ANNEX
MEMORANDUM BY THE SECRETARY OF STATE FOR
HEALTH
This memorandum sets out the Government response
to the comment and recommendation in the report of the Select
Committee on its investigation of selected Health Service Ombudsman
cases.
WORK OF THE OFFICE
The Government recognises that the widening of the
Ombudsman's jurisdiction from April 1996 has inevitably lead to
an increase in his workload and acknowledges the efforts the Ombudsman
has made to adjust the working methods of his office to meet this
demand. In particular, the Government welcomes the Ombudsman's
willingness to become involved in complaints in a more informal
way, if appropriate, where this can result in the resolution of
complaints without the need for formal investigation.
INVESTIGATION TIME
We therefore recommend that efforts be made to reduce
the average time to complete investigations still further, particularly
where this involves complainants (or those on whose behalf complaints
have been made) who continue to be in need of care (paragraph
7).
Previous Government responses to the Committee's
reports have acknowledged the ongoing efforts of the Ombudsman
(both previous and current incumbents) to reduce the length of
time it takes his office to complete investigations. The Ombudsman
is right though to stress the need for a balance to be drawn between
speed and thoroughness of an investigation. However, the Government
understands the concerns behind this recommendation and expects
the NHS to continue to provide appropriate treatment to patients
at the appropriate time irrespective of whether a complaint has
been made.
RECOMMENDATIONS AND REDRESS
The Government is aware that on the vast majority
of occasions the NHS acts on the Ombudsman's recommendations and
would expect this to be the case except where there are valid
reasons not to do so. It is a matter of regret that a dental practitioner
had to be named because he refused to act on, and apologise for,
the shortcomings identified by the Ombudsman. The Government takes
the Ombudsman's investigations very seriously and so must all
those providing services in the NHS. Health professionals are
part of a public service and have to be accountable for what they
do.
On the issue of redress, the circumstances in which
special payments (for example, ex-gratia payments) can
be made are set out in "Government Accounting". The
Department has delegated authority from the Treasury to make special
payments and has further delegated authority to NHS organisations
to make payments within agreed limits. As the Committee knows,
the Ombudsman is already able to recommend financial redress if
he deems this appropriate and the NHS is able to make ex-gratia
payments in certain circumstances, principally where there has
been some financial loss incurred by the complainant. NHS organisations
can make payments where there has been no financial loss incurred
but this can only be in exceptional circumstances. Any change
to these arrangements, for example, the introduction of a separate
broader code for the NHS would need to be agreed with the Treasury.
CASE AGAINST HEREFORDSHIRE HEALTH AUTHORITY
Existing guidance on the setting up of continuing
care review panels (CCRPs) states that a health authority must
convene a panel if a patient seeks a review on the grounds that
local eligibility criteria for continuing in-patient care have
not been correctly applied in his or her case. The guidance makes
it clear that authorities may only decline to convene a panel
in exceptional circumstances i.e. where the patient clearly falls
outside the eligibility criteria or where the complaint does not
fall within the panel's remit. The Department of Health is considering
whether it is possible to make this guidance still clearer as
part of the current review of continuing care policy and the guidance.
The new Chief Executive of the Health Authority,
who attended the Select Committee hearing in his former guise
as Director of Social Services for Herefordshire, has confirmed
that all staff have been made aware that requests for CCRPs may
not be made in precise terminology as the Committee points out.
If necessary, explanations and assistance are offered to ensure
that the Authority is clear about the wishes of the complainant.
NHS complaints procedure and role of the Convenor
The Government acknowledges the concerns expressed
by the Committee about the complaints procedure, particularly
the independent review element and the role of the Convenor. The
Government response to the previous report from the Committee
reported that guidance for Convenors was being produced and this
(Good Practice Guide for Convenors - Advice for Convenors on
their role in the NHS complaints procedure) was issued in
October 1999. The Department of Health is also working on further
guidance for Convenors explaining the effect of the NHS Plan and
picking out some key points for Convenors on their role based
on the experience of Convenors themselves.
The report mentions the evaluation of the complaints
procedure. This two-year, independent project was completed at
the end of last year and the evaluation team has submitted its
report to Ministers at the Department of Health. The intention
is to publish the report as part of a wide consultation once Ministers
have considered the report's findings. In the meantime though
the Government expects the NHS to operate the current procedure
within the spirit and framework of the guidance and Directions.
The Committee's role
The Government shares the Committee's views on its
role and involvement in individual cases as expressed in paragraph
16 of the report. Whilst understanding the point made by the Committee
in relation to this particular case the Government accepts the
Health Authority's assurances that the funding position was agreed
following the proper processes rather than as a result of any
outside influence.
CASE AGAINST BEXLEY AND GREENWICH HEALTH AUTHORITY
In response to concerns about the operation of the
social services complaints procedures over a number of years the
Department of Health undertook a review of these procedures in
1999/2000. The purpose of the review was to evaluate the effectiveness
of the operation of the complaints procedures since their introduction
in 1991 and to identify any difficulties arising from the legislation
and guidance. A consultation exercise, "Listening to People",
on proposals for improving the social services complaints procedures
was completed in September 2000.
The Department will develop proposals for social
services and NHS complaints procedures that ensure that the two
systems relate as closely as possible to each other. The main
objective will be to ensure that service users, including those
receiving services that overlap traditional health and social
care boundaries, have access to a coherent and easily understandable
system for complaints. The Department also plans to ensure there
is a clear definition of who is responsible for investigating
complaints, and clear boundaries between, for example, local authority
procedures and those operated by the National Care Standards Commission
in relation to the services it regulates (such as care homes)
from April 2002. The Department recognises that as the agenda
for joint working, developing Partnership Arrangements, (1999
Health Act), and Care Trusts emerges, the need for a coherent
approach to complaints becomes vital, especially where the focus
is on integrated provision.
On the specific case, the Government would like to
echo the sympathies expressed by the Health authority in its Memorandum
to the Committee to the complainant and his family on the death
of their grandmother.
The Health Authority has provided details of a number
of actions taken as a result of the investigations by the Ombudsmen.
The Bexley & Greenwich Joint Assessment Panels Elderly Care
(JAPEC) which decides whether individuals require residential
or nursing care, now requires a detailed medical assessment by
a clinician and where necessary, a functional assessment by a
physiotherapist or occupational therapist. This is a change that
has been as a direct result of the Health Service Commissioner
report.
Since the time of the complaint, many changes have
already taken place to improve the efficiency of the then Registration
and Inspection arrangements. These arrangements had been inherited
from two former District Health Authorities and a Family Health
Services Authority. At the time, they included two separate Registration
teams provided by local NHS Trusts. The service, which was split
between Bexley and Greenwich, was subsequently amalgamated and
is now provided in-house by Health Authority employed officers.
This team works in a more integrated way with the Council teams.
The Health Authority now works much more closely
with Bexley Council with regard to handling complaints. When the
Council receives complaints in respect of nursing home placements,
the Health Authority Registration and Inspection of Nursing Homes
officer provides specialist advice.
Despite the complaint not being dealt with by the
independent review procedure, it was referred to the Health Authority's
Reference Committee for consideration. The Committee's decision
was to follow up the deficiencies identified by the inspection
team following its investigation of the original complaint. The
Health Authority officer with responsibility for the registration
and inspection of Nursing Homes was asked to use her next inspection
of the home to look at the specific issues raised by the complaint
and report back. Subsequent announced and unannounced visits by
the Registration and Inspection officer showed that improvements
had been made and sustained.
EMERGING ISSUES
The Committee's report highlights two major pieces
of work that will affect the way that the Health Service Ombudsman
works - the review of Public Sector Ombudsmen and the evaluation
of the NHS complaints procedure.
The consultation on the Review of Public Sector Ombudsmen
elicited some 250 responses. These are currently being considered
and an evaluation of them will be announced before Easter.
The evaluation of the NHS complaints procedure is
mentioned earlier in this response. The NHS Plan, published by
the Department of Health last year, made it clear that the Government
will act on the results of the evaluation and reform the complaints
procedure to make it more independent and responsive to patients.
This will be done in conjunction with the development of the other
patient oriented initiatives outlined in Chapter 10 of the NHS
Plan e.g. the Patient Advocacy and Liaison Service, Independent
Advocacy Service, Patients Forums and Councils, and a national
body for patients.
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