Examination of Witnesses (Questions 40
- 50)
THURSDAY 20 OCTOBER 2005
MS ANN
ABRAHAM, MS
TRISH LONGDON
AND MR
BILL RICHARDSON
Q40 Julia Goldsworthy: But the central
presumption in the legislation was that it is centred around overpayments
and this is exactly what is causing the problem, so should this
not have been seen coming a long way off?
Ms Abraham: Possibly so, but we
are where we are. It seems to me that if the nature of the customer
base means that you cannot sort all this out at the year end,
then you have to get it right in year.
Jenny Willott: I was going to ask about
the CSA, but I will save it for another time.
Chairman: Yes, I think we will save the
CSA for another time. We have resolved, I think, to have you back
shortly so that we can do more justice to many of the things that
you are talking about. This is a quick scamper around the field.
Q41 David Heyes: The discussions
that you are involved in with the Revenue, I really would agree
with and support the line that you are taking in trying to get
them to introduce some humanity and sensitivity into this, or
at least that is how I have taken the meaning of what you are
saying, and I commend that, but is there not a risk in this for
you that what you are actually doing is negotiating with them
rather than just having discussions with them and is that an appropriate
role for the Ombudsman? You have come with a very clear set of
recommendations based on an objective investigation, but negotiation
involves compromise, so are you not going to water down your recommendations?
You must have thought of this.
Ms Abraham: No, I am not going
to water down the recommendations. I think it is an important
point that you raise and I know that there is a school of thought
which says that ombudsmen deliver their pronouncements and then
they will not discuss them, but I just do not think that is real.
If I make a recommendation in a report, whether it is a special
report or a report on an individual case, I have got there through
a process of analysis and judgment which means that it is a serious
recommendation. I had a lot of debate with the Revenue about the
question of automated recovery. Now, we may discuss actually what
the words on the page mean and I think when they first saw the
words on the page, they thought I was saying, "No automation
anywhere", but I do not think I am saying that. I am saying
that there needs to be a pause. It could be an automated pause,
but there needs to be a pause and it is inherently unfair not
to have one. I stick to my guns about that and we have talked
about it a great deal, so you will have to judge me on my performance
as well, but I certainly have no intention of compromising my
recommendations.
Q42 Chairman: It is possible, is
it not, that an ombudsman could make a recommendation that was
ill-conceived or a judgment that was wrong?
Ms Abraham: Yes.
Q43 Chairman: In which case, one
would be perfectly entitled to challenge it.
Ms Abraham: Well, who is "one"
in that case? I think there is an important constitutional point
here. I think it is my job to determine maladministration. If
I make a finding which is wholly unreasonable that no reasonable
ombudsman can make, and people have, complainants have challenged
that in the High Court. Now, I am not suggesting for a moment
that we should all toddle off to the High Court on these issues,
but it seems to me that there is a starting presumption that the
ombudsman knows her job and if I say that there is maladministration,
I have not reached that view lightly and I do not expect the Government
or permanent secretaries to say, "We don't agree" and
walk away. They can argue with me, of course they can, and I may
not be right and this Committee may take the view that I have
done something completely off the wall. Well, fine, let's talk
about it, but I think the place for those discussions is not in
the Government or in the NHS where the Government somehow decides
to pick and choose which of my findings it likes. There is an
important constitutional principle here, it seems to me. This
is Parliament's Ombudsman and I am here for a purpose.
Q44 Mr Prentice: On this issue of
NHS complaints I read your paper Making Things Better and
the Department of Health is a suitable case for treatment, is
it not? It is a complete basket case in the way it has organised
and reorganised the complaints system. That is what you are saying
in the report.
Ms Abraham: Because I choose my
words carefully, "basket case" does not feature often,
but the report is a very serious attempt to describe the history
of NHS complaints procedures and the problems that there have
been. What I really feel now is that, particularly post-Shipman,
there is a real opportunity to get this right once and for all.
If this is not the time, I do not know when is.
Q45 Mr Prentice: We have a whole
number of NHS organisations that are constantly morphing and changing
into new organisations. It is all documented in your report. Some
NHS bodies are set up one year and they are dismantled the following
year. You talked about tax credits and the impossible timescales.
You talk about periods when the Department of Health are thinking
up these new complaints systems and patterns of long periods of
comparative inactivity, interspersed with much shorter periods
of frantic activity to unrealistic deadlines. Then you go on to
say that it is not conducive to well planned, thought through
change. That is why I said it is a basket case.
Ms Abraham: We describe it in
different ways but I think we are describing the same thing.
Q46 Mr Prentice: You are very worried
about the fragmentation of the NHS. What the government is now
embarked on, which is to bring in the private sector, not for
profit voluntary sector, in a big way so that in a year's time
we are not going to have practice nurses, physiotherapists, health
visitors and midwives, that whole constellation of people who
are currently employed by the NHS. They are going to be employed
by the private sector and other organisations. How is the complaints
system going to work in this new landscape, where the government
is massively extending the private sector's role in the NHS?
Ms Abraham: Trish and I are smiling
at each other because the theme of the last week seems to have
been the whole question of private health care and complaints
systems. We were talking to the General Dental Council earlier
this week about the systems that they are putting in place. I
will not go into dentists because we could talk about that at
great length, I am sure, but I think the fundamental point is
absolutely right. I suppose I come back in a way to my 40 years
on. When these Ombudsman systems and complaint handling arrangements
were put in place, the world was a lot less complex than it is
now. The delivery of public services was a lot less fragmented.
The mixed economy was not there. In terms of both regulation and
Ombudsman systems, we need coherent, comprehensive complaint handling
which takes on board the public/private, the foundation/non-foundation,
the health and social care—you name it—because for
the individual it is one episode of care or treatment coming from
a whole raft of different places.
Q47 Mr Prentice: It is a complete
dog's breakfast, is it not?
Ms Abraham: It is a complete dog's
breakfast.
Q48 Mr Prentice: I read in your report
that foundation trusts that were supposed to be the way forward
do not even have local complaints handling procedures. There is
no compunction.
Ms Abraham: They come under a
different system of regulation.
Q49 Chairman: We shall come back
to this in detail with you. We will want to perhaps have a separate
session, talking about some of these issues. Finally, the government
in the last two or three weeks has announced that it is going
to make what it calls an apology payment on the Japanese prisoner
of war issue. Just for the record, I take it that that apology
payment is not regarded by you as an adequate response to what
you recommended?
Ms Abraham: I made four recommendations
in that report and two of them were not accepted by the government.
The government's response in its totality does not meet all of
my recommendations and does not address all of the points that
I made. The apology payment and the level of it is a decision
that government has made. It is not one that they agreed with
me.
Q50 Chairman: As you know, we are
going to have a session on this with the Minister from the MoD
before long and we shall want to talk to you again in that context
too because we do take a very serious view of those occasions
when what you recommend is not accepted. It has always been the
convention of your office that there was no need to have enforcement
powers because your recommendations carried such authority that
they would never not be accepted. If we do find that on a number
of fronts this is not happening—we have talked about some
of the instances today—you are right to expect this Committee
to take a very serious view of it and we shall do.
Ms Abraham: Thank you.
Chairman: We are grateful for this morning.
We are going now to use your report on tax credits to take it
further by talking to the people from the Revenue. Thank you very
much.
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