MEMORANDUM TO THE PUBLIC ADMINISTRATION
SELECT COMMITTEE
BY THE PARLIAMENTARY AND HEALTH SERVICE
OMBUDSMAN
Introduction
1. I welcome this opportunity to give evidence
before the Committee, particularly as it is my first such opportunity
to do so since the election of a new Committee. I look forward
to the continuation of the productive and helpful relationship
that has existed between the Committee and my Office.
2. When I last appeared before the Committee
in December 2004, I said that I aimed to provide an accessible,
continually improving service that was responsive to the needs
of its customers. I also expressed my wish that my Office use
its knowledge and experience to contribute to the improvement
of public services.
3. This year, my office has made good progress
towards these goals. This Memorandum describes how we have performed
over the past 12 months and outlines our plans for the future.
It also provides a summary of the main themes that have emerged
from our casework and updates the Committee on some issues of
particular interest.
Improving our service
4. In the past year, and for the first time,
I published a single Annual Report covering both my work as Parliamentary
Ombudsman (which has a UK focus) and as Health Service Ombudsman
for England. Also for the first time, before the summer recess
the Office's Resource Accounts were laid before Parliament at
the same time as my annual report.
5. The year covered by that report and accounts
was a year of significant advances in the governance and management
of the Office, against a background of increased workload.
Workload
6. The annex to the Memorandum sets out the key
highlights of our work last year. The Committee will observe that
our workload continues to grow and that there was a substantial
increase of approximately 30% in the number of new cases.
7. Nevertheless, we were able to meet almost
all of the performance targets we set ourselves. This was a good
performance, but we still began 2005-06 with over 2,300 cases
in hand, and the number of cases awaiting attention has continued
to increase since then.
8. Managing this workload presents a major challenge
and we have put in place a number of measures to help us respond
to it. We are also keeping in regular touch with those whose complaints
are awaiting attention.
Strategic planning and performance management
9. I am also committed to planning ahead. For
the first time, we have developed and published a three-year strategic
plan - now matched, I am pleased to inform the Committee, by our
first ever three-year financial settlement from the Treasury,
subject to Parliamentary approval. This means that we have both
a clear strategic direction and the stability in our resources
that will allow us to plan the development of our service to meet
the needs of our customers and to deliver that service effectively.
10. The three-year strategic plan is already
helping us to shape our work better. It sets out our two main
aims:
- To deliver a high quality complaints handling
service to customers;
- To contribute to improvements in public service
delivery by being an influential organisation, sharing our knowledge
and expertise.
11. The plan provides a clear set of priorities
and a framework for quarterly performance monitoring which enables
us to address workload issues as soon as they arise. Supported
by better management information, this is helping us to manage
our work more effectively. We have also introduced a new approach
to handling cases which means that investigators keep in much
closer and more regular contact with customers.
12. We also need good information about our customers
and what they think of our service, which is why I am carrying
out a comprehensive customer satisfaction survey. In the same
vein, a revised and much clearer system for dealing with complaints
about our own service has also been introduced.
Awareness of, and access to, our service
13. Improving the accessibility of our services
is also one of the main themes of our strategic plan. A joint
survey with the Local Government Ombudsman in 2003 showed low
awareness of our service among the population, particularly amongst
young people and minority ethnic groups.
14. We aim to increase awareness of our service
by, among other things, improving our understanding of, and response
to, issues of diversity and equality. We will develop and implement
a clear diversity strategy, monitoring the demographic profile
of our complainants to ensure that we are reaching those groups
who need our service most.
Themes in our work
15. As in previous years, a small number of government
departments, agencies and other public bodies tend to account
for the majority of the Parliamentary cases with which I deal.
Similarly, there are a number of recurring themes among the Health
cases I investigate. The annex to the Memorandum gives more detail
about the types of complaint that I have received.
16. In addition to using my Annual Report to
highlight these themes, I believe that it is important to make
use of the evidence from our casework to identify systemic or
repeated problems with the operation of services and the implementation
of
policy - and to draw the lessons learned from our work to the
attention of Parliament, government and the NHS.
17. During the past year, among other activities,
I have published a number of special reports to Parliament which
have dealt with such systemic or recurrent issues.
Continuing care
18. Members of the Committee will already know
that following publication, in February 2003, of my report, NHS
funding for the long-term care of elderly and disabled people
(HC 399), in which I recommended that the Department of Health
should review the national guidance on eligibility for continuing
care, making much clearer the situations when the NHS must provide
funding and those where it is left to the discretion of NHS bodies
locally, we received around 4,000 complaints and enquiries about
continuing care.
19. In the light of the ongoing problems revealed
by these complaints, I presented a further report to Parliament
- NHS funding for long-term care: follow-up report
(HC 144) - in December 2004. In that report, I recommended that
the Department of Health needed to lead further work by, among
other things, establishing clear, national, minimum eligibility
criteria; improving assessment tools; and supporting training
and development.
20. I welcome the fact that, since my further
report, the Department of Health has commissioned a 'new national
framework for the assessment for fully funded NHS continuing care'
on which it is consulting. We have also been working closely with
the Department and with strategic health authorities (SHAs) to
support them in their resolution of the large number of complaints
which are still outstanding. We are just completing a useful series
of meetings with all SHAs.
NHS complaints
21. Reform of the NHS complaints system has been
promised for many years and has also been a matter of interest
for the Committee for some time, with the evidence session devoted
to it in January 2004. My concern about the time this reform was
taking and the effect of this on users of the NHS led me to publish
in March 2005 a special report, Making things better? - a report
on reform of the NHS complaints procedure in England (HC 413).
22. In that report, I outlined some of the problems
caused by the fragmentation of complaints systems - within the
NHS, between the NHS and private healthcare, and between health
services and social care provision. This - combined with a failure
to focus on patient needs, poor leadership and lack of capacity
and competence in complaint handling - has led to a system which
makes it difficult for patients to have things put right where
they have gone wrong. A truly patient-focused complaints system,
to which we are all committed, is still far from becoming a reality.
23. In the report, I urged commitment and leadership
from the Department of Health in setting standards to be met by
all providers of NHS care and in ensuring the adoption of a common
approach to complaints across health and social care. The Department
has agreed to my recommendation to develop a new core standard
for complaint handling. Working with the Healthcare Commission,
we have drawn up a draft standard which seeks to promote complaint
handling systems which meet the diverse needs of actual and potential
complainants; are simple and clear to the complainant; help to
achieve successful outcomes; and demonstrate that positive action
has been taken as a result of complaints.
24. I am aware that the Healthcare Commission
has a backlog of complaints. We are liaising closely with them
at both a strategic and working level to support, as far as we
are able, the achievement of their recovery plan.
Access to Official Information
25. In April 2005, after the Freedom of Information
Act had come fully into effect, we published our final reports
on the operation of the Code of Practice on Access to Government
Information - Access to Official Information, Monitoring of
the
Non-statutory Codes of Practice 1994-2005 and Investigations Completed
July 2004 - March 2005.
Promoting best practice in healthcare
26. During the past year, we worked with patients
and with the Society of Cardiothoracic Surgeons of England and
Ireland and a range of key healthcare bodies to produce a guide
to help surgeons and their teams to communicate the risks of cardiac
surgery more effectively to patients. This development has been
widely welcomed and we will consider whether this might become
a model for similar initiatives in other clinical disciplines.
Tax credits
27. Over the past two years, a high proportion
of the cases referred to me as Parliamentary Ombudsman has concerned
Working and Child Tax Credits; indications received from the Committee,
when I last appeared before it, and from other MPs suggested strongly
that these cases reflected only a small part of the problems with
the system that their constituents had encountered. While I recognise
that the new system has created difficult challenges for the Revenue
- not least by bringing them new and unfamiliar groups of customers,
such as low income earners, especially those with children - I
believe that improvements to the system could nevertheless be
made.
28. In June 2005, I therefore presented a special
report to Parliament, Tax credits: making things better
(HC124). My report's recommendations covered how overpayments
are handled, communication with customers, the steps that should
be taken to reduce the risk of financial hardship, the provision
of easier and quicker customer access to staff who could address
problems and queries, and effecting prompt and efficient complaint
handling. I also recommended that consideration should be given
to writing off all excess and overpayments caused by official
error during 2003-05.
29. The Paymaster General responded to my report
in late July, promising improvements to the administration of
the system and to the quality of information to claimants. I welcome
the Government's assurances. I have also had useful and constructive
discussions with the Revenue about the future handling of complaints
and I am hopeful that we will see a reduction in cases in due
course.
30. For the moment, however, I continue to receive
significant numbers of complaints about the operation of the system.
Indeed, over 20% of all cases referred to me as Parliamentary
Ombudsman in the current business year relate to tax credits.
I will continue to monitor the situation carefully and I will
keep the Committee and Parliament informed of any developments
which have significant implications for my work.
'A Debt of Honour'
31. On 12 July 2005, I laid before Parliament
my report of the investigation I had conducted into complaints
about the administration of the ex gratia scheme for British
groups interned by the Japanese during the Second World War.
32. The complaints I had received and investigated
related to a decision to introduce a new eligibility criterion
- that to qualify for payment under the scheme, a claimant had
to have been born in the UK or have had a parent or grandparent
born here - many months into the operation of the scheme.
33. I found that the actions of the Ministry
of Defence had constituted maladministration in four respects:
in the overly quick manner in which the scheme had been devised;
in the lack of clarity in the announcement of the scheme; in the
failure to ensure that the introduction of the new criterion did
not have an adverse impact in terms of equal treatment; and in
the failure to inform claimants that the eligibility criteria
had been changed. I recommended that the Ministry of Defence review
the operation of the scheme and reconsider the position of those
who had been adversely affected by the maladministration. I also
recommended that an apology be made to those refused payment and
that that regret should be expressed tangibly.
34. The Government did not accept all of my findings
and has only agreed to implement the latter two recommendations.
This is of considerable regret to me and, being highly exceptional,
is a matter on which the Committee may wish to reflect.
35. As a result of this investigation, I also
made three more general recommendations about the operation of
ex gratia schemes. These were related to how schemes are
devised and announced, how changes to schemes should be administered
and publicised, and how complaints about schemes should be handled
and reviewed. I have raised these issues with the new Secretary
of the Cabinet and I will take them forward in wider discussions
with government as we develop our principles of good administration.
Balchin case and joint working between Ombudsmen
36. Earlier this month, I published a report
on the case of Mr and Mrs Balchin, Redress in the Round: Remedying
Maladministration in Central and Local Government (HC 475),
which revolved around the actions of both the Department for Transport
and Norfolk County Council. As such, the complaint was in both
my jurisdiction and that of the Local Government Ombudsman and
we both undertook an investigation.
37. Working in close collaboration, we found
maladministration both by the Council and the Department and concluded
that each must carry an equal share of the responsibility for
the hardship caused to the complainants. We recommended that each
body should pay £100,000 to Mr and Mrs Balchin. The Department
for Transport has accepted my recommendation, and the County Council
is currently considering its response.
38. However, the relevant legislation requires
me and the Local Government Ombudsman to publish separate reports.
While both reports can be read separately, it is only when they
are read together that the full story can be understood. For this
reason each report has the other annexed to it. This experience
clearly emphasised the need for reform of the legislation covering
aspects of the working arrangements of public sector Ombudsmen.
The current restrictions on our ability to work together mean
that we cannot provide the sort of joined-up service that we should
be able to give all citizens who have complaints which cross more
than one Ombudsman jurisdiction.
39. I am therefore pleased to note the publication
of a Cabinet Office consultation document in August 2005, on a
proposed Regulatory Reform Order, which aims to remove most of
the legislative constraints on effective joint working between
public sector Ombudsmen in England. The consultation comes to
an end on 18 November 2005 and, subject to Parliamentary approval,
it is envisaged that the Order will come into force in the spring
of 2006. I hope that the proposed Order will attract widespread
support and enable us to work even more effectively together in
future for the benefit of the customer.
Other matters
'MP filter'
40. Following work that the Committee and my
Office carried out in the summer of 2004, jointly to survey the
opinion of Members of Parliament, a private member's Bill was
introduced that aimed to remove the need for the referral by an
MP of any complaint to me as Parliamentary Ombudsman.
41. As the Committee has long recognised, this
'MP filter' is one of the barriers to those who seek to use the
services of my Office. While I value the relationship my Office
has with Parliament and this Committee, I too believe that the
time is long overdue to deliver reform and to make access to public
sector Ombudsmen consistent, transparent and open. It is therefore
disappointing that the Government did not support the Bill and
that it has to date not given an indication as to whether it will
provide time to effect this much-needed reform.
Occupational pensions
42. My investigation into the security of final
salary occupational pension schemes is now nearing completion.
We are in the process of finalising the draft report and will
then seek comments on it from the Government and from the representatives
of complainants. I hope to publish my report before the end of
2005.
Equitable Life
43. My investigators have completed their scrutiny
of the considerable amount of evidence covering the regulation
of the Society from the early 1980s to December 2001. The investigation
team has also met regularly with policyholder action groups and
with officials of the bodies under investigation. We are now considering
the results of the review of the relevant evidence in order to
determine whether that evidence discloses maladministration causing
injustice to individuals. To assist me to establish this, we are
also taking actuarial and legal advice on the relevant issues.
44. I have also set up an academic advisory panel
to provide assurance that the judgements that will be made in
my report fully accord with the regulatory, policy and industry
standards and practices relevant to the period covered by my investigation.
I hope to publish my report of the investigation in spring 2006.
Ann Abraham
October 2005
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