Examination of Witnesses (Questions 1-19)
ANN ABRAHAM
18 JANUARY 2007
Q1 Chairman: Welcome again. It is always
very nice to see you. As you know, at this time we are not doing
an inquiry into your report and your activities specifically but
a more general inquiry into the citizen and consumer side of public
services which involves looking at things like complaint systems
and so on. We think you have a lot to tell us about that and about
some of the wider territory. Thank you very much for the memorandum
that you have given us. Would you like to say anything by way
of introduction?
Ann Abraham: Only very briefly
just to echo what I said at the beginning of the memorandum. I
really do welcome the opportunity to give evidence at this inquiry
for two reasons: one, this is just our area of expertise and I
think we have a lot to offer, and also because of the timeliness
of it. It is, as the Committee knows, our 40th Anniversary. We
are about to launch our Principles of Good Public Administration
in March. It also, looking beyond the office, seems to coincide
with a few things happening in Government around service transformation
which might just resonate with where the Committee is looking.
I am very pleased to be here because of the timeliness and because
of the expertise we think we can bring.
Q2 Chairman: To start with, may I
ask you something which might be unfair because I cannot remember
whether you told me this in a private session or a public session
but let us assume it was public. I think your words were that
since the Citizen's Charter period, Government has taken its eye
off the ball on this whole territory. Firstly, did you say that
or have I made it up; secondly, what did you mean by it; and,
thirdly, is it true?
Ann Abraham: Did I say it? Probably.
Whether I said it publicly I am not sure but I will say it publicly
now. The other thing I probably said privately, and I will say
it publicly if you like, is in a strange sort of way it seems
as if it has all been downhill since the Citizen's Charter. That
really is more me saying something positive about the Citizen's
Charter than necessarily negative about the state of things now.
It seemed there was so much of value in that which was built on
and then seemed to wither on the vine a bit. As a graphic illustration
of that, we did some searching for Cabinet Office documents and
Charter Mark and all the things that had come out of the Citizen's
Charter. We found it eventually in a bit of the website called
"This information is being maintained for archive historical
purposes. It will not be updated." I thought that was hugely
symbolic of where this sits. I am a bit encouraged by the Charter
Mark Review, which John Hutton commissioned and then was delivered
to his successor, which was looking at Charter Mark and how it
might be taken forward. The Service Transformation Report that
David Varney produced took that on a stage. Reflecting on that,
what I was taking from Sir David Varney's report, building on
all of the positive foundation-type material that was in the Citizen's
Charter, was some of the modernisation aspects that need to be
taken on board now, what I would call joined-up service delivery—he
probably has some rather more elegant phrase for it than that—the
whole need to actually give the citizen a single experience rather
than a whole series of compartmentalised experiences but also
the whole technology thing. There are signs that perhaps there
is a recognition, at the centre of government, that there was
a lot of value in that and perhaps we need to get it out, dust
it off and take it forward. I think there are things that were
supposed to happen as a result of the work that was done in that
era particularly around customer satisfaction, complaint handling,
measuring performance, accountability which are not there and
we need to bring back. Whether that answers your three-part question
I am not sure but that is my take on life since 1994.
Q3 Chairman: We have had a blitz
of performance measurement, and all the rest of it, since then
all designed to cast a critical eye over the performance of public
bodies. Would you expect this to have produced dramatically positive
consequences?
Ann Abraham: Not necessarily.
It is terribly easy to measure things without doing the groundwork
to decide what you are counting and to make sure that what you
are counting is comparable to what somebody else is counting over
there so you can do sensible things with it. Again, from the recent
reports from Central Government commissioned by Central Government,
this phrase about robust systems and measuring customer satisfaction,
robust performance measurement, comes through quite strongly.
Just because there is lots of information does not mean we know
a lot.
Q4 Chairman: Some of us this week
went to visit various public service front-line offices. Those
of us who went to the Job Centre in Clapham—and a mighty
fine place it is too—were quite struck, when we asked them
about how they were measuring the experience of people using their
services, that it turns out it is contracted out to some organisation
who do systematic monitoring of people who use the service. They
do mystery shopping and all this is reported and league-tabled
and everything else. Surely this is, from your point of view,
Nirvana, is it not?
Ann Abraham: It would be Nirvana
if Jobcentre Plus did not generate one of the highest numbers
of complaints to my office and one of the highest uphold rates.
There are no easy and quick wins here. There are no single measures
of performance. I do think it is important, as I said in the memorandum,
if we are trying to measure quality then customer satisfaction
measures are absolutely essential as a component to that. Complaints
performance is another essential component. I would add in, particularly
if we are in the benefits world, how many cases actually go forward
to the Tribunal Service and how many of them are overturned. There
is a massive amount of public money going into the whole process
of reviewing first instance decision making. Simply measuring
customer satisfaction does not do it on its own. I would be interested
to know, because I do not know and you have obviously done some
very direct and recent research, who are these things being reported
to. Where are they being discussed? Does the departmental board
of DWP get this information? How often does it look at it? What
does it learn from it? What changes has it made from it? I have
not seen the Jobcentre Plus board looking at those things. They
may do it. I do not know what the DWP board does and I do not
know what the Cabinet Office does in terms of monitoring complaint
handling performance across the piece or customer satisfaction
across the piece. It is piecemeal and there is not a consistent
framework, by which I do not mean a straight jacket, which will
enable that measurement to be meaningful and to take us forward.
Q5 Chairman: Let me ask one further
question on complaints to which you directly referred. In your
memorandum to us, or in your annual report this year, you say
that your experience of complaint handling systems, which you
know more about than anybody else, are incoherent, inconsistent
and ineffective. That is a pretty bleak summary of all these complaint
systems we have developed over the years but it is what you think
is the case.
Ann Abraham: Yes, I think it is.
It is a great shame. I suppose, in a way, that is where I would
go back to the concept behind Citizen's Charter and the opportunity
missed there. What started out as good concepts and good ideas
have turned into an awful lot of activity but the outcomes that
could be grasped from those concepts and ideas are still waiting
to be delivered.
Q6 Mr Burrowes: In terms of learning
from the mistakes when things go wrong, I see the example of continuing
care and specific examples. Are those lessons learnt only when
a great problem has arisen when there is a loud noise? Are lessons
being learnt from the individual complaints or is it just the
active lobbyists that are raising the voice louder? The concern
I have is whether the lessons are really being learnt on a ground
level from those individual complaints when the mistake is made,
or does it have to be a profound and systematic problem before
the lesson is learnt?
Ann Abraham: In a strange sort
of way there is a tension which suggests sometimes it is easier
for lessons to be learnt if there is not a great hoo-ha going
on. If there is not a controversy, a big political spotlight,
a big Committee inquiry, then it may well be that it is easier
for those concerned to actually look at what happened, look at
what went wrong, to learn from it and to do it not quite behind
closed doors but in a measured and considered way. The tension
for me is you almost need the leverage of a high profile report,
like the Continuing Care Report, but then you need time out of
the spotlight for that to work through. I think Continuing Care
is a good example of that. We are in the process of preparing
a report at the moment, which I hope to lay before Parliament
in the next couple of months, which is really documenting the
work we have done on Continuing Care since the publication of
our report nearly four years ago and how we have worked with the
Department of Health and the NHS to really raise the bar in dealing
with Continuing Care in the NHS. I want to do something similar
with Tax Credits. You start with quite a high profile report but
actually I have said to this Committee, some time back now, this
is going to be a long haul. There is progress to report and I
hope, later in the year, to do an update report on Tax Credits.
There is something about having both; you need the leverage. If
I was the chief executive of a government agency or a Health Trust,
and we had something in the news yesterday about the NHS and people
with learning disabilities, that gives you the impetus to make
change and then you need some time out of the spotlight. What
I am saying is there are lots and lots of opportunities for lessons
to be learnt without the high profile headlines as well. I suspect
that is going on every day of the week.
Q7 Mr Burrowes: Can you make a judgment
on which of the government departments are the most responsive
and most sensitive to learning lessons?
Ann Abraham: It is very hard for
me to answer that question other than anecdotally. I do not have
the comprehensive data to give you anything that would pass my
test of evidence on that. I suppose, in a way, there is a sense
of there are the ones we do not see. In the course of the inquiry
it might be interesting for the Committee to talk to those departments
and those agencies that seem to have cracked this, whether it
is about passports or driving licences, the stuff that seems to
trickle along quite nicely and presumably works well. The real
contrast which is interesting for me—and that is why on
my list of people you should see is Paul Gray from the Revenue—if
you look there, and I do have some hard evidence, we have two
sorts of complaints about the Revenue: we have Tax Credits, and
everything else. We have fairly large volumes of both but the
uphold rate for Tax Credits last year was 90%—it is going
down so that is good—and the uphold rate for the others
is about 30%. They are doing something right in other areas and
they have learnt a huge amount, I do believe genuinely, from the
Tax Credits problems and challenges that they have had to deal
with. It would be interesting to hear from them how they view
the different experiences that they have had of people's satisfaction
with their service and see how they reflect on that.
Q8 Mr Burrowes: Taking it a stage
back, you mentioned measuring data. Is not one of the problems
the different ways that complaints are looked at: when is a complaint
a complaint? Is there not a need for some standardisation about
where it is and how it is monitored? How can we really judge how
they are properly performing without that?
Ann Abraham: Precisely so. I could
not have put it better. The NAO had a go at this a couple of years
ago on Citizen's Redress. It was a lengthy report and they gathered
a lot of information but in a way I would almost paraphrase the
conclusion of that report that this is a dog's breakfast and needs
sorting out. Yes, it does, so where have we gone next? It was
an NAO report and it was coming at it from the point of view of
efficiency. What we do is look at it from the point of view of
effectiveness which is where I came in in response to the Chairman's
earlier questions. It is the same point about inability to make
sense of lots of information if what you have is a bunch of grapes,
a pile of apples and three melons, and "What I am supposed
to do with this?"
Q9 Jenny Willott: Does the number
of complaints that an organisation receives really reflect on
their performance? Could you have a well performing organisation
that has an extremely easy to access complaints' procedure which
would mean they have a greater number of complaints than a very
badly run one that has an almost impossible to access complaints'
procedure?
Ann Abraham: It would be very
dangerous simply to compare numbers and construct some sort of
league table. You do not have to get hugely sophisticated and
complex about this. There are other simple measures which will
give you a much better picture. If you are going to do this seriously,
you are going to have to do it over time. From one point of view
actually it could be argued that organisations with very small
numbers of complaints are doing very well. Actually it could be
because they do not tell anybody about their complaints' procedure,
when people try and complain they make it impossible, they do
not record anything, they do not report anything and there is
no accountability so actually it is telling a very bad story.
There is then a sort of dawn of realisation that actually unless
you know what your customer complaint picture looks like you are
not going to learn anything, so you make your procedure more accessible
and the numbers go up and somebody takes you to task because your
complaint numbers have gone up. You need to be careful about that.
For me you need to know something about the numbers. You need
to know something about how many of those complaints are resolved
quickly first time at local level and then actually how many go
forward and what the uphold rates are. I can remember talking
to the Foundation Trust regulator about how he would expect Foundation
Trusts to perform in complaint handling. His view was they ought
to perform better because they ought to be more plugged into the
importance of complaint handling and therefore they ought to resolve
more locally, and when they go to the second stage they ought
to get dealt with more quickly because the Foundation Trust should
be more responsive because it has supposedly passed a certain
standard of performance. There is something about local resolution
in there, how quickly and how effectively. You could construct
a measure but if you try to do it just on how many it will probably
give you some very dangerous answers.
Q10 Jenny Willott: That links quite
nicely to the next question which is about the number of complaints
that your office deals with for each government agency and department.
Do you feel that the numbers are a reflection of the performance
of that particular department or is it more a reflection of the
performance or the quality of the complaints procedure in that
department?
Ann Abraham: I think it is both.
I would add another factor, without trying to make this too complicated.
There is also something about the nature of the business. I will
just explain that point and then put it to one side. If you take
the Revenue, if you take DWP and its customer facing agencies,
Jobcentre Plus, CSA, the Pension Service, Disability and Carers
Service and so on, the nature of their business is such that they
are likely to have quite substantial numbers of dissatisfied customers
and the decisions they are making are ones that are likely to
be challenged either through appeal or, if it is about administrative
issues, through us. There is a volume business there which they
can expect and there is an intervention through complaint handling,
through an ombudsman process, through a tribunal process, that
could well result in a different outcome. There is a different
sort of nature of business. I visit departments like the Planning
Inspectorate, CAFCASS, [1]quite
a lot Court Service complaints, Legal Services Commission complaints,
and actually they are looking for a maladministration complaint
to find a route into the fact that what they really want is a
planning decision overturned or they want the residence decision
about their child overturned. They are never going to get there
through an Ombudsman route. There is something about the nature
of the business which makes it more difficult to get into so put
that to one side. This question of whether the complaint numbers
tell us something about performance, they do at a headline level.
What can the Ombudsman tell you from the information that we have?
If you look at where the large numbers are and where the high
uphold rates are, just look at last year's Annual Report. We have
the Revenue and Tax Credits, DWP, Immigration and Nationality
Department, high numbers. You have high uphold rates in Tax Credits,
DWP generally but CSA in particular, IND again. If you have high
volumes of complaints and high uphold rates, what that tells me
is the nature of the business is such that complaint handling
is something they need to take very seriously in the organisation.
If you have high uphold rates, it means they need to do better.
In terms of where I focus my attention, there is huge dialogue
with the Revenue and DWP, and starting to have it with IND now,
around their own complaint handling. What I have said to each
of them is I am not in the volume complaint handling business.
You have to sort out complaint handling within your organisation
and the Ombudsman is the long stop for these issues. Coming to
accountability again, why should the tax payer pay for a huge
Ombudsman's office to deal with what is, in effect, the DWP's
problem or the Revenue's problem or the IND's problem?
Q11 Jenny Willott: Is there an issue
with organisations and departments not logging complaints as complaints?
I know this does not fall in your remit but I have a constituent
who is trying to complain about the police which they are refusing
to accept. Every time he complains about it they say "We
are not logging this as a complaint against the police."
They seem to be able to arbitrarily decide that his complaint
is not a complaint and they are not going to do anything about
it no matter how hard he tries. Is that ever a problem with the
department and the agencies you deal with?
Ann Abraham: I think the simple
answer is yes. The NAO report found something similar, that there
were different definitions and sometimes anything that is an expression
of dissatisfaction gets logged and in some cases nothing does.
If you wanted to think about people to talk to, ask IND about
their complaints logging. They are really now starting to turn
their minds to putting complaint handling on the agenda but the
starting point is what are we going to record. There is a hugely
mixed picture, different definitions and all sorts of problems
of comparability and, as far as I am aware, but the Committee
may find differently, actually no central repository for information
which is then looked at across the piece. I have been trying to
persuade the people who are running the Capability Reviews for
the Cabinet Secretary to look at the whole question of complaint
handling performance and customer satisfaction measures and responsiveness
to customers, in the Capability Review criteria. That does not
seem to feature with anything more than a passing reference there.
It is that sense of, if these are the sort of measures that are
being used to look at departments across the piece, then where
is complaint handling, where is responsiveness to customers?
Q12 Jenny Willott: On another point
that the NAO brought up, the Cabinet Office guidance is that trends
on complaints should be fed through to senior management so they
can take action on it. The NAO found that in agencies this often
happens and in government and ministerial departments it rarely
ever happens. Is that difference obvious to you in the way that
departments and organisations respond?
Ann Abraham: DWP is an interesting
example. DWP are worth talking to at the moment because they have
done a huge amount of thinking about this. They have a consumer
champion on their executive board. They have just taken this decision
to extend their internal independent complaints examiner across
all of their customer facing agencies and not just CSA. There
is a lot of thinking that has been going on with Leigh Lewis and
his colleagues. I think one of the issues for them, and issues
that came out of the Capability Review of DWP as well, was that
there were a series of agencies, a lot of their customers actually
are multiple agency users, but the bringing together of the customer
experience at departmental level was something that they struggled
with. It seems to me, within a department, that is an illustration
of a wider government problem.
Q13 Jenny Willott: In your experience,
are changes more likely to be made when a department or agency
is looking at trends in complaints or from individual complaints?
Ann Abraham: It has to be trends
otherwise it is piecemeal and ad hoc. If you are not learning
lessons from complaints corporately, if you do not have a corporate
record, if you do not have a corporate performance report, if
you do not pull out of that not just how many, what about and
what were the outcomes but actually what do we learn from this
and what are we going to do, then it comes back to the Citizen's
Charter again. There are so many missed opportunities. It just
so happens I was sat in my Audit Committee yesterday looking at
our internal auditor's report about our own complaints service.
There were two parts to that audit: one, were we actually doing
what we said what we were doing, which was the substantive process
stuff, were we meeting our targets and so on and then there was,
were we actually sharing the lessons effectively throughout the
organisation to improve our service. That was a two-part internal
audit looking at our own complaints service. If you do not do
both, it is half a story.
Q14 Julie Morgan: I am interested
in who are the individuals who complain. I wonder if you, from
your overview, could say there was a pen picture of the person,
talking about individuals, who complains to departments, whether
you have learnt anything from that about those who do not and
how the government departments are dealing with that.
Ann Abraham: I suppose if you
want the pen picture it is white, male, middle class, over 50.
Q15 Julie Morgan: Does research show
that?
Ann Abraham: Yes, that is our
research, which is why we have a huge focus on our own accessibility
and outreach strategy to reach the people that we do not reach
and why we are doing a complete overhaul of our front office in
the way we assess inquiries that come to us to try and redress
the balance a bit and, if appropriate, take some positive action
around all of that but certainly to get out there in the advice
sector and to work with the intermediaries who might help us to
redress that balance. That is one point. What was the other bit
of your question?
Q16 Julie Morgan: You have answered
it in terms of what can be done to redress this balance. I notice
you say, in the documents you sent to us, that your services are
not known to young people and ethnic minority people. Would you
say that is reflected in the department's complaint services,
whether there are fewer young people and ethnic minority people
who know how to complain when they are using government services?
Ann Abraham: All I can say is
I suspect it is likely. I do not have any hard evidence about
that. We are trying to improve our own hard data on this to try
and get comparators between our complaint population and the complaint
population of our major customers. We have really struggled to
get any information out of departments that would help us with
that. I suppose, in a way, that is my slightly anecdotal evidence,
slightly more than a suspicion. I do not have here my complaint
population hard data that I have then compared against departmental
data. We have tried it and we have not been able to get from departments
the sort of information that would enable us to do it. We are,
as you will have seen from the strategic plan and the annual report,
very keen to progress our outreach and accessibility strategy,
and I have talked about working with intermediaries. The front-end
overhaul that I have talked about actually means that we now have
a much more active and much more senior level engagement in requests
for investigation that come to us and decisions to consider cases
that, in the traditional normal course of the events, we might
not have looked at because they were premature, because they had
not worked their way through departmental systems or NHS systems.
Sometimes you look at a case and because of the circumstances
of that individual, which might be to do with the fact that they
are homeless and living in a hostel, that they are actually sectioned
under the Mental Health Act, somehow or other they have managed
to find our telephone number, and you just know if you say to
them "Actually what you need to do is go back to the Mental
Health Trust and then if you are not satisfied you go to the Health
Care Commission", we will never see them again. We try and
be proactive in either putting them in touch with an advocate,
an advice agency or saying "OK, we will take this on".
Even though it would be a discretion to take on what would otherwise
be a premature case, we know if we throw them back in the system
we will never see them again. There is some positive action that
is entirely proper for my office to take, not as a matter of course
but as part of our strategic objectives around accessibility.
Q17 Julie Morgan: I suspect there
are a whole range of people who do not complain and have causes
to complain. Certainly that was the experience from the surgeries,
that the white, male, middle class person is the one who will
pursue the complaint. I wonder if you have looked at how the voluntary
sector deals with complaints at all and learnt from it.
Ann Abraham: Not specifically,
although I can bring some personal experience of that from my
own past where, as chief executive of the Citizen's Advice Bureau
Service, I had responsibility for dealing with complaints about
our own organisation but also about the Bureaux. That was always
an interesting challenge because you were at arm's length from
the trustees of the Bureau. I think our interest is much more
about closing the gap in terms of communication channels, understanding
what we can and cannot do and what, in the CAB Service, we would
always call effective referral. We looked at an inquiry the other
week, somebody who had actually contacted us who was detained
under the Mental Health Act. His complaint was he was hungry;
he was not getting enough food. It was wrapped up on the basis
that he was not allowed to make telephone calls to the take-away.
He was trying to get food in because the hospital food was not
enough for him. That was not an Ombudsman issue but we did not
just say "That is not for us." We got back to the Trust
and said "Come on, there is something here for you to sort
out." There are times when a bit of intervention by the Ombudsman
can unlock something. Sometimes that intervention is an effective
referral to the appropriate advice agency. It is not my business
to go looking at how the voluntary sector deals with complaints
but engaging them in appropriate ways in relation to people coming
to us.
Q18 Kelvin Hopkins: The Government
has been moving in a very determined way away from a model of
providing public services through direct public authorities and
towards a system of commissioned private companies, market forces
and competition. In that sense, it is possible that they may be
less concerned about complaints because the market will take care
of things. Do you get that sense? Do you have a feeling that the
Government is less concerned about complaint procedures because
the market will, in future, take care?
Ann Abraham: It is a very interesting
question. My answer has to be no, I do not get that impression.
Q19 Kelvin Hopkins: The Government
has made a great fuss about re-organising or modernising patient
complaint provisions in the National Health Service, PPIs and
PALS and so on. At the core of this was a determination to get
rid of using Community Health Councils, walk-in shops, at arm's
length from health service provision where ordinary people, who
were not necessarily articulate, could make a complaint very directly
with somebody who would take up their case. Was that not part
of it? Was there a sense in which because it was moving towards
a more privatised, competitive marketplace, this sort of complaints
system would be inappropriate and might even put off companies
from bidding for contracts if they felt they had to deal with
the Community Health Councils?
Ann Abraham: It is not my perspective.
It is not my take on where the NHS is with its complaints handling
agenda at the moment. My sense is a rather different one on health
and it is a challenging one. It seems to me, from everything I
read that is coming out of the Department of Health and recent
White Papers, Your Health, Your Care, Your Say, the importance
of patient voice, the importance of listening to patients, all
the right words are there. Then there is a force that has been
driving the NHS, certainly in recent months, around financial
balance, reconfiguration and waiting time targets, that has almost
blown anything to do with complaints off the agenda for now. I
am not saying there are not people thinking about this in the
Department of Health but the storm force gale that is blowing
through is around balancing the books and re-configuration and
so on. The really challenging question for me is how do you bring
about the real change on the ground in terms of service delivery
and complaint handling. There is a fair amount of consensus about,
certainly in health; there are plenty of reports about it. Therefore,
what are the levers for change in the health context now which
would make a difference on the ground? Anna Walker, the chief
executive of the Healthcare Commission, is doing some really interesting
thinking on this. Here she sits as regulator and second tier complaint
handler. What, within her regulatory role, are the levers that
might deliver change on the ground so that her complaint handling
work actually gets pushed back to where it ought to be dealt with
in the front line and actually changes the experience for users
of the NHS? My Making Things Better report was the starting
point for a discussion in the Department of Health about a core
standard for complaint handling, the Healthcare Commission building
that into their regulatory framework so NHS bodies are actually
assessed against it, their performance is rated with complaint
handling in there as one of the things that drives their performance
assessment, which presumably somewhere drives the chief executive's
salary and certainly drives the sort of resources that are going
to be available to that organisation. For me I would be hugely
interested if this inquiry could shine some light on these challenging
questions of how you turn all these fine words in the reports,
whether it is Citizen's Charter or Our Health, Our Care, Our Say,
or service transformation being the most recent one by Sir David
Varney, to make that happen. Sir David Varney talks in his report,
if I can remember it, here is the vision, and it is an impressive
vision, it is radical. He says you need visible commitment and
leadership, you need governance and management, you need performance
and measurement frameworks and you need accountability and openness.
I will try and say politely that those are not the things that
the civil service actually gets lots of ticks for. If you look
at the Capability Reviews there is an interesting mismatch there
between what David Varney is saying about what is necessary to
transform public services and actually what the Capability Reviews
are saying Government is geared up to do. It is a very long and
slightly cheeky answer to your question but I think I am saying
no, I do not see it that way. What I really think is we have got
plenty of reports. What we need is to unlock some of these blocks
to real change on the ground.
1 Children and Family Court Advisory and Support Service.
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