Memorandum submitted by Parliamentary Ombudsman and Health Service Ombudsman (H&SC 28)




Health and Social Care Bill Public Bill Committee

I have been following with interest the work of the Bill Committee and felt that it might be helpful if I clarified some relevant points about the role and remit of the Ombudsman, my views about the proposed changes in complaint handling arrangements and my plans for ensuring that my Office is able to meet the resulting challenges to our service.


Role and remit of the Health Service Ombudsman for England

My role as Health Service Ombudsman for England is to consider complaints made by or on behalf of people who have suffered because of unsatisfactory treatment or service by the National Health Service, including complaints about NHS Foundation Trusts. The Health Service Ombudsman for England has been investigating complaints about the NHS for over 30 years, during which time we have built up an unparalleled knowledge of complaint handling generally, and the NHS in particular.


As Ombudsman I am independent of Government and the NHS and provide an impartial and fair service to both citizens and the NHS bodies within my jurisdiction.


I can investigate not only complaint handling and the administrative aspects of health care, but also the clinical aspects of a complaint, such as a failure to provide reasonable diagnosis, care and treatment, or to follow prevailing clinical standards. The majority of the complaints which complainants bring to me involve aspects of clinical care.


Where I uphold complaints, because I have identified maladministration or poor service leading to an unremedied injustice or hardship, I make recommendations both to remedy the individual injustice or hardship and to avoid a recurrence of the circumstances of the complaint. In 2006-07 all my recommendations were accepted.


My report to Parliament, Making things better? (2005), set out my recommendations for improvements in complaint handling in the NHS, many of which are reflected in the current proposals. In March 2007, I issued my Principles of Good Administration which set out the behaviours I expect when public bodies deliver public services. I followed this with my Principles for Remedy to guide public bodies, like the NHS, on how to provide remedies for injustice or hardship resulting from their maladministration or poor service. I expect to publish my Principles for Good Complaint Handling later this year, so that they can inform the NHS as it seeks to improve the way it handles complaints.


The proposed, new, integrated arrangements for handling health and social care complaints

I fully support the Department of Health's proposals, set out in the consultation document, Making Experiences Count, and in particular the emphasis on:

Coherent coverage for complaints which cover both health and social care

Effective complaint handling at the local level

Effective local leadership

A major cultural shift by the NHS from a defensive application of process to a welcome for the learning from complaints and a will to resolve them

A simplified, two stage system.


Both the Healthcare Commission and I consider that complaints handling is not an appropriate role for the present, the new or indeed any regulator. My experience and my research convince me that effective local resolution followed by timely independent review by the Ombudsman is the complainant-centred way forward for dealing with health and social care complaints. I responded to Making Experiences Count jointly with the Local Government Ombudsmen and a copy of our full response is attached.


My capacity to deliver an effective second stage of the NHS complaints arrangements

I have been fully involved in discussions with the Department since the gestation of the proposed new arrangements. I do not see my role, as the last resort for complainants, changing in any significant respect. The Department, the Healthcare Commission and my Office have been working collaboratively for some time to improve the standard of complaint handling in the NHS. This work will continue and I expect that the number of complaints to my Office will fall as competence in the NHS increases.


Clearly I recognise that, in the short term, the changes will result in an increase in the number of enquiries made to my Office and the number of investigations I undertake. I do not, however, expect to receive the same number of complaints for investigation as the Healthcare Commission has done. As evidence, I note that when the Scottish health system moved to a similar two stage model, at the time of the introduction of the Healthcare Commission in England, the number of investigations increased, but not unmanageably so. The Scottish Public Services Ombudsman accounts for this by the focus, during the transition stages, on effective local resolution, coupled with the disincentive of a referral to the Ombudsman, with the potential for adverse publicity which an Ombudsman finding can bring.


I have recently restructured my Office and I am confident that we will be able to meet the forecast increases in my workload, and will be able to provide an efficient and effective response to demand. I have already explored with the Treasury the additional funding I am likely to require. I am working with the Department of Health and the Healthcare Commission to ensure that the transition to the new arrangements is smooth for both complainants and bodies in jurisdiction. I have plans in place to ensure that my Office is prepared to handle any increase from 1 April 2009.


I hope that the Committee find this clarification helpful and would be happy to provide any further written or oral briefing which the Committee might require.



Ann Abraham

Parliamentary Ombudsman for the UK and Health Service Ombudsman for England

14 January 2008