · Select Committees · Public Administration and Constitutional Affairs Committee
Sixth Report - Parliamentary and Health Service Ombudsman Scrutiny 2021–22
Public Administration and Constitutional Affairs Committee
HC 745
Published 31 March 2023
Recommendations
4
Acknowledged
Para 34
In its response to this Report, the PHSO should provide a detailed account of the...
Recommendation
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 …
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Government Response Summary
The government states that they have already made improvements to several aspects of the casework process, including casework management (IT) system; forms, letters and templates; learning resources for caseworkers; and revised training and guidance for caseworkers, and are evaluating call recording and transcription of casework discussions.
6
Accepted
Para 36
We are concerned by the number of Level 1 and 2 cases that are not...
Recommendation
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 …
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Government Response Summary
The PHSO states they consider all complaints, but for less serious NHS complaints, they will consider whether they can resolve the complaint promptly and if not, they will not take those complaints further. They also state that a proportional approach to deciding which cases to progress to investigation is common among the Ombudsman community.
7
Acknowledged
Para 37
The Committee welcomes the improvements the PHSO has made to its website to give clarity...
Recommendation
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 …
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Government Response Summary
The government acknowledges the improvements to the website and will review the content to see if further improvements can be made to explain their process and the complainant journey, whilst ensuring that the website remains succinct, accessible and easy to navigate, also exploring technological solutions.
9
Accepted in Part
Para 39
The Committee appreciates that there are issues to address with the use of mediation, such...
Recommendation
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 …
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Government Response Summary
The PHSO aims to double the number of mediations again in 2023-24, has trained more caseworkers, and will start publishing outcomes of complaints resolved through mediation, but does not commit to the specific 25% target due to complainant availability and the need for systemic investigations.
11
Accepted
The PHSO should update the Committee on the outcomes of the review of how the...
Recommendation
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 …
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Government Response Summary
The government has redesigned the complainant satisfaction survey based on recommendations from an independent research agency, tested it with users, and will roll it out in May 2023. They will publish the data coming from the new survey later in the year, disaggregated by case outcome as well as the stage the complaint was concluded.
13
Acknowledged
Para 53
In light of the increase in staff turnover in 2021–22, we reiterate our call from...
Recommendation
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 …
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Government Response Summary
The government acknowledges the importance of staff retention and outlines steps taken such as training, staff surveys, and monitoring turnover, but makes no specific commitments to address the PHSO's loss of institutional knowledge or casework management pace.
15
Accepted
Para 55
The PHSO should clarify how the Clinical Advice Quality Framework will improve trust and confidence...
Recommendation
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 …
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Government Response Summary
The PHSO has completed implementation of all recommendations from the Donaldson Review. Provisional views are shared with clinical advisors. They will not take forward naming clinical advisers due to concerns about safety and security, and the risk of giving disproportionate weight to their evidence.
17
Acknowledged
Para 57
The PHSO should report back to the Committee on how the organisation intends to continue...
Recommendation
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 …
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Government Response Summary
The government acknowledges the challenges of the current labour market but does not plan to target applicants over 50, citing good representation in the PHSO workforce, and states the review of pay and grading will help them remain competitive.
18
Acknowledged
The PHSO should report back to the Committee in its response to this Report on...
Recommendation
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 …
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Government Response Summary
The government acknowledges the importance of understanding the protected characteristics of their workforce and are planning a campaign to raise the benefits of staff declaring this information with the aim of having as complete data as possible and will report this, for the grades where they have sufficient numbers of staff to maintain anonymity, once they have more complete data.
19
Acknowledged
The Committee is pleased that the PHSO was able to secure an increased budget in...
Recommendation
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 …
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Government Response Summary
The PHSO is absorbing an increase in demand and managing inflationary pressures by implementing the 2022-25 Corporate Strategy to drive efficiencies in the casework process and enhance the service, as well as reviewing corporate functions to release resources.
20
Acknowledged
Para 75
The PHSO should put in place robust plans to deliver further efficiencies across the organisation...
Recommendation
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.
Government Response Summary
The PHSO outlines plans to implement the 2022–25 Corporate Strategy, increase efficiency, introduce new mechanisms to respond to demand, identify and progress systemic cases, and ensure reports meet high accessibility standards but does not commit to specific or new efficiency targets or plans.
23
Accepted
Para 78
It is unsatisfactory that data provided to this Committee has been subsequently revised.
Recommendation
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.
Government Response Summary
The PHSO states that it conducts a thorough review of all performance data annually and that data provided to the Committee is quality assured to the highest standard, explaining the circumstances around the data revision.
26
Acknowledged
Para 81
The Committee firmly agrees with need for legislative change of the PHSO.
Recommendation
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 …
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Government Response Summary
The government welcomes the recommendation and states that it is actively raising the matter of Ombudsman reform with the Government, parliamentarians and wider stakeholders.
29
Acknowledged
Para 97
The Committee is encouraged by five organisations that have volunteered to adopt the UK Central...
Recommendation
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 …
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Government Response Summary
The government is supportive of the complaint standards and, assuming they are shown to be working in practice, the Cabinet Office should play a role in working with other departments to encourage their adoption.
32
Accepted
Para 100
We recommend that the PHSO increases its engagement with departmental Select Committees to encourage them...
Recommendation
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.
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Government Response Summary
The government states that PHSO maintains a programme of regular engagement with Parliament, including Select Committees, and shares information with Select Committee clerks about key themes or recurring issues identified in complaints.
34
Accepted
Para 102
Ahead of the next annual scrutiny hearing, the PHSO should provide an update to the...
Recommendation
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 …
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Government Response Summary
The PHSO will update the Committee on the progress of its Outreach programme ahead of the next scrutiny inquiry, focusing on building trust and engagement with communities that rarely complain, and will explore options for gathering additional information about complainants to understand barriers to complaining.
35
Accepted
We also welcome the PHSO’s efforts to engage with MPs and their staff on the...
Recommendation
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 …
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Government Response Summary
The government acknowledges the PACAC's role in encouraging engagement and are piloting activities with MPs' offices, including bespoke training and constituency visits based on feedback from a recent event, and will report back to PACAC on the impact of this work during the next scrutiny inquiry.
Conclusions (18)
1
Conclusion
Accepted
Para 15
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, …
Government Response Summary
The PHSO is absorbing an increase in demand for its service, and its plans for implementing the 2022-25 Corporate Strategy will drive efficiencies, enhance service, and ensure a user-focused approach by increasing efficiency, introducing new mechanisms, and identifying systemic cases.
2
Conclusion
Acknowledged
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. …
Government Response Summary
The government says PHSO is absorbing an increase in demand and outlines planned actions including increasing efficiency, introducing mechanisms to respond to increases in demand, and identifying systemic cases, as well as establishing a new Public Engagement Advisory Group.
3
Conclusion
Accepted
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 …
Government Response Summary
The PHSO has already made improvements to aspects of the casework process, including the casework management IT system, forms, letters and templates, learning resources for caseworkers, and revised training and guidance. They are evaluating a test of call recording and transcription of casework discussions, and will plan for wider digital and technological improvements.
5
Conclusion
Acknowledged
Para 35
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 …
Government Response Summary
The PHSO considers all complaints, and uses a proportional approach, and will review the methods applied to the casework process to ensure it is dynamic and able to adapt to the levels of demand for its service.
8
Conclusion
Acknowledged
Para 38
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 …
Government Response Summary
The PHSO aims to double the number of mediations again in 2023-24, has trained more caseworkers, and will start publishing outcomes of complaints resolved through mediation; however, they state that complainant availability and the need for systemic investigations are limiting factors.
10
Conclusion
Acknowledged
Para 40
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 …
Government Response Summary
The government states that staff turnover has stabilised and that they continue to prioritise developing PHSO's people to ensure they remain an attractive employer.
12
Conclusion
Acknowledged
Para 52
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 …
Government Response Summary
The government states that the increase in staff turnover in 2021-22 was in-line with national trends following the pandemic and that turnover has now stabilized. They continue to prioritize developing PHSO's people and are committed to continuous improvement and learning.
14
Conclusion
Accepted
Para 54
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 …
Government Response Summary
The government states that they have completed implementation of all recommendations made by the Donaldson Review into PHSO’s approach to clinical advice and have a framework for assuring the quality of clinical advice.
16
Conclusion
Acknowledged
Para 56
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 …
Government Response Summary
The PHSO notes that the current labour market is challenging, but they have successfully recruited to roles which have historically been difficult to fill. They do not have plans to target applicants who are over the age of 50 as workforce data shows that they have good representation from this age group.
21
Conclusion
Accepted
Para 76
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 …
Government Response Summary
The government is committed to embedding the peer review recommendations, taking action on coaching/training, communication, publishing cases, anonymisation, and reducing queues in 2023-24, and progressing outstanding actions through the 2022-23 Corporate Strategy by 2025, including digital updates and IT system integration with the NHS.
22
Conclusion
Accepted
Para 77
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 …
Government Response Summary
The PHSO states that it conducts a thorough review of all performance data annually and that data provided to the Committee is quality assured to the highest standard, explaining the circumstances around the data revision.
24
Conclusion
Accepted
Para 79
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 …
Government Response Summary
The PHSO has robust performance management systems and continually seeks feedback on the impact of business changes on workforce productivity and wellbeing, including on hybrid working, through staff engagement mechanisms and the annual Staff Survey.
25
Conclusion
Accepted
Para 80
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 …
Government Response Summary
The PHSO states that following the decision to maintain hybrid working, they have made some updates to systems to maximize productivity, including integrated telephone and ICT systems, simplified login process and remote connectivity, enhanced office wireless networks and piloting the further capability offered by Microsoft Teams.
27
Conclusion
Rejected
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 …
Government Response Summary
The government does not consider fundamental ombudsman reform a priority or that legislation is the answer, but is content to keep it under review and look at specific proposals on a case by case basis.
28
Conclusion
Accepted
Para 96
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 …
Government Response Summary
The government welcomes the Committee's support and will report on progress embedding the Complaint Standards in its first twelve months of operation, publishing feedback, best practice, training, support, and guidance early in 2024-25.
30
Conclusion
Accepted
Para 98
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 …
Government Response Summary
The PHSO maintains a program of regular engagement with Parliament and shares information about key themes in complaints with Select Committee clerks. In rare cases of non-compliance, the PHSO has statutory powers to bring a case to Parliament's attention.
31
Conclusion
Acknowledged
Para 99
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.
Government Response Summary
The government acknowledges the Ombudsman's work and the challenges it faces, including dealing with backlogs and increasing service demand, while noting the committee's request for robust plans for further efficiencies.
33
Conclusion
Acknowledged
Para 101
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 …
Government Response Summary
The government will update the Committee on the Outreach program as it progresses, focusing on building trust and engagement with communities that rarely complain.