Select Committee on Public Administration Second Special Report



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.


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.


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.


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.


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.


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.


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.

previous page contents next page

House of Commons home page Parliament home page House of Lords home page search page enquiries index

© Parliamentary copyright 2001
Prepared 4 April 2001