Memorandum by the Parliamentary and Health
Service Ombudsman (OMB 01)
1. INTRODUCTION
1.1 At my first appearance before the Committee
in March 2003 I said that I was aiming to deliver a continually
improving, customer-focused, accessible, modern and responsive
Ombudsman service, which shares learning to improve public service
delivery. It is now just over two years since I took up my post
and in that time I believe that the office has made excellent
progress towards creating the vision I set out in my first Memorandum
to the Committee. I am grateful for the support that the Committee
has given me since I was appointed.
1.2 My 2003-04 Annual Reports as Parliamentary
Ombudsman and Health Service Ombudsman for England were laid before
Parliament on 13 July 2004. Resource Accounts for the Office of
the Parliamentary and Health Service Ombudsman were laid before
Parliament on 17 November 2004.
1.3 This Memorandum describes what we are
doing to modernise our service; gives details about the increase
in our current workload and explains how we are managing it; and
highlights a number of issues and areas of our work which are
likely to be of particular interest to the Committee.
1.4 I would also like to draw to the Committee's
attention a number of matters that have been of particular concern
to me over the past year. They are:
— The lack of progress in removal of
the MP filter.
— The failure to deal with continuing
care reviews in a fair, accurate and timely manner.
— The current position with the NHS
complaints system.
2. MODERNISING
OUR SERVICE
The OPHSO change programme
2.1 To ensure we can provide a powerful
and effective service based on users' needs, we carried out major
stakeholder research amongst complainants, MPs, complaint handlers,
senior civil servants and the voluntary sector—and indeed
the Committee itself. The results have informed the development
of three statements which set firm foundations for our continued
development:
— A statement of our Role and Purpose
and Values (Annex A).
— Our Governance Statement:
to signal our commitment to openness and accountability I have
put in place an Advisory Board which includes two external members.
I have also appointed an external Chair of our Audit Committee.
— A Statement of Responsibilities
setting out the responsibilities of the Cabinet Office, the Treasury
and the Department of Health in providing the necessary resources
and support to OPHSO to ensure the effective operation of my office
in accordance with the intentions of Parliament; and my responsibilities
in demonstrating proper accountability for the public monies provided
to me.
2.2 To deliver the changes our users want,
we have introduced a major change programme to modernise our processes,
systems and ways of working. We have introduced new procedures
to improve communications with our customers and to manage our
workload more efficiently. We are piloting a new case management
IT system to support us in that and to provide key management
information, not least to help us identify patterns of complaints
both within and across the organisations under our jurisdiction.
2.3 In addition, we have established a number
of specialist teams to tackle complex and large investigations
such as Equitable Life and continuing care.
2.4 All this change has been delivered whilst
dealing with an increasing caseload. I am convinced the outcome
of the change programme will be a better service for the public
and those involved in the delivery of public services alike.
Progress on regulatory reform of public sector
Ombudsmen legislation
2.5 As the boundaries in delivery of public
services become increasingly flexible, collaborative working amongst
public sector Ombudsmen becomes increasingly important if we are
to offer a single point of reference for complainants. The Committee
will be aware that Tony Redmond, the Chair of the Commission for
Local Administration in England, and I have been in discussion
with the Cabinet Office and the Office of the Deputy Prime Minister
(ODPM) with a view to removing the legislative constraints on
effective joint working. We have identified a number of areas
where legislative changes would assist both offices in conducting
joint investigations, issuing joint reports, and consulting and
sharing information with other UK public sector Ombudsmen.
2.6 The Cabinet Office have advised us that
it should be possible to introduce the majority of the changes
we are seeking by way of a Regulatory Reform Order. We are now
in detailed discussion with the Cabinet Office and ODPM and I
understand that the Cabinet Office hope to publish a consultation
document on proposals for regulatory reform early in the new year.
MP filter
2.7 I said in my Annual Report that, whilst
MPs have a key role to play in supporting their constituents when
they have problems with public service providers, members of the
public should also have direct access to the Parliamentary Ombudsman.
It is clear that removal of the MP filter will not be possible
by regulatory reform, but will require primary legislation.
2.8 Our public awareness research has shown
that the MP filter is one of a number of possible barriers to
the Ombudsman's services, particularly amongst young people, black
and minority ethnic communities and unskilled and unemployed people.
In the survey of MPs which my Office conducted jointly with PASC
this summer, two thirds of MPs favoured removal of the filter.
Removal was also recommended by the independent Policy Commission
on Public Services, set up by the National Consumer Council, in
their recent report on public service reform.
2.9 I would welcome any support the Committee
is able to give in pressing for this important and, I believe,
overdue legislative change.
3. WORKLOAD
3.1 During 2003-04 our workload increased
significantly. In total we received 11,983 enquiries and 6,684
complaints (excluding AOI cases), an increase in complaints received
of 11% on the previous year. Of these, 47% (3,148) were investigable
cases.
3.2 In both 2003-04 and 2004-05 our workload
has included an unprecedented number of complaints on continuing
care, over 4,000 since I issued my special report in February
2003.
3.3 To improve our efficiency in dealing
with cases, the Office committed to challenging performance targets
in 2003-04. During the year we completed just under 3,000 cases,
and reduced the number of cases waiting for a decision for over
a year from 64 at the beginning of 2003-04 to 19 at the year end.
We also dealt with more cases more quickly, with 64% of complainants
receiving a decision within three months and 81% within six months.
3.4 The pressure has continued into 2004-05
where there has been, to date, a 37% increase in investigable
complaints over 2003-04.
4. CONTINUING
CARE
4.1 Following my special report to Parliament
in February 2003, the Department of Health and NHS staff across
the country have developed new eligibility criteria and undertaken
thousands of retrospective reviews of the cases of patients who
may have wrongly been refused NHS full funding for their continuing
care. In September this year the Department of Health announced
that "almost 20% of cases have been granted recompense."
However, since my report was issued I have received more than
4,000 further complaints and I am disappointed to report that:
— The review process has been characterised
by significant delays. The Department of Health has reported that
whilst it undertook to complete all reviews by 31 December 2003,
only 22% were completed on schedule. 57% (6,713 out of a total
of 11,724) were completed by the extended deadline of 31 March
2004 and 85% by the end of July when 1,600 cases were still outstanding.
— Eligibility criteria are still unclear
and in some cases inconsistent.
— In over half the cases referred to
us, we have found the assessment process to be flawed.
— There was insufficient staff capacity
locally to deliver the reviews. Competence has built up over the
last year, but there remains a need for training and development.
4.2 I have raised these issues with the
Parliamentary Under Secretary of State for Community and I plan
to publish a further report to Parliament later this year.
5. NHS COMPLAINTS
SYSTEM
5.1 In April 2003 the Department of Health
(DOH) published "NHS complaints reform: making things
right" which set out reforms designed to make the NHS
complaints system more accessible, responsive, independent and
linked to the improvement of services to patients. The proposals
received Parliamentary approval as part of the Health and Social
Care (Community Health and Standards) Act 2003. The legislation
moved responsibility for the local, second stage of the complaints
procedure to the newly created Commission for Healthcare Audit
and Inspection (now the Healthcare Commission). In December 2003
the Department of Health consulted on draft regulations to govern
the new complaints system from 1 June 2004.
5.2 In March 2004 I expressed my concern
that the draft regulations:
— Focused on process and timescales
rather than outcome, leadership and staff competence.
— Failed to address the issue of redress
for justified complaints.
— Included time targets which were
not achievable for all complaints and so would result in disappointment
and dissatisfaction.
5.3 I also expressed my concern that the
Healthcare Commission was not ready to deliver the new independent
second stage and highlighted the risk that the credibility of
the system could be compromised as a result.
5.4 I understand that many other organisations
had concerns about the draft regulations, which required significant
redrafting to meet the original aims of the scheme. Then, during
the summer, the Department of Health decided that the local resolution
first stage should remain unchanged pending publication of the
Shipman Inquiry's report. Accordingly the only substantive change
to the complaints procedure was the introduction of the new role
of the Healthcare Commission. The Commission eventually took on
its new role with effect from 30 July 2004.
5.5 I am concerned about the confusion caused
to complainants by the delays in implementing these changes, the
lack of preparedness for the new arrangements and the missed opportunities
to deliver a patient-focused procedure. I am preparing a report
to Parliament on these matters which I hope will inform the next
set of regulations which I understand will be drafted in the spring.
6. EQUITABLE
LIFE
6.1 The Committee will be aware that I decided
to conduct a further investigation into the prudential regulation
of Equitable Life following the publication of the Penrose Report
and in the light of representations I received as part of a public
consultation exercise I conducted in April and May 2004. I reported
my decision to Parliament on 19 July 2004.
6.2 I sent a letter to all Members of Parliament
on 25 November 2004 outlining the progress that has since been
made in terms of bringing the Government Actuary's Department
within my jurisdiction for the purposes of the investigation;
in establishing the investigation team and securing the resources
necessary to support it; in obtaining the Penrose archive and
other relevant evidence; in discussing with the policyholder action
groups the selection of representative complainants and the agreement
of a statement of the investigation's terms of reference and the
main heads of complaint; and about other matters.
6.3 I will keep the Committee—and
Parliament more generally—informed of progress on the investigation.
7. OCCUPATIONAL
PENSIONS
7.1 I wrote to all Members of Parliament
on 16 November 2004 to inform them that I had decided to conduct
an investigation into complaints I had received that related to
the information and advice provided by public bodies, and about
decisions made by them, in relation to the risks to the pension
rights of members of final salary occupational pension schemes
should their scheme be wound up due to an employer's insolvency
or for other reasons.
7.2 I have asked the public bodies—the
Department for Work and Pensions, Her Majesty's Treasury, the
Occupational Pensions Regulatory Authority and the National Insurance
Contributions Office—to provide their formal response to
these complaints by 17 December 2004.
8. ACCESS TO
OFFICIAL INFORMATION
(AOI)
8.1 The Freedom of Information Act 2000
will be fully implemented from 1 January 2005. The Code of Practice
on Access to Government Information will cease to operate and
the Information Commissioner will be responsible for dealing with
complaints about a failure to provide information under the Code.
8.2 The Information Commissioner and I wrote
to all MPs in July 2004 to tell them of the arrangements we had
agreed to facilitate a smooth transition from the Code to the
Freedom of Information Act. I will continue to accept complaints
made under the Code up to 31 December 2004 to ensure people who
have made requests for information are not disadvantaged.
8.3 After the implementation of the Act
my Office will publish, in the spring of 2005, a full report on
our role in monitoring the operation of the Code since its inception
in 1994.
9. WELSH ADMINISTRATION
OMBUDSMAN
9.1 Adam Peat, the Public Service Ombudsman
for Wales, took over my responsibilities as Welsh Administration
Ombudsman on 4 November 2004.
Ann Abraham
Parliamentary and Health Service Ombudsman
November 2004
Annex A
OFFICE OF THE PARLIAMENTARY AND HEALTH SERVICE
OMBUDSMAN
ROLE AND
PURPOSE
Our role is to provide a service to the public
by undertaking independent investigations into complaints that
government departments, a range of other public bodies in the
UK, and the NHS in England, have not acted properly or fairly,
or have provided a poor service.
We aim to:
— make our services available to all;
— operate open, transparent, fair,
customer-focused processes;
— understand complaints and investigate
them thoroughly, quickly and impartially, and secure appropriate
outcomes; and
— share learning to promote improvement
in public services.
VALUES
The values which underpin our work are:
Excellence
— We pursue excellence in all that
we do in order to provide the best possible service;
— we seek feedback to achieve learning
and continuous improvement;
— we operate thorough and rigorous
processes to reach sound, evidence-based judgements;
— we are committed to enabling and
developing our staff so that they can provide an excellent service.
Leadership
— We lead by example and believe our
work should have a positive impact;
— we set high standards for ourselves
and others;
— we aim to be an exemplar and provide
expert advice in complaints handling;
— we share learning to achieve improvement.
Integrity
— We are open, honest and straightforward
in all our dealings, and use time, money and resources effectively;
— we are consistent and transparent
in our actions and decisions;
— we take responsibility for our actions
and hold ourselves accountable for all that we do;
— we treat people fairly.
Diversity
— We value people and their diversity
and strive to be inclusive;
— we respect others, regardless of
personal differences;
— we listen to people to understand
their needs and tailor our service accordingly;
— we promote equal access to our service
for all members of the community.
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