Further memorandum from the Parliamentary
and Health Service Ombudsman
WORK OF
THE OMBUDSMAN
2007-08
Thank you for your letter of 11 November 2008[1]
and for the opportunity to provide written answers to questions
about the work of the Parliamentary and Health Service Ombudsman.
I would like to take this opportunity to set
my reply within the context of the work of my Office over the
last few years and the positive actions which my organisation
has been taking, and continues to take, to respond to a rapidly
changing external environment. Some of the work has had a direct
impact on our performance in 2007-08 but now places us in a good
position to respond to future challenges.
As you are aware, I 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. I decide whether maladministration
or service failure, or both, have occurred, draw attention to
failings and suggest how things may be put right. Lessons learnt
from complaints are shared to help to improve the way in which
public services are provided. The Office has been in existence
for over 40 years and we have been working hard to develop and
improve our business processes to reflect changes in our casework
to make sure we can meet the standards laid down in my publication
Principles of Good Administration. The role of the Ombudsman
has evolved but the principle behind its creation remains valid.
The year 2006-07 saw us developing a new strategic
approach to complaint handling which differentiates much more
clearly between: (i) complaints which are either inappropriate
for my Office to take on or can be dealt with in a different way
other than by an investigation; and (ii) those cases which are
sufficiently serious or complex to justify the full attention
and force of an Ombudsman's investigation. A consequence of this
is that while we continue to assess substantial volumes of complaints,
we will now conduct a much smaller number of investigations than
in the past, but ones which on average are likely to take longer
and have a greater impact. This new way of working, together with
looking in a much more focused way at alternative opportunities
for resolving complaints, has inevitably had an impact on the
time taken to complete our casework. However, I am clear that
this will ultimately provide a much better service and individual
benefit for our customers, and help us to better achieve the wider
public benefit set out in our objectives.
Our new processes involve a new concept of assessment
panels—where enquiries to the Office are considered by me
or senior members of my staff to consider whether full investigation
is appropriate, or whether there are better routes to achieving
positive outcomes. The way we do this is to consider whether in
each case there is:
— prima facie evidence of administrative
fault or service failure;
— injustice or hardship as a consequence
of that fault; and
— a reasonable prospect of delivering
what the complainant is seeking by making their complaint, or
some other overriding issue why I should investigate.
The assessment panel process was introduced
in 2006-07.
The development of our work in this way has
continued and in 2007-08 led to a major restructuring of our casework
services to focus more clearly on the customer and the skills
required by our staff to deliver this service. This resulted in
a significant number of staff departures during the year and a
larger number of caseworker vacancies in the second half of the
year than we had planned for—which has taken some time to
recover from and, unfortunately, impacted on the level of service
we provided at that time. In my evidence to the Committee I acknowledged
that during this period we may have taken our eye off the ball
and also did not put in place the rolling programme of recruitment
that we later realised was necessary to enable us to achieve our
service standards.
2008-09 has seen us complete our reorganisation
and has enabled us to focus on improving our throughput and meeting
our service standards, at the same time as embarking on robust
planning for the changes required to enable us to become the second
stage complaints handler of the NHS from 1 April 2009. The organisation
is undergoing a further period of significant change with the
recruitment of more staff to increase our complement and the opening
of an office in Manchester. However, we have not lost focus on
our performance. Since April we have been making steady and substantial
improvements in the waiting times for cases to be allocated for
action. Progress has been good, although it is clear that the
number of older cases currently in the system will mean that it
takes longer to meet our service standards. 2008-09 will be a
transitional year in that respect.
One of the challenges for my Office is the volatility
in the number of enquiries received at any time, which makes planning
and forecasting very difficult to ensure that a good service to
complainants is maintained. This will be particularly so in the
last quarter of this year as we work with the Healthcare Commission
to take on responsibility for complaints direct from the NHS.
While it is difficult to predict the impact of new NI-IS cases
in 2009-10 we are continuing to work to ensure we have effective
systems, early identification of problems or bottlenecks and contingency
plans for identified risks. We have strengthened our senior team
and our management information to give early warning of difficulties
and devote more time to understanding the effect of change upon
our performance. At the moment we are as confident as we can be
that we will achieve a smooth transition to the new NHS complaints
arrangements as they impact on this Office and will report further
to you on this in 2009-10.
As I have said above earlier, the Office aspires
to the standards set out in our trilogy of publications, Principles
of Good Administration, Principles for Remedy and Principles
of Good Complaint Handling. I am also mindful of the importance
of both the Disability Discrimination Act and the Human Rights
Act on the way in which organisations should respond to the legitimate
needs and expectations of individuals. The clarity on these issues,
which my Office is now developing in the investigation of complaints,
gives an opportunity to speak with even greater authority on the
quality of services which public bodies should aspire to deliver.
RESPONSES
1. Do you have any further comments that you
would like to make in writing to supplement your answer to Q 21
about the productivity and resourcing issues that have hampered
the work of your office, and about what you have done to resolve
these issues?
The effects of my Office's restructuring programme
Organising for the Future, to which I referred in my evidence
to the Committee on 30 October, meant that we ended 2007-08 around
a third down on our full complement of caseworkers. This reduction,
coupled with the time we required to change the way in which we
worked, impacted on our capacity to deliver against Our targets.
Some cases therefore took much longer than I would have wanted
to progress.
The lead time for recruiting and training caseworkers
is substantial. We have now instituted a rolling programme of
recruitment: the programme is starting to take effect and new
caseworkers are coming on stream. However, the nature of the work
of my Office means that there can be no quick fixes when it comes
to permanent caseworkers. In the interim I have taken two actions
to address the gap between our staff resources and the capacity
we need. I have expanded the pool of Associate Caseworkers we
are able to draw on; they are a flexible resource who can be called
upon to carry out work as and when they are needed. I have also
set up a project team to work on reducing the number of assessment
cases in the pipeline.
As a result of these changes and the increasing
availability of new recruits, our capacity to deal with assessment
work has increased. We are now clearing more cases than we receive
and the number in hand has been falling each month, from 1,507
at 31 March 2008 to 1,371 at 30 September 2008. Moreover, the
number not assigned to a caseworker for assessment fell from 755
to 431 in the same period. Over those same six months, the number
of cases accepted for investigation and waiting to be allocated
to a caseworker fell from 207 to 58. Progress is continuing during
the third quarter.
2. From your comments to the Committee at
Q26, you seem to be saying that the main bottleneck in your processes
has been at the assessment stage, rather than at the investigation
stage. For the sake of clarity, can you explain what is involved
in the assessment process, which parts of the process have been
causing delay, and what you have done and plan to do to reduce
this delay?
The assessment stage is the process during which
we consider whether we can accept a case for investigation and,
if we can, whether we should. The process comprises two linked
phases. The first involves a "preliminary assessment"
to ensure my Office has jurisdiction to look at the complaint,
it is properly made and it has exhausted the relevant complaints
procedure within the body complained about. 70-80% of enquiries
are closed at this stage with advice given to the complainant
as to the next steps they need to take if they wish to pursue
their complaint.
If we have jurisdiction for the body complained
about and the appropriate complaints process has been completed
but the complaint has not been "properly made" (for
example, a parliamentary case which has not been referred via
an MP), we will refer the case back to the complainant to give
them an opportunity to make the complaint properly. The case remains
open—for one month (health) and for three months (parliamentary)—while
we wait for the complainant to respond. Such cases are a significant
proportion of our work (8% of enquiries received this year so
far) and impact on our performance against our enquiry throughput
service standard.
If we have authority to look at the case and
efforts to resolve it at local level have been exhausted the complaint
is passed to the second phase, "further assessment".
This is where we make additional enquiries of the complainant
and body complained against, obtain any necessary papers, and,
where clinical issues are raised in health complaints, we might
take advice from one of my clinical advisers. We are looking for
three things: prima facie evidence of administrative fault or
service failure; injustice or hardship as a consequence of that
fault; and a reasonable prospect of delivering what the complainant
is seeking by making their complaint, or some other overriding
issue why I should investigate. If any one of the conditions is
not met, we will decline the case and inform the complainant.
Where all three of these elements are confirmed by the assessment,
the assessor will then make a recommendation which I, or my senior
staff, will consider and we will make the final decision as to
whether a case is accepted or declined for investigation.
This should be a relatively seamless process
with the case passed to an assessor for further assessment in
a matter of days, and it was not our process itself that caused
the delays we experienced at the start of the year. Rather, these
were caused by the change in the way in which we organised ourselves
and the need to develop expertise in a new group of staff, together
with a shortage of staff undertaking assessment work, This latter
factor was particularly acute in terms of the number of experienced
health assessment staff and clinical advisers available to support
further assessment work. Since June 2008 we have made the following
changes to our working practices:
— reorganising our casework staff to
focus on specific areas of work to increase their individual productivity;
— removing procedural bottlenecks around
authorising decisions taken to decline enquiries failing the three
elements set out above;
— strengthening our liaison work with
bodies within jurisdiction that are a cause for significant numbers
of complaints;
— improving the tracking and performance
management of work undergoing assessment; and
— bringing in additional resources
in the form of new staff, temporary staff and associate staff
to increase the overall pool of assessors.
The effect of these changes is reflected in
the fall in assessment work in hand referred to in my response
to Question 1 above. My monitoring of the work suggests that,
by the end of January 2009, we expect there to be a seamless flow
of casework from receipt of an enquiry, through preliminary and
further assessment to investigation.
It is also worth noting that, at any stage during
the assessment process, we may contact the body complained about
to try to resolve the complaint to the satisfaction of the complainant
at the earliest possible stage. These cases are termed "interventions
short of investigation" and reflect a more customer-focused
approach to less complex issues. We are developing this area of
work and expect the number of such interventions to increase in
the future.
3. During 2007-08, you accepted 951 cases
for investigation, against an assumption of 1,400, You also received
fewer enquiries than you had assumed: 12,500, against an assumption
of 16,000. Why were [you] unable to take advantage of a situation
in which you had less work than you anticipated, to make inroads
into clearing the backlog of work that had built up?
As I explained in my response to Question 1,
the effects of my Office's restructuring programme, Organising
for the Future, meant that we ended 2007-08 around a third
down on our full complement of caseworkers. This reduction, coupled
with the time we required to change the way in which we worked,
impacted on our capacity to deliver against our targets. This
meant that we were unable to take advantage of the opportunity
arising from the lower than expected intake of work. Our interim
performance data demonstrates that we are now making significant
inroads to dealing with the work in hand. We are as confident
as we can be that this will be cleared before the end of the year
and in time to take on the increased NHS complaints workload arising
from 1 April 2009.
4. How do you encourage the speediest possible
response to on enquiry once the 40 working day deadline has been
missed? Are there internal targets for the remaining 10-20% of
enquiries that you do not expect to process within forty working
days?
I take the matter of customer service very seriously
and I ask for a list of the oldest enquiries and an update on
their progress every two weeks. This is the first item on the
agenda at our assessment panels. Managers also have access to
management information that allows them to identify cases that
have exceeded the 40 working day deadline and they are expected
to ensure that they are progressed effectively. I can assure you
that there remains a sense of urgency around these cases, although
we do not have a specific target for clearing them.
While we do everything that we can to process
enquiries as speedily as possible, there will always be a minority
of cases where we will not be able to provide a substantive response
to an enquiry within 40 working days or where to do so would not
be appropriate in the particular circumstances of the case. The
types of enquiry where experience has shown that normal casework
targets are not appropriate and thus are unlikely to be met include:
(i) cases where our consideration is suspended
because of the existence of other proceedings relevant to the
substance of the complaint, whether in the courts or before public
inquiries, with a substantive response being made once those other
proceedings have concluded. Examples of enquiries falling into
this category include those concerning the regulation of Barlow
Clowes in the 1980s, where no decision was taken as to whether
to conduct an investigation until after the conclusion of the
Le Quesne inquiry, some eight months after the first complaint
had been made to the Ombudsman;
(ii) cases where the complaint raises complex
factual or legal questions which are the subject of dispute between
the parties, and which might require us to seek further information
or obtain and share legal advice to resolve such questions. Examples
in this category include those concerning Railtrack, where doubt
existed about whether the Ombudsman had jurisdiction to conduct
an investigation, which took some time to resolve through obtaining
legal advice;
(iii) cases where we recognise that the particular
circumstances of the case require us to seek to resolve the complaint
without conducting a formal investigation, particularly where
the subject matter of the complaint is distressing to those affected
and where an investigation would add significantly to that distress.
Examples in this category include those concerning unresolved
issues related to our report A Debt of Honour, where we
have sought to engage in dialogue with the Ministry of Defence
to seek a resolution of the complaints without conducting a further
investigation which might prove distressing for the complainants,
given the nature of the experience at the heart of the events
complained about;
(iv) cases which form part of a large group of
similar complaints which all need to be considered together. Examples
in this category include those concerning the role of government
bodies in the security of final salary occupational pensions,
where decisions on individual enquiries were taken within the
context of consideration of the wider issues raised by a substantial
number of complaints made which raised broadly similar issues.
A substantive decision to conduct one investigation covering all
the complaints made that were within jurisdiction was taken some
seven months after receipt of the first enquiry; and
(v) cases which concern the same subject matter
as an existing investigation, where we would effectively "park"
our consideration of a particular enquiry, with our substantive
response to it being dependent on the outcome of the existing
investigation into the same subject matter. Examples in the last
category include those we received concerning the regulation of
Equitable Life whilst our recent investigation was under way.
The resolution of some enquiries received in early 2005 was not
provided until July 2008, with the publication of the report setting
out the results of our investigation into the same matters which
formed the basis of those enquiries.
How best to progress our consideration of enquiries
which fall into these categories often depends on the particular
context in each case, the circumstances of those making enquiries,
and the nature of the issues complained about. Whatever approach
is taken, we make every effort to ensure that the most appropriate,
effective and proportionate result is achieved as speedily as
possible.
5. In 2004-05, 62% of parliamentary cases
were being completed within 3 months. In 2007-08, only 29% were
being completed within six months. Why has there been such a dramatic
fall over the last few years in the speed with which your office
is able to complete its investigations, in particular for parliamentary
cases?
Because of changes in our business approach
explained in my cover letter it is not possible directly to compare
data from 2004-05 and 2007-08 as the types of case accepted for
investigation have changed. In the case of the 62% of parliamentary
cases completed within three months in 2004-05, most would no
longer be counted as an investigation as they would now be closed
within our enquiry stage (see my response to Question 6 below).
This means that the proportion of cases accepted for investigation
that are complex has increased greatly over the years, with the
effect of increasing the average time over which we complete our
investigations. However, the proportion that will take over 12
months to resolve has remained relatively stable, which is reflected
in the retention of our 12 month throughput service standard.
We were able to achieve a higher percentage
of health investigations within six months (53%) because the overall
figure includes complaints against the Healthcare Commission's
handling of complaints which are relatively straightforward. Following
the abolition of the Commission from 1 April 2009, we will no
longer undertake these investigations. In future, health investigations
will consider the substance of the complaint against NHS bodies
and will therefore take longer on average to complete.
6. In 2005-06, you accepted more than 3,000
cases for investigation. There has since been a sharp decline,
and your assumption for 2008-09 is that you will accept only around
750 cases, This is a drop of more than three-quarters over only
three years. What kinds of cases are you no longer accepting for
investigation? Are there genuine cases of injustice now falling
through the net?
Much has changed between 2005-06 and 2008-09:
some significant public service issues that resulted in high volumes
of complaints have come to an end, in particular cases relating
to continuing care, where 553 cases were accepted for investigation
in 2005-06. We have also seen more developed complaints systems
within government departments and arm's length complaint handlers
which have had some success in moderating numbers of complaints
that are escalated to my Office. For example, this applies to
tax credits where we accepted 404 cases in 2005-06 and which now
represents only a few of our current cases.
However, the main change has been the introduction
of our new, more robust assessment process which is described
in my response to Question 2 above, In 2005-06 we were accepting
and investigating a large number of quite straightforward cases
which we are now able to refer back to the body concerned (or
the appropriate complaint handler) to resolve rather than investigating
ourselves. These are generally cases that can be quickly and more
easily resolved at local level once they are brought to the attention
of the relevant body. An example of this has been where benefit
payments have not been processed due to oversights, or where the
complainant has not received the redress arising from an upheld
complaint because the department failed to follow it up. We are
now taking this a step further so that we can address more complex
situations without the need for detailed substantive investigations
by my Office. This may result in better routes to achieving positive
outcomes within shorter timescales. It would reduce the number
of substantive investigations which are resource intensive. In
2007-08 we completed 47 interventions of this kind. At the end
of September 2008 the number completed in this year was 60.
I believe that these processes ensure that we
make better decisions about the action required on a case at the
earliest possible opportunity and that this is the best way forward.
It means that those cases that we do accept for investigation
are most appropriate to the unique authority of my Office and
to the application of publicly-funded resource. Genuine cases
of injustice do not fall through the net.
7. In 2005, your target for providing a substantive
response to a complaint about your own work was 20 working days,
or four weeks. Gradually this has been extended, and for 2008-09,
your target is now 16 weeks. Why this change? Are you happy that
16 weeks is an acceptable length of time for people to wait for
a substantive response to their complaints?
When we launched the review process in April
2005, it consisted of two distinct and separate tiers which represented
the opportunity to escalate serious complaints to me personally.
Very briefly, if a person had a complaint about this Office it
would first be considered at "Tier 1" by a team specifically
set up to consider complaints about us, or by a senior manager.
We aimed to issue responses to Tier 1 complaints within 20 working
days of the complaint being received in the Office. If a complainant
remained unhappy following the Tier 1 response they could complain
again and I would personally consider that under Tier 2 of the
complaints process. I also aimed to respond to those complaints
within 20 working days of them being received in the Office. In
2005-06 we received around 1,000 complaints.
Since then, the process has evolved as we have
built up our knowledge of the most appropriate way of handling
complaints, the level of work they require and the importance
of capturing and sharing the learning that comes from them. The
most significant change to the process came in January 2008 when
we moved to a single Tier process. That was not as a means of
limiting the number of complaints being received, but recognised
both that we had significantly improved the quality of our work,
and that it was only on very rare occasions decisions reached
at Tiers 1 and 2 were significantly different.
Over the years we have reviewed the time taken
to deal effectively with complaints about us and I consider that
at present the 16-week time frame better reflects the length of
time they can take to consider, which may involve making enquiries
of the bodies concerned, seeking legal advice or seeking independent
professional advice. I also believe that the 16-week service standard
allows sufficient time for complainants' concerns about our decisions
or our service to be fully considered and explored.
— Why did only 58% of these complaints
receive a response within this target period during the year?
2007-08 began with 296 complaints about us in
hand, We underestimated the number of complaints we would receive
resulting from the impact of changes we had made through introducing
an Assessment Panel. In common with other areas of my Office there
was a resource issue that meant that this caseload significantly
exceeded our capacity to resolve complaints within the service
standard. During the course of the year we addressed the resourcing
issue and reviewed ways of handling cases with the result that,
over the year, we resolved more than we received. That is not
to say that I do not consider that there is room for improvement,
and we are making progress to meeting our service standard of
issuing 90% of our responses to complaints about us within 16
weeks. At the end of September 2008 this stood at 87%.
— How long did it take you to respond
to the remaining 42% of complaints? What was the longest time
that a complainant had to wait?
The following table indicates the age of responses
to complaints about us at the date they were closed against a
range of time periods:
Age |
<16 weeks | 16 weeks to
6 months
| 6 to 9 months | 9 to 12 months
| >12 months | Total
|
Number of
cases | 559 |
269 | 109 | 20 |
7 | 964 |
Percentage of
cases | 58%
| 28% | 11% | 2%
| 1% | 100% |
| |
| | | |
|
The longest time that a complainant had to wait was 462 days.
This was a complex complaint about an investigation decision which
exceptionally required a full review of the work undertaken and
of the evidence supplied, following which we overturned our original
decision and reopened the case.
— What have you been doing to ensure you come
closer to meeting this target in future?
Please see above.
8. Can you provide examples of occasions over recent years
when your office has learnt from complaints that it has received
about its own work?
We are committed to continuous improvement and the feedback
we receive through complaints about us provides us with rich opportunities
for learning and developing our service. Complaints are generally
about the decisions we have taken on individual complaints or
about the service we provide; both are valuable sources of feedback
which are taken forward by the Outcomes and Learning Directorate.
In one of the most recent examples we received a complaint
about our general enquiry line having an 0845 number rather than
an 0300 number. We looked into the relative benefits of different
numbers for a range of people who might want to call us. The outcome
of this consideration was a recent senior level decision to change
to an 0300 number to make telephone access cheaper for a larger
number of callers.
Reviews have also identified areas where decisions to accept
cases for investigation could be made in a more strategic and
consistent way. This played a key part in the introduction of
the Ombudsman's Assessment Panel, where I or my Deputy personally
discuss cases with senior managers and individual assessors to
decide whether to accept a complaint for investigation.
December 2008
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